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    Old 07-31-2013, 11:04 AM   #1
    barryboy
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    Confused over MRI Results - Help?

    Hi everyone,

    I've spent some time reading the boards as I have had my MRI results today to try and make sense of them but am just getting myself more and more confused.

    I've had back pain and sciatica for some time and there was some concern as the reflexes and sensitivity in my left leg was decreased. The MRI report says:
    [INDENT]Normal disc morphology throughout the lumbar spine except for LS-S1.

    L5-S1: Almost complete loss of disc height with focal midline disc protrusion and osteophyte causing mild canal compromise. This may contact the traversing left S1 nerve root in its lateral recess. No exiting nerve root impingement.

    No significant facet joint degenerative changes. The lumbar spine usculature is maintained.

    Conclusion:
    L5-S1 degenerative disc which causes mild irnpingement on the traversing S1 nerve root. This does not correlate with described symptoms.[/INDENT]
    I've now got to wait 4-5 weeks to see the specialist, can anyone give me some pointers as to how bad (or not) this is and what the likely prognosis/treatment may be?

    Thanks in advance

     
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    Old 07-31-2013, 11:52 AM   #2
    teteri66
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    Re: Confused over MRI Results - Help?

    I can tell you what might occur in the US but I know treatment and the medical professionals you'll see will be different.

    The MRI is just one piece of the diagnostic puzzle. The doctor will look at the images and will correlate what the images tell him to what he finds upon physical exam, neurologic exam and from listening to your description of your symptoms and what type of impact they have on your life.

    Basically all the lumbar spine is normal except for the issues you have at the last lumbar disc, referred to as Lumbar 5-Sacral 1. It is showing degenerative changes, including a protruding disc. The disc space has flattened significantly due to the disc losing its "plumpness." This results in the L5 and S1 vertebrae moving closer together, which can sometimes result in a spinal nerve getting a bit squished. The report is not indicating that this is happening...but the disc space has been lost.

    The disc protrusion is located right in the middle -- this means it is not pushing out to the left or right side...There are some osteophytes which are like little bone spurs. As the disc begins to degenerate, the body lays down osteophytes in an attempt to stabilize this segment of the spine. Unfortunately the result is that the osteophytes take up space in two areas where the nerves need to be able to exist without impingement, the central canal, and the foramen, which are openings at each pair of vertebrae where the spinal nerves exit the spine out to the limbs of other parts of the body. When there is a narrowing, caused by things like osteophytes or discs that are bulging out of the disc space, this is often a source of nerve compression, and thus, nerve pain. This narrowing is called "stenosis."

    This may be more information than you want...but you'll notice the report refers to the traversing nerve root. The nerve roots run in a longitudinal fashion (traversing nerve roots) before they exit (exiting nerve root). The neural foramen at the L5-S1 level is labelled the L5-S1 neural foramen. The nerve root that exits at this level is the exiting L5 nerve root. The S1 nerve root is called the traversing nerve root at this level because it traverses the disc space at this level in the spinal canal before it exits out of the neural foramen one level lower at S1-S2. Hence, a paracentral disc protrusion L5-S1 level will affect the S1 traversing nerve root, but a foraminal or far lateral disk herniation at L5-S1 will affect the exiting nerve root which in this case is L5. It's a little confusing, but I hope you see the difference. (pull up an illustration of the spine and check out the nerves as they come out of the spine -- then it will be easier to understand ).

    The problems caused by the disc protrusion are affecting the traversing S1 nerve. However, the report indicates that this finding does not correlate with what you are reporting in the description of your pain...nothing indicates left side for example, and I guess the S1 nerve root innervates areas that are different from your reported pain.

    So the doctor will want to examine you very carefully.

    Nothing in your report indicates that surgery would be considered. The nerve compression is described as "mild" which usually means that conservative treatments would be recommended to deal with the pain. This might be a course of physical therapy, oral medications for inflammation and pain, perhaps a series of epidural steroid injections for the same purpose.

    Hope this helps you understand the language in the report.

     
    Old 07-31-2013, 12:11 PM   #3
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    Re: Confused over MRI Results - Help?

    Many thanks for your very thorough reply. The bit I was most concerned about was the "Almost complete loss of disc height" as I read that as it's nearly all gone!

    I'm also a little concerned that the symptoms do not appear to match the scan, but I suppose there are a number of other factors that could be causing them.

    Again, thanks

     
    Old 07-31-2013, 12:15 PM   #4
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    Re: Confused over MRI Results - Help?

    Before we do that, could you explain more specifically where exactly the pain is in your back and where exactly the sciatica goes down your leg?

    Also, how bad is your pain? Are you able to work, or are you taking a lot of days off due to pain? Does this interfere with your life at home, and how?

     
    Old 07-31-2013, 12:34 PM   #5
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    Re: Confused over MRI Results - Help?

    I have a sharp achy pain in my lower back which often radiates out to my hips - it almost feels like an outward pressure which can make sitting for long periods unbearable and makes me want to rip my legs off I also often have numbness and sharp pain in my perineum and a needle like pain in my testes (left one more often).

    I have sharp, burning, needle like pain in both legs. In my right leg it's mainly in the bottom of my calf, front of my shin and top of my foot, right into the top of my big toe and often a warm sensation and in my left leg the pain is more on the left (outside) side of my calf, front right of my shin and more on the top left side of my foot. I often have a icy cold feeling in both feet, almost like being dunked into icy water but without the wet feeling! (If that makes sense)

    Hope this makes sense...

    I work part time (25 hours a week) and occasionally take an early finish - though its been about 18 months since I've had a sick day - though its been close!

    At a recent checkup - I had no reflexes in either my knee or ankle joints on my left side also the specialist noted that I had a lower sensitivity down my left leg.

    I used to play a lot of badminton and run occasionally but now have a pretty sedentary lifestyle. I'm also fairly overweight and feel pretty down most of the time.

    Last edited by barryboy; 07-31-2013 at 12:43 PM. Reason: added work & additional info

     
    Old 07-31-2013, 03:13 PM   #6
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    Re: Confused over MRI Results - Help?

    [B]I have sharp, burning, needle like pain in both legs. In my right leg it's mainly in the bottom of my calf, front of my shin and top of my foot, right into the top of my big toe and often a warm sensation and in my left leg the pain is more on the left (outside) side of my calf, front right of my shin and more on the top left side of my foot. I often have a icy cold feeling in both feet, almost like being dunked into icy water but without the wet feeling! (If that makes sense)[/B]

    This sounds like classic L4 symptoms. The fact that the disc protrusion is in the center allows symptoms to appear on left side, right side, changing back and forth....the L4 dermatome runs down to the big toe. The quality of the pain can be just about anything and it can change from one type to another.

    You should also ask for a flexion/extension x-ray to check for spondylolisthesis. This is a situation where one vertebra slides over the top of the adjacent one. It can result in instability.

     
    Old 07-31-2013, 04:10 PM   #7
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    Re: Confused over MRI Results - Help?

    I did have an MRI about 3-4 years ago - but I can't find the reading for that one and am waiting for a copy of them but it did mention a retrolisthesis!? at L5S1 and a slight loss of disc height.

    Once I get a copy if the old MRI I'll post the details but the symptoms have got much worse since then.

     
    Old 07-31-2013, 05:41 PM   #8
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    Re: Confused over MRI Results - Help?

    Hi - When my son was about your age, he had a back problem which sounds very similar to what you are describing. The MRI showed a bulging disk.
    At first he didn't notice that he had been walking differently to compensate for the pain. The MRI showed a bulging disk was causing the problem. He got several opinions (one doctor insisted that he should have an operation!).
    He had a great physical therapist who taught him several exercises to do at home and now is free of pain and very active in sports, etc. He does exercise daily and still does the exercises. He learned that he had been sitting at an odd position when using his drums, which caused his back problem with the disc. He also looked up a website of a person who called himself the chiro-geek, and agreed with him that these things can be corrected with therapy. (he wanted me to look up this person on the internet, but I never did!). Has your doctor prescribed physical therapy?
    The main thing I want you to know is that my son cured himself with proper exercises. Good luck! Mabent

     
    Old 08-01-2013, 10:59 AM   #9
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    Re: Confused over MRI Results - Help?

    The retrothesis is a spondylolisthesis that slides toward the posterior side rather than forward. Often when there is a spondylolisthesis it accounts for why there is pain in both legs or why the pain can move around. A spondy can be active and still slipping or it could be a situation that happened a long time ago and is now stable.

    It may be that the person reading the MRI didn't report everything or missed seeing something. I hope you will be able to spend some time with the doctor and try to figure out if there is something else that is also causing your pain.

     
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