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    Old 10-27-2015, 05:45 AM   #1
    Hookem 996
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    MRI Results

    Need some help as per the following MRI results that I got yesterday:

    Impression:
    At L4-5 level, posterior central and bilateral posterolateral broad-based herniations are seen measuring 7.7mm in thickness resulting in spinal stenosis with AP central canal diameter of 5mm. Severe bilateral foraminal narrowing is seen with impingement of L4 bilaterally.

    At L5-S1 level, posterior central broad-based disc herniation is seen measuring 7.2mm in thickness resulting in compromise of ventral sac. Mild abutment of the S1 nerve roots is seen bilaterally.

    I was seeing a pain magement doctor for a previous nerve issue, told him that I was having severe back pain, and he ordered the MRI. His PA, informed me of the results yesterday. At which point before I saw the results she had asked what my expectations were, regarding my back. I have done a lot of background searching, and said I did NOT want to have back surgery because of all the negatives I had read. She then showed me the actual results, and said that I needed to atleast visit a surgeon/spine specialist to hear what they had to say because my results were pretty bad, actually she said very bad and that this was not going to get better on its own, and said in her view and in discussion with my pain specialist that basically there were three choices, (1)-be dependent on pain meds, (2)-surgery, (3)-live with the pain until it worsen.

    I am only 41, and originally herniated my L4 disc when I was 24 at work. Completed a 4 month physical rehab which left me feeling good...just recently I was loading my 80lb punching bag and it slipped, therefore causing this extreme pain...has gotten a little bit better, but both of my legs get the tingling sensation, and my right foot specifically, along with getting severe cramps on both sides of my rib cages back to front.

    Sorry sor the long post, but trying to figure out my options with those who have had the similar results and what was there treatment plan?

    Thanks!

     
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    Old 10-27-2015, 04:02 PM   #2
    teteri66
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    Re: MRI Results

    Welcome to the board. We only have the report from the lumbar area of your back so couldn't guess what is causing your pain on both sides of the rib cage. Hopefully it is muscular from the accident.

    The disc at L4-5 is herniated. This is pushing into the central canal, causing a fairly severe narrowing of the spinal canal. A normal diameter of the lumbar spine is between 15-23 mm. Yours is about 5 mm.

    This is also causing narrowing of the foramen on both sides at this level. The foramina is an opening through which the spinal nerve exits the spine and goes out to innervate a particular part of the body. You can look online for a dermatome map that will show you the pathway of the L4 spinal nerve, to see what areas it innervates.

    The central canal stenosis is more serious in that it squishes all the nerves of the "cauda equina," which is the bundle of nerves that carry on after the spinal cord ends around L1. With a diameter for the canal of only 5 mm at the L4-5 level, you need to pay close attention to your symptoms.

    If you develop sudden loss of control of bladder or bowel, or experience sudden muscle weakness such as in a drop foot, you need to regard it as an emergency and seek medical attention immediately. For this reason alone, it is a good idea to have a spine surgeon that you have met with previously so you have someone to call. Otherwise you take your chances in the emergency room when no specialist can see you for eight weeks. IF you have developed what is called "cauda equina syndrome,". It needs to be treated quickly or damage to these nerves can be permanent. Read up on CES to familiarize yourself with the other symptoms.

    There is another bulging disc one level down at L5-S1. It is pushing into the Dural sac which surrounds the central canal but apparently is not compressing it. There is some narrowing of the foraminal openings that is abutting the S1 spinal nerves on both left and right side. The nerves are not compressed but are probably irritated from this.

    You need to see either a fellowship-trained orthopedic SPINE surgeon or a neurosurgeon whose practice is limited to issues of the back and neck. Depending on what is causing the severe stenosis at L4-5, you may need surgery to make sufficient room for the nerves of the cauda equina.

     
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    Old 10-27-2015, 04:09 PM   #3
    teteri66
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    Re: MRI Results

    As to the three choices the PA gave you, I do not feel that choice #1, pain meds is valid. First they are ineffective for nerve pain. Second, you cannot leave the nerves squished without some type of consequence. Something has to be done to increase the diameter of the central canal at L4-5. The question is, can something other than surgery achieve this result?

     
    Old 10-29-2015, 05:49 AM   #4
    Hookem 996
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    Re: MRI Results

    Actually I should clarify that 1) choice, as per meds...that was her intent, as in the meds is not a choice because all I would do is become dependent on them and just masking the pain and that is not a long term solution. Her goal was in convincing me to see a surgeon for consultation.

    I was seeing a pain specialist because last December I had what was supposed to be a single hernia surgery turn into 4 hernias (when doctor was looking inside); and somehow this surgery triggered my nerve going to my groin area and caused severe pain to my right testicle ( had previous hernia repair in the right groin area 17 years ago.). I have had a lot of surgeries from sports and military, I just don't want anymore. Also I don't know how I can afford to be off very long with the recovery time?

    Thanks for your replies, I greatly appreciate it!

     
    Old 10-29-2015, 02:37 PM   #5
    teteri66
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    Re: MRI Results

    I certainly can understand your reluctance to have any more surgeries, but, you need to see a spine specialist (again by that I mean an orthopedic spine or neurosurgeon) to receive an accurate diagnosis and to see what are your options. I am afraid that the narrowing of the central canal at L4-5 will not improve on its own and may very well get even worse.

    If you develop permanent nerve damage in the cauda equina, you could end up in a wheelchair, become incontinent and lose all sexual function. It would be foolish to risk this when you have an opportunity to find out just "how bad" your nerve compression is. Then you can at least make an educated decision on how to address your issues.

     
    Old 10-29-2015, 03:26 PM   #6
    Hookem 996
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    Re: MRI Results

    Yes mam, you are correct...I will be seeing the spine specialist tomorrow, and will listen carefully.

    I know this is no joke, and I will take it seriously, as you said, I don't want to suffer any further damage!

    I will post his recommendations tomorrow after the visit!

     
    Old 10-29-2015, 05:09 PM   #7
    Hookem 996
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    Re: MRI Results

    Yes mam, you are correct...I will be seeing the spine specialist tomorrow, and will listen carefully.

    I know this is no joke, and I will take it seriously, as you said, I don't want to suffer any further damage!

    I will post his recommendations tomorrow after the visit!

     
    Old 11-04-2015, 09:44 AM   #8
    Hookem 996
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    Re: MRI Results

    Quote:
    Originally Posted by teteri66 View Post
    I certainly can understand your reluctance to have any more surgeries, but, you need to see a spine specialist (again by that I mean an orthopedic spine or neurosurgeon) to receive an accurate diagnosis and to see what are your options. I am afraid that the narrowing of the central canal at L4-5 will not improve on its own and may very well get even worse.

    If you develop permanent nerve damage in the cauda equina, you could end up in a wheelchair, become incontinent and lose all sexual function. It would be foolish to risk this when you have an opportunity to find out just "how bad" your nerve compression is. Then you can at least make an educated decision on how to address your issues.
    Okay, visited the Orthopedic Surgeon this past Friday and basically it was a standard exam, where is your pain, what are your pain levels?

    He pulled up the MRI picture were it clearly shows the herniation (I saw this before I even went to the doctor, via the dad I was given.).

    Told me to lose weight, exercise, and follow back up with the pain doctor office to receive injections to the area.

    Said that when I started having issues with my bowels, urination, and couldn't walk...to come back to him!

    He did not talk about the stenosis at all, and about the results of the MRI? I thought the whole point was to prevent me from getting to that point were I can't walk or suddenly lose bowel control?

    This Friday I go see the Spine Specialist, but this ortho doc was very disappointing, hell I knew about the herniation when it first happened in '99. Yes, I know losing weight and exercising will help, but dang how can I do that when I have very little wiggle room as it is, in regards to pain...been down this road twice, and I was always told that down the road there would be complications from my herniation.

     
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