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  • please help me understand my mri

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    Old 06-01-2016, 01:04 PM   #1
    Join Date: Jun 2016
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    ashley24 HB User
    Red face please help me understand my mri

    im in horrible pain everyday. please help me understand my mri. Pain management acts like its nothing but im suffering everyday. tia.

    MRI OF THE LUMBAR SPINE WITHOUT CONTRAST 05/16/2016 CLINICAL HISTORY: Patient had a fall 2 years ago, patient reports a history of sacral fracture. Patient has low back pain. TECHNIQUE: Sagittal T1, proton density and fat-suppressed T2-weighted images were obtained of the lumbar spine In addition axial T2-weighted images were obtained from L1 to S1 thin cut axial T1 weighted images were obtained angled through the interspaces from L3 to S1. There are no prior imaging studies from Baptist Health Louisville for comparison. FINDINGS: The distal thoracic cord and the conus is normal in signal intensity. The conus terminates at the L1 lumbar level which is normal. The T11-12, T12-L1, L1-L2, L2-L3 disc spaces and facets are normal with no canal or foraminal narrowing from T11 to L3. At L3-4, the disc space is normal. There is mild bilateral facet overgrowth, there is no central canal or foraminal narrowing at L3-4. At L4-5, there is mild bilateral facet overgrowth. There is posterior annular tear and there is broad-based posterior central bulging or minimally protruding disc material which only mildly indents the anterior aspect of thecal sac minimally narrowing the thecal sac comes close to the anterior medial margin of the traversing right L5 nerve root but does not abut or compress it. There is no significant lateral recess or foraminal narrowing at L4-5. At L5-S1, there is only minimal bilateral facet overgrowth. There is mild disc space narrowing, diffuse disc desiccation there is a 4 mm retrolisthesis of L5 with respect to S1 with uncovering of the posterior inferior aspect of L5-S1 disc space and there is posterior annular tear and there is uncovered protruding disc material extending diffusely along the posterior superior endplate of S1 that contacts the anteromedial aspect of the traversing S1 nerve roots but does not displace or compress them. There is no significant canal or lateral recess narrowing, there is no foraminal narrowing at L5-S1. There is an ovoid area of rather discrete T1 low signal T2 high signal involving the central aspect of the S3 sacral segment seen on the sagittal images that measures 13 mm in craniocaudal dimension 6 mm in anterior posterior dimension. No axial images were obtained through this area. It is an indeterminate but benign finding, may be a tiny bone cyst. It is incompletely assessed on this exam and given the history of prior sacral fracture if there is any outside sacral imaging I will be glad to addend my report with comparison or at least correlate clinically with outside sacral imaging. The remainder of the lumbar spine MRI is unremarkable.

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    Old 06-02-2016, 09:06 AM   #2
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    Re: please help me understand my mri

    Welcome to the board. I am not clear as to whether you have seen a spine specialist? This could be either an orthopedic spine or neuro surgeon whose practice is limited to the neck and back.

    It is important to note that the MRI is just one piece of the diagnostic puzzle. It provides some information, but it must be correlated with what is found on physical exam and neurological exam, and after listening to a person's description of symptoms and their impact on the person's everyday activities.

    The MRI can be misleading in that sometimes a huge disc herniation can actually cause little pain while something else that looks meaningless is in reality the source of lots of pain.

    The most obvious pain generator is a spinal nerve that is compressed. Nothing in this report jumps out as the obvious pain generator, but there are a number of issues that could be causing your symptoms.

    It looks like there are issues that could be lumped into the degenerative disc disease label. DDD is not really a disease but a collection of symptoms where one degenerative change results in other degenerative changes....for example, a disc bulges which causes changes in the adjoining facet joint, causing it to sometimes develop little bony overgrowths and to enlarge, which causes stenosis or narrowing in the foraminal openings, which results in a spinal nerve being compressed.

    This process begins at L3 and goes on down through S1. At L4-5, there is a rip in the outer layer of the disc, which is also bulging and some of the disc material is coming out of the disc and pushing into the thecal sac (the tough membrane sack that contains spinal fluid and encases the nerves of the cauda equina in the central canal). The report indicates that this comes in contact with the L5 nerve but does not compress it. (In my experience, this is enough to cause painful symptoms).

    At L5-S1 the disc is beginning to lose moisture and is flattening, causing the disc space to narrow a bit. At this level the facet joints on both sides have slightly enlarged. There is a retrolisthesis...which is a spondylolisthesis that is slipping to the back. This is where one vertebra slips over the top of the adjacent this case instead of the edge of the vertebrae lining up, one is sticking out 4mm over the edge of the other vertebra. This is not necessarily an issue unless it creates instability at this spinal segment. In addition, there is disc material coming out of the disc that is coming in contact with the S1 nerve...again not enough to compress the nerve, but certainly enough to cause irritation (and symptoms!).

    In addition there is an "incidental finding" concerning the sacral area. This is where the machine picks up something that isn't completely imaged because it was not part of the assignment! So you will probably need to go back and have the sacrum scanned, if the doctor feels it is necessary. He may be able to take a look at what's there and tell if it is unimportant, or, if it needs to be examined further.

    It is described as an oval shaped mass measuring 13mm x 9mm that might be a tiny bone cyst. The writer assumes it is probably just something left over from your sacral fracture --nothing significant, but if you have imaging from that earlier fracture, it could be compared to this new MRI.

    So, hope this gives you some idea of the terms used...nothing is "bad" at this point...but certainly enough to cause pain. Any time a nerve is irritated, it can result in pain.

    You can look online for a dermatome map to see which areas of the body are innervated by which nerve. You see where L5 and S1 nerves go and whether that pattern matches what you are experiencing.

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