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    Old 10-11-2009, 09:57 PM   #1
    abawan
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    help me to understand MRI report

    Sir, My mother is 70 year old. She is facing pain from lower part of back bone up to end of right leg from last 8 years. We conducted MRI test twice, their report is given below.
    “MRI LUMBO SACRAL SPINE
    Performed on : April 14, 2009
    Clinical info: Backache with radiation to right leg with numbness for 6 to 8 years.
    TECHNIQUE:
    Multiplanner, multisequential, non contrast MR study of lumbar spine.
    FINDINGS:
    There is mild scoliosis and grade I anterolisthesis of L4 over L5. All lumbar vertebral bodies are of normal heights and reveal normal MR signal. Disc dehyderation throughout lumbar spine with reduced height at L4-L5 is seen. Conus medullaris reveals normal MR signal. Multi level central canal and lateral recess stenosis throughout lumbar spine due to ligamentum flavum hypertrophy, facet degenerative changes, scoliosis and circumferential disc bulges is seen. These changes are more marked at L3-L4 at L4-L5 and L5-S1. Paraspinal soft tissues are symmetrical.
    CONCLUSION
    Multi level and multafectorial moderate central canal and foraminal stenosis from L3 through S1.
    In comparison to previous study of April 15, 2008 there is subtle interval aggrevation is appreciated.” Report of MRI performed on April 15, 2008 is as under

    “MRI LUMBAR SPINE.
    CLINICAL DATA: History of lower back pain radiating to right leg.
    Multiplanner, multisequential non-contrast MR study of lumber spine.
    Transitional segment at lumbar spine is noted. Increased lumbar lordosis with mild scoliosis is seen. Grade I anterior listhesis of L4 over L5 is noted. Marrow signal is normal. Dehydration of all lumbar discs with end plate osteophytosis consistent with discogenic disease is noted. Reduced L4-5 and L5-S1 disc spaces more for L4-5 is noted. At L2-3 there is right foraminal disc protrusion causing compression and affacement of fat planes around exiting root. At L3-4 there is diffuse annular bulge of intervertebral degenerated disc causing effacement of ventral epidural fat and flattening of thecal sac and mild bilateral foramina narrowing. At L4-5, there is mild to moderate stenosis of spinal canal and foramina, further compounded by a small diffuse disc protrusion. No other intra or extra dural abnormality is noted. Theca, cauda equine and roots have normal MR signal. Paravertebral soft tissues are intact.

    CONCLUSION:
    - Scoliosis with increased lordosis of lumbar spine.
    - Grade I anterior listhesis of L4 over L5 with spinal stenosis of mild to moderate degree involving the canal and foramina compounded by a diffuse degenerated protruding disc.
    - Right foraminal disc protrusion at L2-3 causing compression and obliteration of fat planes around right root.
    - Disc bulge at L3-4 with flattening of thecal sac and mild foraminal narrowing.
    - Mild diffuse discogenic disease throughout lumbar area with disc dessications and end plate osteophytosis.”
    Sir, kindly in light of above reports kindly guide me that
    - Is there any option other than surgery?
    - Since my mother is 70 year old will it be normal for surgery or age factor can create problems.
    - If surgery is only option how much chances are of success and what will be nature of surgery i.e. is it a risky operation or normal.
    - Can this problem may repeat after surgery.
    - Is it “sciatica” or it is some other pain.
    - Any advice useful to relief pain as pain is too much.
    I will be very thankful for your guidance.
    < edited >

    Last edited by hb-mod; 10-12-2009 at 12:29 AM. Reason: Please don't post your email address, per Posting Policy.

     
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    Old 10-12-2009, 08:35 PM   #2
    PNo
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    Join Date: Jan 2005
    Location: USA
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    Re: help me to understand MRI report

    This is a board who has mostly cervical patients, however many of us also have lumbar problems. In the future you might check out the back board, where you find mostly people focusing on their lower backs.

    We are all patients just like your mother, we just share our experiences from what we personally have gone through. I do understand your mother's condition as I have some of the same in my lumbar. For your mother's age this condition is very normal. I am 50, there are some people even in their 20s that get these problems. As we age we our discs in our spine dry out, and we also start growing arthritis - some people faster than others. When the discs degenerate they don't function like they are supposed to, they cannot support the vertebrae correctly, allowing some slippage or movement and they can weaken and the inner material can bulge out as your mother is experiencing. Eight years is long time for this to be going on the doctors might tell you they have low hope of completely removing her pain because the length of time it has been going on. When it bulges it can press on nerve roots - as is your mother's case.

    I can tell you that what she feels looks to be sciatica - and it is very painful leg condition. It can take over your life, make you not sleep, and make it disabling to walk and get around. I take the highest level pain mediciations for my neck , yet when my lumbar did what your mother's did I was in such horrible pain - I wanted to cut my legs off (I have it both legs).


    You asked these questions:
    - Is there any option other than surgery?

    There are conservative therapies, they are aimed at making a patient more comfortable - they do not fix the problem. All the way from rest, ice/heat, anti-imflammatory medications. Then moving on there are treatments like stronger medications, therapy, and epidural injections. For me the epidural injections were the single thing that help me the most. The may not take the pain entirely away, but the injections can help reduce the pain level. I ice my leg quite a bit and it really helps. Also there are some exercises specifically aimed at providing comfort to this problem - a physical therapist knows how to instruct her in these. There is also a procedure called nerve ablation where they burn the nerve to kill it, this too is temporary as it does regenerate over time and can possible grow back. Discuss this with the doctor. They would do the epidural first, if successful then the ablation.


    - Since my mother is 70 year old will it be normal for surgery or age factor can create problems.

    It might be possible to find a surgeon who does less invasive surgeries. Maybe this won't solve her whole problem, but maybe they can knock down the pain level, by getting in there are reducing the size of the disc bulges. In the US I know of centers who specialize in these procedures but I am not sure where you are.

    - If surgery is only option how much chances are of success and what will be nature of surgery i.e. is it a risky operation or normal.

    This is best discussed with her doctors who best know her condition and risk factors.

    - Can this problem may repeat after surgery.

    From what I have experienced in spinal degernation on myself, you may fix one level and another may go bad. It would also depend on the procedures. With your mother's age - this is entirely possible - should be discussed with her doctors.

    - Is it “sciatica” or it is some other pain.
    Yes - sounds like it matches sciatica. You can see diagrams on the internet to help you understand the path the nerve takes. If her pain matches you can pretty much be assured if the doctors are agreeing it is sciatica. Look for Dermatome Maps - Lumbar.


    - Any advice useful to relief pain as pain is too much.
    Again, in the immediate time, rest, ice/ heat, anti-imflammatories, may take narcotic pain medications to get her comfortable. Sleep on side with pillow between legs, ice along the nerve path. Find a doctor who would evaluate for an immediate epidural injection. Some people like massage, but I find this to be too painful.


    Good luck , it is extremely painful - I hope you help her find relief.

    Last edited by PNo; 10-12-2009 at 08:37 PM.

     
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