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    Old 02-23-2012, 07:09 AM   #1
    frenchfri1003
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    Question Lumber MRI Question

    Hi to all. I have been on this site for some time as I had ACDF C5-6 C6-7 12/9/2010 then a car accident 9/2/2011 (rear ended). My lower back has been an issue since the car accident. Finally asked for an MRI. I have been going to PT and at times seems helpful for both neck and back. Let me know what you think about the Lumber MRI. When I spoke to the PA he did not feel that there were major issues, just to keep an eye on the situation. He did say that there was some fluid lose at the tear which concerns me. He does feel it is recent and probably from the accident. I also notice many white spots which he said were cysts or hematomias . Again not a concern. Should have asked if they were caused by the accident and if they can be a future concern. Oh well, next time.

    The lumbar lordosis is preserved and there is a slight convexity of the lower lumber spine to the left. There is diffuse mild dehydration. There is a transitional lumbosacral junction. Based on the termination of the conus which would be at L1-2 level, the last well formed disc space is considered

    L5-S1 with sacralizaton of the L5 vertebral body. There is no collapse or subluxation.

    L1-2 is normal

    L2-3 there is bulging with flattening of the ventral thecal sac. There is no central or foraminal compromise.

    L3-4 there is bulging and facet hypertrophy with flattening of the ventral thecal sac. There is no significant central or foraminal compromise.

    L4-5 there is facet and ligamentous hypertrophy. There is bulging with superimposed annual tear along the left posterolateral aspect of the disc space. There is flattening of the ventral thecal sac and slight left lateral recess/foraminal compromise.

    L5-6 is unremarkable

    The consus medullaris is normal in position and signal intensity. There is no intradural or paraspinal mass. There are Tarlov cysts at the S1-2 level. Transitional lumbosacral junction as described. Mild degeneration changes without significant central or foraminal compromise.

     
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    Old 02-24-2012, 10:14 AM   #2
    feelbad
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    Re: Lumber MRI Question

    honestly FF, the very BEST board forum to get the very best description of anything below the C spine impact types of situations is by far the back board forum wayyy up in the "B" section? this spinal forum is mostly c spine stuff which can be very different in what real impact just is when you do not have the spinal cord itself invloved(your conus, or cord termination actually stops before most of your specific issues, but this can depending, disrupt the CSF flow within your dura). and you are also dealing with only one "pair" of c spine nerves at every level compared to every level below that c 8 nerve as 'pairs' of nerves too, as in one motor/muscle nerve and one sensory nerve at each and every level starting with the T 1 on down.

    i too have an L 4-5 issue with annular tear/fissure, heavy L sided stenosis, and what is stated as 'prominant perineural vessels(in same level) which everytime i have tried to find out what THAT means, i keep getting stuff about tarlov cysts too, i still do not get that one. but since it has not been really overly symptomatic(knock on wood there) and i have other spinal cord injury and c spine stuff that IS, i have kind of not yet 'gone there'. it is kind of like 'triaging' your crap, ya know? whatever is screaming the loudest and killing me i tend to try and deal with first.

    but i still really do not understand as much about that partular level as i do about what has been my main nightmare up in the c spine. but i can tell you that there ARE some very helpful and much more knowledgable and experienced folks up there who CAN, in a much more in depth way, actually best explain your findings to you hon. just the fact that THAT many people have looked at your post and yet really could not give you the best description/advice kind of would indicate that need to go to the folks who just 'know backs' in a much more detailed way since most have been thru it there. hope this helps FF. good luck with this hon,marcia
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    Old 02-24-2012, 10:51 AM   #3
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    Wink Thank you for your response :)

    feelbad, Thank you so much for your recommendation and reply. I understand how you feel. My neck was screaming at me for many years prior to having the ACDF C5-6 C6-7. Sometimes I wonder if they should have done C4-5 also. They contemplated but decided against it. My neck still screams at me when I do too much, but my back stops me in my tracks, wakes me up on and off all night and prohibits me from lifting or standing too long. I will post on the site you recommended. Wish you the best.

     
    Old 02-24-2012, 10:53 AM   #4
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    Re: Lumber MRI Question

    It may be because there is another board called the "Back Problems" board where most people with lumbar issues post. I usually hang out there, but occasionally see what's going on here, so I happened to see your post.

    I don't know how great an impact was involved with your car crash...but in general, getting hit tends to cause arthritic changes in the spine, developing much earlier than it would normally occur.

    I would agree with the PA that there are some somewhat unique aspects to your lumbar spine, but they aren't anything to get terribly excited about...but are worth watching. Several of the issues mentioned are the type of thing that wouldn't be treated...at least not as they are.

    First of all, you have an extra vertebra in your lumbar spine. That is what "sacralized" means. It is generally something one is born with and is almost always a "finding" but it usually doesn't cause problems or pain. It only becomes significant if you were to have lumbar surgery. The surgeon would need to know this so you wouldn't be operated on at the wrong level -- surgeons often use vertebrae as a visual marker...and they are assuming there are 5 lumbar vertebrae, not six!

    The major problem mentioned is the slight degenerative changes in the lumbar segments, with the most change occurring at the L4-L5 segment. If anything is causing pain, it would be my guess that this is the level. L4-L5 issues often result in pain that radiates down the leg -- what is typically thought of as "sciatic" pain by the layman. Sometimes it ends at the knee; other people find the pain continues on down the leg into the big toe.
    Slightly less common is that the pain will be located in the knee and the anterior thigh.

    There is some slight bulging of the discs beginning at the L2-L3 level and continuing down the spine, and there are some signs of degeneration at the facet joints at the L3-L4 and the L4-L5 segments....facets are synovial joints just like the fingers, ankles, knees, etc. Cartilage can swell; fluid can accumulate; ligaments can thicken, etc. The report indicates you have some hypertrophy at these levels -- this is just a fancy word for the joint and ligament enlarging (think arthritic changes).

    L4-5 there is facet and ligamentous hypertrophy. There is bulging with superimposed annual tear along the left posterolateral aspect of the disc space. There is flattening of the ventral thecal sac and slight left lateral recess/foraminal compromise.


    The good news is that the problems are not causing any loss of space in the central canal or the foramina...with the exception of the left foramen at L4-L5. The thecal sac is a thick ligament type covering the goes around the spinal cord up above the L1 level and covers the nerves that bundle together to form the cauda equina below this level where the spinal cord ends. Sometimes when a disc bulges or tissue swells, etc. it can press into the thecal sac which can cause some nerve compression. This is what is happening at L4-L5 and also slightly in the lateral recess and left foramen which is the opening through which the spinal nerve exits the spine out to the body.

    Now to the annular tear that is mentioned at L4-L5. I believe this is what the PA was referring to when he mentioned a fluid leak. The annulus is the tough outer ring of the disc that wraps around the center of the disc, kind of like the belt of a radial tire. It's purpose is to protect the nucleus, but sometimes it develops a tear...often through injury or just daily wear and tear. The car crash could have caused this part of the disc to tear.

    Sometimes when there is an annular tear, a small amount of fluid can leak out from the disc. Because it contains certain chemicals that are noxious to the nerve, it can result in pain. Since it is irritating the nerve, the pain can be felt anywhere along the length of that nerve...so the radiating pain that is felt in the leg or foot could be coming from this tear. But sometimes an annular tear doesn't cause any symptoms.

    Annular tears are affected any time the patient bends or twists the spine. Any normal activity or stress on the spine can cause some movement in the disc, so they can be very difficult to heal.

    So those are the highlights of your report. Your doctor can give you the medical scoop on what's going on. I might add that even though nothing on your report runs up a red flag, there are things that can cause lots of pain. Sometimes it is the "small" problems that result in a great deal of pain.

    Please stop in the Back board if you have any questions or want to discuss further!

    Last edited by teteri66; 02-24-2012 at 10:55 AM.

     
    Old 03-07-2012, 07:26 AM   #5
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    Re: Lumber MRI Question

    Regarding your MRI results, the facet hypertrophy should be looked at. This is something that turned up in my MRI results, but it wasn't until over 5 years later when seeing a new doctor (pain management) that it was even looked at. Two diagnostic injections (anesthetic only, no steroids), and 3 level bi-lateral RF ablation and that pain is gone. I am still dealing with right SI joint pain, but that is the next target.

    Regarding the L5-S1 sacralization, do you have xrays that were done as well? That particular scenario is also referred to as a Transitional Vertebra and also as Bertolotti's Syndrome. A bilateral sacralization isn't usually a problem, but a unilateral can actually be a problem. I have a Transitional Vertebra, with 6 lumbar and only 4 sacral, so, unilateral and unfused. I actually have a paddle of bone extending from the vertebra on the right side that is not fused to the sacrum.

    Just because the issues don't look major on the MRI or x-rays, doesn't mean they aren't causing pain. Pain management docs can be very good at diagnosing things that should not be a major issue, and coming up with a good treatment plan.

    My MRI's and x-rays don't really look like I should be in the pain I have been in for the last 6 years, but through the efforts of my pain management doc, I have actually gotten answers at to what is causing my pain, and even some relief. One thing that I have learned is that if there are certain things that increase your pain, do those things before going to the doc so that they can see what you are actually dealing with. For me, driving 20 minutes is enough to set things off with my si joint, and my docs are all over an hour away.

     
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