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Help understanding MRI?


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Old 07-09-2013, 02:01 PM   #1
ShellJusk
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Question Help understanding MRI?

Hi all. Brand new here. I've seen many posts like this, but couldn't find one that was similar enough, so I'm asking for help interpreting my MRI results.

For background, I'm 49 female with few health issues historically. I'd had some instances of back pain, but would go years between them until the last 3 years or so. I started getting more frequent and severe bouts of pain, including numbness and tingling in my legs. I tried conservative care including PT, acupuncture and chiro. Acupuncture helps with the pain, but only temporarily. And NSAIDs cause severe stomach pain when taken regularly. Finally went back to my PCP and she ordered an MRI. After seeing the results, she referred me to a neurosurgeon.

Here are the results:

FINDINGS: There is a transitional S1 vertebral level. There is 3 mm retrolisthesis of L5 on S1. No fractures or spondylolysis. There is extensive reactive endplate edema at L5-S1 (right greater than left). Conus extends to L1-L2 and demonstrates normal configuration.

At L1-L2, L2-L3, and L3-L4, there is mild disc desiccation with small annular disc bulges minimally narrowing the central canal and neural foramina without evidence of nerve root compression.

T12-L1 and L4-L5 disc levels are normal.

At L5-S1 there is moderate disc degeneration with annular disc bulge and left paracentral disc protrusion. There is mild to moderate central canal stenosis and effacement lateral recesses with disc protrusion effacing the traversing S1 nerve roots (left greater than right). There is mild to moderate bilateral neural foraminal stenosis. There is mild facet arthropathy and ligamentum flavum thickening with facet and periarticular edema (right greater than left) and small synovial effusions.

IMPRESSION: 3 mm retrolisthesis of L5 on S1 with moderate disc degeneration, extensive reactive endplate edema (right greater than left), annular disc bulge and small left paracentral disc protrusion, effacement lateral recesses and traversing S1 nerve roots (left greater than right), mild to moderate neural foraminal stenosis, and mild inflammatory facet arthropathy with facet and periarticular edema (right greater than left).

Thanks in advance for any insight you can give me!

 
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Old 07-09-2013, 06:35 PM   #2
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Re: Help understanding MRI?

Welcome to the board.

As you can see, even though there are some minor disc problems in other lumbar discs, the majority of your issues are at the L5-S1 level. First there is the issue of the transitional vertebra at S1. This is a problem that occurs during fetal development, resulting in an incomplete separation of bone, which results in a partial additional vertebra. (You can look this up online to find pictures of this condition if my attempt at explanation has confused you!) It usually doesn't cause any problems or pain, but it is important for the doctor to be aware of this situation. If you were to have surgery or a spinal procedure such as an epidural steroid injection, the traditional "landmarks" that a doctor would use to find the appropriate location would be inaccurate on a person with a transitional vertebra.

Basically your entire lumbar spine is showing some degenerative changes that are indicative of the type of change brought on by daily wear and tear and the aging process.

From L1 to L4 the discs are showing some indication of drying out a bit, and there are some minor disc bulges.

For some weird reason, L4-L5 is normal...and then, there are many signs of degenerative process at L5-S1. At this level there is a 3mm slippage of the vertebra over the adjacent vertebra, and it is slipping toward the back (retrolisthesis). This can be a source of instability. It may be something you were born with, since you have the transitional vertebra at this level as well. It may be that your retrolisthesis is stable and isn't causing any problems. This can be determined by having a flexion/extension x-ray.

IMPRESSION: 3 mm retrolisthesis of L5 on S1 with moderate disc degeneration, extensive reactive endplate edema (right greater than left), annular disc bulge and small left paracentral disc protrusion, effacement lateral recesses and traversing S1 nerve roots (left greater than right), mild to moderate neural foraminal stenosis, and mild inflammatory facet arthropathy with facet and periarticular edema (right greater than left).


Without going into too much detail, this disc is showing signs of degeneration, resulting in the disc bulge and protrusion, and it is affecting the surrounding structure. The protrusion is pushing out of the disc space and is causing a narrowing in the neural foraminen. The foramen are openings at the edge of each vetebra that allow the spinal nerves to exit the spine and go out to the limbs and other body parts.

When the foramina is no longer wide open due to a problem like a protruding disc, the narrowing can cause the nerve to become pinched or compressed. This narrowing is called stenosis and it can occur in the foramen or in the central canal.

In addition the facet joints, which are synovial joints located at each level that allow the spine to bend and twist, are showing arthritic type changes...enlarging and swelling. This enlargement also causes stenosis or contributes to it...it is the S1 nerve that is being squeezed, more on the left side than on the right.

There are varying degrees of stenosis...and yours is described as mild to moderate.

The S1 nerve innervates from across the buttocks, down the back of the leg to the outer side of the foot, concluding at the little toe. You might have pain in the lower lumbar region, and anywhere along the path of that nerve.

Keep in mind that the MRI is just one piece of the diagnostic puzzle. The spine specialist will correlate it to what he finds on physical examination, a basic neurologic exam and from listening to your description of your symptoms and their impact on your day to day living.

I imagine the neurosurgeon will want to start with some conservative treatment modalities, probably including a series of epidural steroid injections to help with pain and inflammation, to perhaps help the disc at L5-S1 to reabsorb and take pressure of that S1 nerve. Surgery would only be considered as a last resort, unless you should suddenly develop bladder or bowel problems or a sudden weakness causing foot drop, etc. If that were to happen, and it is rare, the surgeon would want to decompress that S1 nerve right away.

 
Old 07-09-2013, 09:24 PM   #3
ShellJusk
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Re: Help understanding MRI?

Thank you SO much! This is very helpful. My mother had back surgery a few years ago and told me she had an extra vertebra. I joked and told her we must not be completely evolved.

I will post again when I see the neuro in a few days.

 
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