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    Old 03-04-2015, 02:26 PM   #1
    johnz562
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    Exclamation Please please help me understand my spinal MRI scan

    I'm a 39 year old male. Probably abouty 4 to 5 stone overweight, mostly put on gradually over the past 10 years or so. Borderline Type 2 diabetic.

    I have been struggling with a bad back on off for 15 years. Nothing too bad.

    About 5 months ago my back got very bad with pain one day when on the treadmill ( I have been trying to lose weight ) and I could feel some sudden numbness and tingling on the inside of my left foot (inside and top of big toe and underside of left foot). Wasn't better much after a month and so went docs. Usual anti inflammatory and pain killers from GP, come back if no better etc etc. Went back 2 months later and GP referred me to a back specialist, who ordered an MRI scan 2.5 weeks ago.

    MRI results come through in post today ....... can anybody please translate this into English for me!??!?

    MRI Spine cervicothoracic : See below
    MRI Spine thoracolumbar :
    There is moderate loss of disc height and hydration at L4-5 and L5-S1. Slight loss of normal lordosis. Normal conus medullaris and cord. The higher lumbar discs and facets are normal.
    Moderate central bulging L5-S1 with slight bilateral impingement on the transiting Si nerve roots. Minor facet arthrosis.
    L4-5 shows a large inferocentral disc extrusion impinging on the anterior thecal sac and transiting L5 nerve roots. There is slight bilateral lateral recess narrowing
    There is a slight long curve thoracolumbar scoliosis convex to the left. Normal epidural space. Moderate degenerative endplate change L4-5. No significant abnormality on fat-suppressed imaging. Normal cervical medullary junction. Slight loss of normal cervical lordosis with moderate disc degeneration and slight bulging C5-6 and C6-7 just impinging on the anterior thecal sac. The upper thoracic discs are normal.
    C2-3 shows moderate broad disc osteophyte. C3-4 shows extensive broad disc
    osteophyte with right foraminal osteophyte impinging on the right C4 nerve root.
    C5-6 shows shallow disc osteophyte.
    C6-7 shows moderate right lateral disc osteophyte impinging on the anterior thecal sac and right C7 nerve root
    C7-T1 shows moderate left lateral disc osteophyte impinging on the anterior theca! sac and left C8 nerve root.

    Many thanks

    John

     
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    Old 03-04-2015, 02:56 PM   #2
    johnz562
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    Re: Please please help me understand my spinal MRI scan

    Anybody ???

     
    Old 03-04-2015, 04:17 PM   #3
    Moonstar22
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    Re: Please please help me understand my spinal MRI scan

    Hang in there, someone will answer you. There's some very knowledgeable people on here. They aren't doctors but some of them know all about reading MRI's.
    One thing I know for sure is that osteophytes are bone spurs (bone growths).

    I'm not good at explaining anything else. Like I sid, hang in there someone will answer your post.

    Good luck & be well.
    __________________
    ACDF C4-5 & C5-6 Dec 2011
    DLIF L1 to L5 Dec 2013
    Jul 2014 MRI, C3-4 hern/comp, C6-7 disc protr/spurs, Thor T6 cyst, T6-7 disc protr on thecal sac, T7-8 spurs/mild on sac. Oct 2014 Diag-Osteoporosis

    Last edited by Administrator; 03-13-2015 at 11:55 PM.

     
    Old 03-05-2015, 03:10 PM   #4
    ChuckStr
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    Re: Please please help me understand my spinal MRI scan

    It helps to know just a bit about basic spinal anatomy. Your spine consists of bony vertebrae that protect the spinal cord and nerve roots. The vertebrae are separated by spongy disks that allow movement but provide cushioning. The discs are made of about 90% water, and over time they can dry out leading to loss of disc height. This can make the discs easier to herniate (push out) or can lead to the vertebrae rubbing on eachother causing bone spurs or osteophytes. These herniations and/or osteophytes can move into the space behind the vertebrae where the spinal cord is located and compress the cord or the nerve roots or move laterally and impact the nerve roots where they exit the vertebrae to provide sensory and motor pathways to the muscles of the body. The spine is generally broken into sections, cervical (first 7 vertebrae), thoracic (next 12), lumbar (next 5), sacral (next 5), cocyx (last 4), the last 9 being fused. There is also a natural curve to the spine known as lordosis.

    In your case, you have a slight loss of lordosis in both the lumbar and cervical regions. This could be due to postural issues or other things but probably isn't an issue at this point.

    In your cervical spine from the top down you have :
    C3/C4 - pushing right into the space and impinging the right nerve root at the exit from those vertebrae (cervical nerve roots are C2 - C8, labelled for the bottom most vertebra where the exit)

    C5/C6 - disc bulge impinging the thecal sac which is the sac surrounding the spinal cord filled with cerebral spinal fluid.

    C6/C7 - osteophyte impinging on thecal sac and the right exiting nerve root (C7 root).

    C7/T1 - osteophyte impinging on thecal sac and left exiting nerve root (C8 root)

    You don't mention symptoms in your upper body which is where you'd expect to feel any issues stemming from compression of the cervical nerves. Also, the radiologist doesn't give any indication as to how bad the "impingement" is. Impingement can mean "encroaching on" as in getting close to or it can mean touching. It appears from the report that the radilogist is using impingement to mean "just slightly touching" but that's a guess. It's important to distinguish as nerves that are compressed are likely to cause symptoms whereas if things are approaching them, no symptoms are likely.

    Now for the lumbar spine :
    At L5/S1 there is a disc bulge impinging on the both the left and right S1 nerve roots.
    At L4/L5 there is a disc extrusion. This means that the tough outer material of the disc has broken open and the inner material is leaking out. This bulge impinges the thecal sac and L5 nerve roots.

    You have the same issue with the word "impinging" again.

    You don't mention where the pain is located. If I were to guess I'd say down your leg radiating from your back. That and the numbness and tingling you felt is most likely to be caused by the disc extrusion at L4/L5. The substance that is leaking can irritate the surrounding nerves and cause symptoms like those you describe. That I would guess is your main symptom generating issue.

    You also have some degenerative changes in your cervical spine. From what you describe, and what I can make out of the report, those are not causing issues now but could in the future if the osteophytes or bulges get worse.

    I would suggest that you get under the care of a spine specialist . That is either a neurosurgeon or orthopedic surgeon that has specialized training in treating spine ailments and limits their practive to issues with the spine. If your "back specialist" meets that criteria, that should be fine. They can help correlate your symptoms with findings on the MRI. They would likely do their own interpretation so the vagueness of the language wouldn't be an issue. They could then recommend appropriate treatment which would likely start with conservative treatment such as PT. They can also monitor the issues that are not yet causing issues but may in the future.

    Good luck and let us know how you get on...

     
    Old 03-12-2015, 03:51 PM   #5
    johnz562
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    Re: Please please help me understand my spinal MRI scan

    Thanks ChukStr.

    Yes, the pain is down the lower back and hips and inside left leg.

    Ironically, the back pain has hugely lessened within a day or two of getting the MRI scan results ...... it seems strange to think that some problems exist but then the pain can suddenly go away ?????

    You mention:
    "At L4/L5 there is a disc extrusion. This means that the tough outer material of the disc has broken open and the inner material is leaking out. This bulge impinges the thecal sac and L5 nerve roots."

    In your opinion is this 'fixable' by surgery? Does it need surgery to make the slight tingling disappear?

    How much better would me back be if I was to lose, say, 3 or 4 or 5 stone?

    I'm sat in a office chair 8 hours a day (have done for past 20 years) .... could this brought on these issues?

    Regarding:
    "You don't mention symptoms in your upper body which is where you'd expect to feel any issues stemming from compression of the cervical nerves."

    Before the back pain got bad about 6 / 7 months ago, I had a terrible bout of stick neck and right shoulder pain, that made my right hand and arm tingle at times. This didn't last long and seemed to settle .... although I did visit a GP who sent me to a physio and she suggested tucking my chin in and pushing my head back into my next using my neck muscles .... this could have been the thing that helped .....

     
    Old 03-13-2015, 11:19 PM   #6
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    Re: Please please help me understand my spinal MRI scan

    Sometimes the problems in and of themselves aren't enough to cause nerve (or cord) compression. Something happens which causes inflammation which is enough to trigger the compression. When the inflammation goes away, some or all of the symptoms may go away as well. In your case maybe the irritation of the disc material was the culprit.

    it probably is fixable by surgery, but it may very well go away with conservative treatments as well. One of the problems with surgery is that it can be a slippery slope and lead to more surgeries. So you and your spine specialist need to weigh the options. Usually, conservative methods are tried before surgery.

    Excess weight is bad for your spine, no doubt. It can accentuate posture and other problems and contributes to the degradation of the spine supporting muscles like the abdominals. Its difficult to say how much your existing issues would improve with weight loss, but your spine would definitely be in better shape overall. Losing weight would also improve your chances of a good surgical outcome should the need for surgery ever arise.

    Poor posture, especially coupled with excess weight can definitely put a strain on back anatomy and cause and/or accelerate spine degeneration. Sitting excessively definitely contributes to poor posture. Some PTs have "back school" where they teach you to sit more properly, coach you to take frequent breaks and give you advice on the ergonomics of your office. It was very beneficial to me although my problems are mostly in my c-spine.

    Ah, the pain you are talking about in your shoulder and issues with your neck, I know well. The symptoms radiate out from the spinal nerve roots that are compressed and/or irritated. These are known as radicular symptoms. Most radiculopathies can be treated with conservative measures and generally resole within a couple of months. I know the chin tuck exercises well and they can even strengthen the small muscles of the neck enough to slow down or arrest some kinds of degenerative issues. I should be doing them more often myself .

     
    Old 03-14-2015, 01:49 AM   #7
    johnz562
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    Re: Please please help me understand my spinal MRI scan

    I want to lose weight anyway ...... but the fact it affects my spine adds even more desire for me to lose weight.

    Do you think jogging on a treadmill (it has a 'cushioning' bounce type feature to it to absorb the person's running) will help or make my back worse? If I can't run and burn weight off, it seems a catch 22 scenario ...

     
    Old 03-15-2015, 05:51 PM   #8
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    Re: Please please help me understand my spinal MRI scan

    I'm not sure really. I have an incline treadmill which allows me to walk up an incline the steepness of Mt Everest if I want which actually burns about twice the calories of a 10min/mile run for me. It takes a lot of stress off the joints for sure. However, I know when you have back surgery they warn you to walk only on flat surfaces so I really don't know what would be best. I imagine water aerobics or something like that would be good. I guess you could give running or whatever a try and change if it doesnt work for you.

     
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