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MRI Notes and Myleogram Notes To Follow

AnonymousUserAAnonymousUser Posts: 49,671
MRI: Mild disc degenerative changes are noted from L2 through S1. A Mildly bulging disc occurs at L2-3 with no spinal stenosis. The L3-4 level demonstrates a mildy bulging disc with a small central disc herniation which mildly focally effaces the thecal sac and overall there is moderate central stenosis at this level. A slight retrolisthesis of L3 on 4 is also evident due to mild disc space narrowing. The L4-5 level demonstrates a slightly bulging disc. There is a somewhat asymmetric bulge laterally to the right with no focal erve impingement. The L5-S1 level demonstrates a mildly bulging disc with no disc herniations. The facet joints aremldly degenerated.
Impression 1: Mild disc degererative changes from L2 through S1. 2: Small central disc herniation at L3_4 with moderate central stenosis.
Myleogram:Five non rib bearing lumbar type vertebral bodies are present. There is no evidence for acute fracture or compression deformity. Grade I retrolisthesis is present at multiple levels including L2 through L5. These measure between 3 and 4 mmat the L2-L3,L3-L4 levels. This is most pronounced at the L5-S1 level measuring approximately 6 mm. L1-L2 the intervertabral disc height is well maintained. There is no evidence for signoficant disc bulge, neural foraminal narrowing or central canal stenosis.
L2-L3:There is some mild narrowing of the intervertabral disc space. Mild end plate sclerosis and spuring most notably anteriorly. A mild broad based disc bulge is present which results in some mild flattening of the anterior aspect of the thecal sac.No significant neural foraminal narrowing or nerve root impingement is identified.
L3-L4:There is some mild narrowing of the interertabral disc space. Mild end plate degenerative changes are present as evidenced by sclerosis and mild spurring most anteriorly. A moderate sized broad based disc bulge is present. This results in some thickening of the soft tissues just posterior to the inferior aspect of the L3 vinterverterbral body. This could reflect superior migration of aan extruded disc herniation. This is not definitave and correlation with the patient's MRI is recommended. No significant neural foraminal narrowing or nerve root iimpingement is identified.
L4-L5:The invertabral disc space height is well maintained. A moderate sized broad based disc bulge is present. This is ssomewhat eccentric to the right neural foramen which appears mildly narrowed. No definitive nerve root impingement is identified.
L5-S1 There is narrowing of the intervrtabral disc space. Vacum disc phenomenon is noted. End plate degenerative changes are present as evidenced by sclerosis and spurring. A mild broad based disc bulge is present, This results in mild to moderate bilateral neural foraminal narrowing. No definitive nerve root impingement is identified. No central canal stenosis.
1: Suggestion of a superiorly migrated central disc extrusion at the L3-L4 level.This should be correlated with the patients MRI.
2: Mild to moderate broad based disc bulges at multiple levels as described above. This does result in neural foraminal narrowing most pronounced at L4-L5 on the right and L5-S1 bilaterally. No definite verve root compromise is identified.
3: Mild to moderate central canal stenosis at L3-L4.



  • There is quite a bit there and wondering if any due to injury or age related. Most of it seems to be disc bulging throughout the lumbar area.

    With so much going on now I see why they want to perform the EMG. They are not sure where the pain is coming from and hoping this can help narrow it down. I know you have been through alot but I would do the test. You do not want to have to do a discogram unless absolutely needed.

    During the time though they take to nail it down you need to see a PM to get these pain levels down though!!

  • Leo, Did you have flexion/extension x-rays as well?

    My retrololisthesis was almost completlely disclocated in the flexion/extension films and even though the mri was minor my NS felt that the large amount of movement/instability was causing major problems. Every time I moved my disc was probably moving and many times it moved into the spinal cord causing severe pain/radiculopathy.

  • I am 47 and have been dealing with lower back pain for quite a long time in my life. I had a second MRI in November to update the march MRI which says almost the same exact words. I could hardly get off the table and the pain has been getting worse ever since, My hip and butt are so huge now that I can barely moved.
  • I have not had the flexion x rays as yet.Sounds like I'm facing a microdiscectomy from the sounds of it eh?
  • My PM (did the injections) thought a micro d would be a good idea. Thank goodness I was lucky enough to meet the NS. The micro d was not recomended because of the instability/movement (it would be more likely to re-herniate). It would have been a huge waste of money/time and recovery. Plus I didn't have much disc left in L4/5 & L5/S1.

    Are you working with a fellowship trained NS or OS?

  • I'm currently seeing a Neuro guy. I've had 3 facet joing blocks as well as 3 R.F.A's which the last one has made things worse. I used to take lots of pain meds but refuse to do much as I'm a recovering alcoholic 4.5 years but don't want to get back into that lifesyle. I love my new wife and life as a newly ordained(Januay 2009) minister. I'm just kind of nervous about all this stuff. Yeeks, lol. Thanks for all the kind attention honey.
  • See a PM right away to help you with the pain and have the EMG test to see if they can narrow down where the pain is coming from. I understand that you do not want to take meds but in this case they are not for pleasure but a necessity.

    Maybe they can than see where the pain is coming from and get you on your road to recovery or if a procedure is needed they can recommend one.

  • I read through all the comments and agree with the suggestions you have been given. From the written report, It appears you have a number of things wrong, but they are mostly the type that most of us have after we hit a "certain age." In other words, nothing jumps out as being the obvious source of your pain.

    Most people have small bulges in their discs after a certain age as the spine begins a degenerative process in our twenties. One comment you made I do not understand. "My hip and butt are so huge now ..."
    Are they swollen or what do you mean? This is the only description that struck me as odd, but I'm not sure what you mean by that.

    Is your pain with you all the time? Do some activities give you some relief? For example, I have terrible sciatic-type pain when standing or walking, but as soon as I sit down, I feel fine.

    I'm delighted to hear you have gotten your life on track. I hope you can get some answers soon so you can enjoy your new wife and career. Congratulations!

  • My Si joint and nerve are very inflamed. if I sit too long it hurts, It hurts real bad if I try to the leg lift thing. My foot burns real bad, I almost have to drag my leg behind me when I walk, I have to force it to walk properly. I can not stand very long either. it is just a big pain in the butt, tee hee. Sorry couldn't help myself, one must interject comedy to help make ones day brighter.
  • Since all the tests show that extruded disc, isn't that something that should come out? I mean pain for more than 6 months now and stenosis and extrusion etc. Doesn't sound like as one person put it "normal wear and tear." No disrespect but normal people don't get extruded herniated discs as a rule at a certain age do they?

  • Not necessarily. Unless it is causing bladder or bowel problems, an extruded disc would never be considered a medical emergency. Any surgery would be considered elective. Probably the majority of patients with a ruptured disc end up having surgery, but it is not necessary. Actually the way I read your report says there is a small herniation at L3-4. None of us have medical training, but I would be surprised if that is the source of your pain.

    You do have a lot going on but most of it is mild or moderate in nature and does not immediately jump out as the pain generator. I doubt that a surgeon would simply perform a microdiscectomy on you at the L3-4 level and leave it at that.

    You need to have flexion/extension x-rays to see how unstable the lumbar spine actually is. Retrolisthesis is mentioned and may turn out to be greater than thought once you see it on the flexion studies. Also there are degenerative changes at every disc level from L3 to S1. As I mentioned previously, these may be similar to most people have after a particular point in their life-span or, it may be a significant problem in your case.

    Your symptoms that you describe correlate more to an L5 and/or S1 spinal nerve root radiculopathy. However, the testing indicates that no neural root compromise is noted. There is some mild stenosis which can cause nerve root compression, but it is not clear on the MRI or myleogram that the nerve is being affected.

    Are you under the care of a fellowship-trained spinal specialist? Have you had any steroid injections to see if that calms down the sciatic-type pain you are having? Most of the changes in your back as noted are degenerative. Just what the surgeon would recommend doing about them will vary. He might want to do a discectomy but it may increase the instability in the adjacent levels...and thus, he may recommend fusion. Or he may recommend conservative treatments to get the L3-4 to heal on its own without surgery.

    You say it has been six months that you've been in pain, but have you been doing any conservative treatments to help the disc heal? These would include physical therapy, steroid injections, etc.

    Please tell us where you are in your treatment and who has been treating you thus far...that will help to know what to suggest might be the next step.

  • As stated before, I am seeing a neuro guy. I have had cortizone quite a few times this year. I just finished a 20 Mg. dose pack two and a half weeks after a regular dose pack and steroid shot in emergency room around November 26th or so. The second dose pack was given around December 13th.
    I have had facet joint blocks and radial frequency ablation treatments done as of this year March made the third time around. My behind feels very I guess the word would be "heavy" kind of like somebody kicked my rear end. I have still burning foot pain and kind of little jumpy things going down my leg. My entire bottom spinal area is really stiff and sometimes I feel like I don't want to walk around. I can't get comfortable even with flexaril at night. I just want this over. I have an emg tomorrow and a flexsion x-ray as suggested but am almost ready to run out into traffic so somebody will help me. This hurts like heck but I'll be patient, that's what God would want so i'll be good.
  • Well, it certainly sounds like you are ready for a surgical procedure. It will be interesting to see what your neurosurgeon suggests. Then you will probably want to get at least another opinion with a different spinal specialist.

    Sounds like you have maxed out on the steroids and will not want to take anything more for awhile.

    As I'm sure you know, there are no quick fixes with back surgery...and often, even the experts are not 100% sure in how to approach a problem. The spine is very complicated and you can see how the problems become intertwined.

    It can be difficult to know what levels to operate on, etc. Do you do as little as possible, or do you do all the levels that show some problem? Even the simplest procedure requires a period of healing and recovery.

    I hope you will get some answers tomorrow and that your surgeon will then know what needs to be done to help you.
  • Thanks for all the hellp folks, I truly appreciate all the hellp everybody has given me so far. Hopefully by midweek, I should have an answer, you know the drilll, get the procedure then wait half a week to find out what's next.

    Pastor Leo
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