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Negative MRI Frustrated

weezlewweezle Posts: 14
edited 06/11/2012 - 8:44 AM in Lower Back Pain
Ok let me start by telling you my story as short as possible. I am 30 years old women in PA work as a teaching assistant in the PA Pre-K counts program with 15 kids ages 3-5 , 7 hrs a day 5 days a week.
On 4/12 I tripped over the foot/leg of a physical therapy swing (kinda like a playground swingset). Did not fall completely but did twist back hard. Continued the rest of my day as I didnt feel any pain immediatly after incident. Woke up nxt morning in horrible pain unable to bend at my waist. I reported it to super and filled out all necessary papers. NExt day I came to work thinking I could just work through the pain. My legs started to go numb so I left work and went to ER. They did a quick physical exam and gave me muscle relaxers and pain meds and sent me on my way. Followup with family dr and he ordered a CT scan which turned up 3 bulging discs L3/L4/L5/S1 with some anterior flattening of thecal sac and facet joint hypertrophy. Dr kinda blows this off as "normal changes" , well since I have not had ANY issues with my back and have had previous CT scans after falling the year before these issues to me are new. Dr stillsays though that he thinks they are results from tripping even if they are normal tripping irritited them. OK
I go about my days and nothing is changing after resting and trying to resume normal activities. Dr sends me to get ESI in my back. That Dr does a physical and finds that I am unable to push against his pressure on my big toe, his report states that I present with symptoms consistant with the findings in the CT scan and that of a L5/S1 disc injury. I get the injection and again return to my normal adjusted activities. Shot does nothing for 5 days then relief for 2 then right back to pain and feels like more then before. Fam Dr. sends me for MRI. Get that report back and it shows absolutly NOTHING ! no herniations, no bulging, no facet joint issues.......NOTHING. I know there is something becasue I feel it, I am still in pain and experiencing things I never have had issues with before in my life. So there is something going on. I return for another follow up with Fam Dr and this time I am starting to have new symptoms including foot drop and muscle twitches throughout my right leg and back, and increased numbness and heavy feeling in my right leg... along with all the previous symptoms like pain in back and down right leg. So now both Dr. looked at me like I am nuts since the ONE scan showed nothing so there must be nothing. They both said I am confused as to whats wrong with you, not sure what to do. So now I am going to physical therapy and hope that someone there may be able to tell me an idea as to what might be wrong or affected in my back or leg to cause all these symptoms.
I googled it myself and found nerve issues, but neither Dr mentioned anything like this to me.

Does anyone have any clue as to what may be wrong and what I should ask about ? or if I should be going to see a different Dr and what kind of Dr ?
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Comments

  • I'm sorry to hear how the CT scan shows issues but not the MRI. Have you had flexion/extension x-rays? Also an EMG test? I recently had a repeat MRI and showed only Degenerative discs and the x-rays I had showed facet joint problems and mild narrowing of the spinal column. I'm going to another and it will be my 4th Othosurgeon and see if I can get some more testing done. Keep looking for a OrthoSurgeon or a Neurosurgeon to help you. Have you seen a Neurologist yet? I hope a Dr. can give you some answers soon. Best wishes and hope Physiotherapy can help you also. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Weez, sounds like your having a tough time, sorry.
    I think that the PT that your in now should help, I've found them helpful. Also, You might want to try Chiropractic for a few weeks to see if that helps.

    AS far as MD's if you can find a good Sports Medicine doctor then go to one. I've found family doctors and Ortho doctors to be of little help.
    Sports MD's have many different tools at their disposal.
    And definitely don't let anyone talk you into surgery
    until you've exhausted all other safe low risk treatments possible
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  • The good news is you are very early into this.

    I think there are some key things to focus on:

    1) You have a prior CT to compare to. I would recommend tracking down the actual films and CT report from the scan you had previously, as well as requesting your most recent films and reports. I think having both and asking your doctor to compare the two could help narrow down on changes. I think you'll unfortunately find that with spine issues it is always wise to get copies of all your films and reports because for most it seems to take a few specialists visits to figure things out, and the more films you can bring the better.

    2) As far as another doctor, it's definitely your call. I agree with charry that your foot symptoms suggest that a neurologist may be the most appropriate specialist at this point. They can do nerve tests to determine what nerves are affected to help narrow down where the problem is.

    3) As much as doctors like to depend on MRIs, imaging is not absolute. Things can be missed. It's important for doctors to rely on both physical exam and imaging studies, and I think it's a red flag if you're having neurological difficulties and your doctors are basically saying it's impossible based on the MRI. Did you ask them why the CT showed a disc bulge but the MRI did not? Usually MRIs are better for visualizing soft tissue structures like discs...

    You're early into this, and hopefully the physical therapy will help. That's usually the first line treatment for most spine issues, but I would keep pressing for a diagnosis and it sounds like since you've stumped your current doctors it's time to move on to a specialist.
  • Welcome. I would suggest seeing a neurologist before doing anything else. Family doctors are good for colds and minor issues but they have nothing more than basic training in spine and neuro issues.

    A good neurologist (not surgeon) will do all the tests necessary to determine what is going on. Doctors diagnose based on what you feel not necessarily what the tests show. When they talk about "normal" wear they mean that all of us over the age of 20 will show some wear on the spine. The neurologist will use your symptoms to determine where to look on the tests.

    A few ideas on your CT and MRI. Sometimes the bulging disks will shrink back on their own so it is possible they were bulging for the ct but had shrunk back by the time you had the mri. Also they are open to interpretation by the radiologist. If you read enough posts on here you will find out that sometimes things are missed and sometimes they are down right wrong in what they say. They are not perfect and if the exam doesnt agree they should be repeated. Usually the mri is better with soft tissue like the disk and ct is better with bone but again it all depends on the radiologist.

    A good idea is to start a pain log. Write down date & time when you feel something. describe what part of the body and what type of pain. THen what you did and if it helped. You will be amazed at the patterns you will find when you look at a week of this. It will also help the doctor to understand what is actually going on. I bet he will be impressed also that you are so serious.

    Lower back injuries that happen like yours are often considered suspicious. Everyone can see a cast on a broken arm and know you are in pain. Spine pain can't be seen and many people think we are making it up. Don't get discouraged and don't think you are alone.
  • OK so I went to physical therapy yesterday, when PT looked at me I could see that she believed everything I was telling her, she didnt need to look at any tests to know something was wrong. After running the gammet of test to see which ways I could and could not bend and what causes more pain. The PT said that everything I am exhibiting is conclusive with a nerve issue along the L4,L5 and S1 area, consistant with what the CT scan reported. She said that sometimes this could be an indicator of bulging disc pressing on the nerves or muscles pressing on the nerves. She found that I was way out of line in regards to my hip height and leg length, so she worked on getting those back which she was able to correct it to a degree. She believes that because I am having so many muscle spasms and twitches that when I go to see her again tomorrow its all going to be back out again.
    Today I feel really weak in my leg and its shaking really bad when I stand and walk, kinda like if your nervous how you shake, thats how it feels. When walking it feels like my back and hip could pop out at any minute. Back still hurts pretty good. But the shaking and unstable feeling are different so something is changing let just hope its for the good.
    I never thought in a million years that just a tripping incident, even though I did twist pretty good, would land me in this kind of situation. I always thought of back issues coming from huge accidents, falling real hard, or something like that but not just tripping.
    I am going to see how things go with PT for a while and then make a decision whether to go see a nuerologist. This is a workers comp issue so I have to treat with their Dr for 90 days, I have about 45 more to go before I can switch.
    Thank you everyone for replying and I an def. going to start a journal of how I am feeling everyday.
    Oh and as far as getting the images from ct and mri, I have all of the reports just not he images. The hospital said that I have to pay $8 per image to get them for my own record and that could be costly since there could be over 100 images per scan. Any suggestions on how to get them without paying $8 per image?
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  • i dont know where you are located, but here in ny state you are entitled to 1 free copy of your films. after that they charge a flat rate of 25.00 per set. i would check on the policy of your state medical authority as per your rights in getting film copys.
  • You need to get a second opinion by a doctor who reviews both your MRI and the original CT. It's easy to get both- you paid for them, they belong to you!
  • Most docs will give you the films or cd that they receive. Often they don't even want to keep them because they have to pay to store them.

    John I think that is the set you are referring to. I know when I have requested a copy I have to pay. If it is films they can usually narrow it down to the ones that are important. I love the CDs. They are so easy to keep and take with you to appts.
  • Welcome to Spine-Health.

    First, please be careful about seeing a chiropractor with any spine problems. If you get manipulated in a bad way, it can only make things worse. Those with spine problems, especially disc issues, need to be careful about any manipulation that doesn't come from a direct prescription from your doctor.

    Second, I'd try to find a fellowship-trained spine surgeon, ortho or neuro, but someone who only works on spines. Seeing a surgeon doesn't necessarily mean surgery, it just means you're seeing someone who knows more about your spine than someone who doesn't specialize in it and can offer many more options.

    Third, many times our spine problems come from something that happened to us many years ago and has just been exaserbated by a recent event. In my case, I was in a very serious car accident 30 years ago that started my spine problems, but my symptoms didn't show up until two years ago. So you may have had problems for years that you didn't even know existed until now.

    I know with WC things get much more complicated, but hopefully you can find a spine specialist that can really pinpoint what's happening and what steps to take next. I'm glad to hear about your PT and how she understands what you're going through. That's a great first step.

    Take care and please keep us posted.
    Cath
  • So I went for my second round of PT and after the first was scared to even try. I was in soooo much pain yesterday, the day after seeing PT, that I wanted to cry most of the day. I go today and everything is going smoothly, until ...... she lays me flat on my stomach to ice and stimulate my back. Instant pain down my leg and I mean hard pain. So we worked through this and got to a point where the pain only went to the top of my knee. This was laying on a table with pillow under feet and belly and feet elevated and head lowered towards floor. I was still in pain in this position but not as much as when head was lifted. Anyway....I am laying there for about 5 minutes when another PT comes in the room and starts asking me questions and moving the table to see what the pain she told him about was. Lifted my head and lowered it, asked me all the same questions. Then he asked me what the Dr's are/ and have done for me...and I told him not much CT scan , injection, MRI, PT in that order over the course of month 1/2. He asked what the CT scan showed and what the Dr's and the other PT think. I told him. This is what I dont get. Every single person I have talked with has told me that my symptoms are consistant with someone who has a disc issue in the L4,L5,S1 area. I told him this. And yet again I get that look like they are completely confused and dont understand or know whats going on with me.... I am seriously frustrated because the look that I am getting is making me feel like they think I am making things up or something. the literally look very confused everytime I tell them whats going on and what the MRI shows... I dont know what to do. I am in pain and it feels like I cannot get anyone to believe me or do anything about it.
    I didnt get to ask him what the confused look was about or what he thought was going on, should I call down there and ask what that was all about ? I am not a person to complain either but I do feel like they are looking at me like I am a loonie.
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