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MRI Results - Please help me understand them.

VirtualizethisVVirtualizethis Posts: 1
edited 06/11/2012 - 8:44 AM in Back Surgery and Neck Surgery
I just got the results of my MRI and need the decoder ring!

History - Over the past couple of years I have been dealing with some pretty bad back and leg pain. Last year the pain started getting much worse and I had an MRI about 14 months ago.

At the time I was using Kaiser for my insurance and after the MRI I was sent to a spinal specialist. The spinal specialist had me first try physical therapy for about six months, during this time the pain got worse.

After the physical therapy the spinal doctor had me doing epidural steroid injections into my spine. Those would help for a week or two but then would gradually stop helping. We did four rounds of injections, after which the doctor seemed to just give up.

During this time my other doctor was trying to treat the pain and she tried several different medications, I really don't remember all of what she had me taking but it was a long list.

The main form of pain treatment has been Vicodin/Norco. I started off about 18 months ago taking 2-4 vicodin and now am up to 6-8 Norco a day. The problem is that even with this level of medication I am still constantly feeling severe pain.

The pain that I feel is as follows. In my low back I feel sharp pain on the left side at L4 and L5. On the right side I do not feel sharp pain but I feel what I can only describe as a lot of pressure (sometimes I can lay on my back and rock my legs back and forth and I will feel a pop, when that happens the pressure in the right side will feel a lot better). On both sides my butt is constantly numb and painful. The backs of my legs also feel constantly numb. On my left leg I feel numbness and tingling down the side and back of my leg extending all the way to my foot. A lot of times now I will feel tingling down my left leg on both the outside of the leg as well as the area around my ankle and foot. Occasionally I feel some numbness and tingling on the inside of my legs and my groin area, I have never had any incontinence but when the inside of my legs feels numb I do feel like someone had just kicked me in the groin. These symptoms seem to follow me if I am sitting or standing alike. Every once in awhile when I step just right, going up the stairs or twisting funny, my left leg will buckle a little bit. Also if I twist just right I will feel twinges of pain shoot down my left leg.

I have a new doctor that I got after the first of the year, and recently he put in an order for an MRI. They tried fitting me in a high-field (tube) MRI unit but I could not fit because my shoulders were too wide, so I ended up going and getting an open MRI. I went in on Tuesday and got the MRI and today a picked up the report from them. Below is how it reads. Can you guys help me decipher this and help me understand what it means.

Exam: MRI of the lumbar spine:

History: Bilateral lower extremity pain and weakness for evaluation.

Technique: MRI of the lumbosacral spine was performed on the Siemens Concerto MRI scanner using the following pulse sequences: Sagittal T2-weighted, sagittal T1-weighted, axial T2-weighted, axial T1-weighted, and coronal T2-weighting.

Findings: The lumbar vertebral bodies are normal in height. There is a 6 mm retrolisthesis of L4 on L5. Alignment at the remaining levels is maintained. The conus terminates at the normal level. The examination is technically limited due to the patient's body habitus.

L1-2: There is no evidence of disk bulge or protrusion. There is no evidence of central canal or neural forminal stenosis.

L2-3: There is no evidence of disk bulge or protrusion. There is moderate bilateral facet and ligamentous hypertrophy, which causes a mild degree of central canal stenosis and mild to moderate stenosis of both lateral recesses. There is no evidence of central canal or neural forminal stenosis.

L3-4: There is no evidence of disc bulge or protrusion. There is moderate bilateral facet and ligamentous hypertrophy, which causes a mild degree of central canal stenosis and mild to moderate stenosis of both lateral recesses. There is no evidence of central canal or neural forminal stenosis.

L4-5: The disc is desiccated. There is a 3-4 mm disc bulge with focality in the posterior central location. There is moderate bilateral facet hypertrophy. There is no evidence of central canal stenosis. There is mild bilateral neural forminal stenosis.

L5-S1: There is a 3 mm disc bulge. There is mild bilateral facet hypertrophy. There is no evidence of central canal stenosis. There appears to be moderate left-sides neural forminal stenosis.

1) Technically limited exam due to the patient's body habitus.
2) Multilevel lumbar spondylosis with varying degrees of central canal and neural forminal stenosis as detailed above.

Any help you guys can give me decoding this would be great. Is this a big deal, should I be really concerned?

Thanks in advance for any help.



  • Hi Tim

    Welcome to spine health. No one here can "read" your MRI for you. FOr that you need to see your doctor. You can find some articles on the site that might help you understand the terms like desication.

    Looks like you have some issues at a few levels. But the doctor will compare these to what you feel. Keep in mind that we all have some issues throughout our spine but unless it hurts we leave it alone. Kinda "if it ain't broke don't fix it".

    Hopefully you are going to your doctor this week. Untill then I would put this report away and forget about it. YOu can drive yourself nuts trying to figure it out. And to be honest you may screw up your meeting with your doctor if you read too much and start to image pain where some article says it should be.

    What would be better is to start a pain log. Write down date, time, part of the body, type of pain, what helped to releave it. THis is not easy to do but it will give a very clear picture of what you are feeling. Often when you look back at it you will be surprised to see where your real problem areas are.

    Good Luck
  • If you look closely at the summary and the description of the findings at the last 2 vertebral locations, it seems that is where much of the problems you're having are originating. I'll try to help "un-doctor" some of the terms.

    First, it seems that you have some minor ligament issues up toward the top of your lumbar. I believe hypertrophy is an "over-extension", but you might want to check that one out.

    I think the ones you're going to want to know more about are the findings of L4-5 and L5-S1.

    L4-L5: Desiccated means that your disc is "dry" or low/lacking in moisture or dehydrated. There is also a bulge here, directly behind your spinal cord, that sticks about about 3-4mm. The "lateral foramin" are the holes in which your nerves spread out from your spine. The holes at this level (on both sides) are slightly narrowed (often due to irritation/inflammation).

    L5-S1: No mention of dehydrated disc here. There is a 3mm bulge in the disc, but no mention of the bulge's location. It would appear that your join facets (the parts of the vertebrae that typically touch or situate next to each other) have been over-worked/over-extended. Now, both sides of the "nerve outlets" here are referred to as
    "moderately" narrowed vs slightly. So, a little worse on the sides here.

    On the positive note, neither level showed "spinal stenosis" which is more or less a constriction of your spinal cord itself. If that starts to happen you begin to be at risk for additional problems like cauda equina syndrome. That can lead to bowel and bladder incontinence and even paralysis.

    The question would be whether or not those disc bulges are in danger of rupture or if they are the source of severe pain. If they continue to expand or if they rupture, it would put direct pressure on your spinal cord. The findings should probably be compared to your last MRI prior to this (if there is one).

    The main to the sides would most likely be related to that inflammation/narrowing of the lateral foramina. You're basically squeezing/constricting those nerve roots. Let us know what your doctor decides as a course of action. My guess would be their first thought goes to physical therapy (as they almost always do). The general belief there being that if you have a "strong body core" of abdominal strength and back muscles it will reduce the stress on your spine.

    Did you hyper-extend your back somehow? Like, pick up something really heavy from a bent stance? Just curious. Hopefully this helps. I'm lucky to have many of my friends in the medical field, and my wife.
  • The retrolisthesis means backwards out of alignment. A question is whether this moves with flexion and extension so it may be beneficial for your doctor to order flexion extension views of your spine to see whether it changes with movement and whether this is the pop that you feel.
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