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Latest lumbar MRI results

HuggyHHuggy Posts: 321
edited 06/11/2012 - 7:48 AM in Lower Back Pain
I posted a while ago about my cervical problems (severe central and foraminal stenosis with spinal cord compression, severe spondylosis and facet arthropathy, etc.). The neurosurgeon I saw recently suggested I have a more up-to-date MRI of my lumbar spine Here are the main results (with the repetitive bits omitted):

-----------------------------------------------------------

46-year-old male with history of chronic low back pain.

MRI of L-spine without contrast in axial and sagittal sections:

There is extensive degeneration and spur formation throughout the lumbar spine and DJD was considered.

L2-3: Axial T2WI MR shows disc bulge compressing thecal sac.

L3-4: Axial T2WI MR shows disc protrusion compressing thecal sac with spinal stenosis.
Axial T2WI MR shows high signal zone in anulus at midline of L3-4 disc. Vertebral disc anular tear is suggested.

L4-5: Axial T2WI MR shows right-sided disc herniation with osteophyte formation compressing thecal sac with severe stenosis.
Axial T2WI MR shows marked facet hypertrophic degenerative arthropathy with enlarged facets, producing severe foraminal stenosis and spinal stenosis.

L5-S1: Axial T2WI MR shows left-sided disc protrusion with osteophyte formation compressing thecal sac.
Axial T2WI MR shows marked facet hypertrophic degenerative arthropathy with enlarged facets, producing severe foraminal stenosis and spinal stenosis.

Sagittal T1WI MR shows type II endplate changes due to fatty marrow replacement at L4-5 and L5-S1. There is grade 1 retrolisthesis of L4 on L5 and L5 on S1.

However, image findings may underestimate degree of spinal canal and nerve root compression. Please correlate with clinical manifestations and follow up.

--------------------------------------------------------

The findings are consistent with what the spine specialist in the US (whom I consulted last year) told me after looking at my previous MRI, although he did not mention the retrolisthesis. The MRI report doesn't mention the polyneuropathy that causes some of my pain, of course. I've seen several surgeons about my lower back over the last year or so and they all agree that it presents a difficult case as far as treatment goes. Most of them think I should continue with pain management for now. I asked the last neurosurgeon I saw what he would do if it was his back and he said he couldn't answer that and told me that maybe there would be new procedures available in the future. He also said that the last two levels of my L-spine are pretty much collapsed (there's almost nothing between the vertebrae, just thin, jagged black cracks), and he said a fusion operation may not do any good as far as pain is concerned.

I'm off to see more surgeons about the spinal cord and nerve root compression in my neck next, so I'm hoping to get some helpful suggestions about how to deal with that.
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Comments

  • Not sure exactly what your question is. Of course, since you've been a member for a while, you know we're not qualified here to read MRI's.

    As far as your lower back, it sounds like collectively you've been told to pursue pain management. Have you set up an appt. for this? Regarding the retrolisthesis, my NS told me not to worry about it as I had no instability from it.

    Not sure why you were told to get an updated lumbar MRI when you went to see an NS about your cervical problems. What are your symptoms? Any radiculopathy from this, etc.?

    Good luck with your future consults. Keep us posted.

    TC,

    Marianne
  • Hi Marianne, I didn't have any questions as such. I understand everything in my MRIs, so wasn't looking for interpretations, just a bit of empathy, I suppose - I usually just post in other folks' threads, and thought it was time I made one myself! I was just keeping anyone who might be interested posted, as I've noticed this is what a lot of folks here do (i.e. post updates on appointments, new findings, new treatments, dilemmas, etc.). I guess I wanted to share or 'offload' a little with others here in a similar boat, as all this has been on my mind a lot lately and it's hard to decide what to do next (esp. regarding the cervical stuff). Sharing with other people here seems to help sometimes, as I know members here understand what it's like. It's hard to talk about this stuff with people who haven't been through it.

    I should have clarified, the doctors I saw about my cervical issues didn't tell me to get another lumbar MRI. This was something other neurosurgeons suggested I do when I last went for a consultation about my lower back problems a couple of months ago. They wanted to see if there was any progression in the degeneration and retrolisthesis. The doctor seemed surprised when I brought him a year-and-a-half old MRI to look at.

    I should have mentioned, I've been in pain management for a long time (I've had chronic back pain for 20 years), and I'm not new to any of this, but it still gets to me sometimes.

    Thanks for your reply, and sorry for being so vague. It's late here, and I have insomnia, as usual...
  • Hello Huggy...I am sorry that you are having to deal with all of this pain!!

    I am new to the cervical/upper back part of the spine...LOL...I have the lumbar covered...:)

    But I will keep you in my prayers and I will be looking for more of your updates!!!!
  • Thanks, Polly. I'm a newbie to the cervical stuff too. I only discovered recently that I had serious problems there when I started having weird arm symptoms - before that I just assumed I had a stiff neck from using the PC and reading too much. I've had lumbar problems since my mid-twenties, but the neck stuff kind of crept up on me!

    Thanks again for your concern, I appreciate it!
  • Hi, Huggy,
    From what I read I'm sure you're in a lot of pain ("severe stenosis", etc.) What can make it more frustrating is something I read in a recent newspaper article, that doctors can often have a hard time pinpointing the exact cause of it - especially when the sufferer has multiple back problems. Like everyone else on this Board, you'll be in my prayers, and I hope everything works out for you.
  • Thanks, essmoe29 - I really appreciate it. The recent MRI reports and discussions with my doctors really brought it home to me what a bad state my spine is in. I was disheartened by how many times the word 'severe' was used - not the kind of word you want to hear when talking about your spine!

    I'm in a lot of pain right now, and it's increasingly difficult to do things without having to stop and collapse in a heap on the nearest seat, or whatever's available if I'm outdoors. It's like being squeezed in a vice and having coals inside my back getting gradually hotter and hotter until it becomes unbearable. Not to mention the constant grinding of bone against bone and the nerve compression causing all sorts of weird symptoms. It's really hard to put up with sometimes!

    Pain management here in Taiwan is not as sophisticated as it is in the US or Europe, so I don't have access to the kinds of things many PM patients take for granted. Much of the time I'm just grinning and bearing it, frankly. I'm usually able to get my pain level down from an average of 8 in the morning to about a 5 or 6 by early afternoon, but any sustained activity brings it back up again within minutes. It's got to the point where I'm considering going to stay with my aunt in the States for a while in the hope that I can get more effective pain control (and possibly some new ideas for solutions).

    Thanks again for your kind reply.
  • i think it helps to see others scan results, sorta helps you feel not so alone
    i have similiar issues to you , though my cervical has been something ive been aware of for 20 yrs as i have a lot of symptoms and have loss of ROM for years
    what sort of symptoms do you have from your lumbar, mine are extremely limiting and painfull
    my L4-L5 disc completly shattered/broke into bits, so i have vertebrea on vertabrea, no disc at all, now my NS says it should be fused, im wondering why yours recommends not.

    hope you get some answers with your consult for your cervical
    keep us updated
    take care flower
  • Thanks for updated us on your status. Yes, we like to hear members' updates, vents and status.

    When I read your lumbar MRI report, I understood your later statement about how difficult it is to stand or walk for a length of time and then feel the "hot coals" and have to sit or double over if that's the only option.

    I too had severe stenosis and hypertrophic facet joints at L4/5 and know how painful it can be to simply stand. At one point I had to have a stool in the kitchen simply to sit so I could cut vegetables for dinner. When my MIL asked hubby why this was necessary he replies "She just wants to try and live a normal life as much as she can right now!"

    When it's all inside the body and you can't see it, others don't really understand, but that's why this site is so valuable. Not only can you get info on your condition, but you know others will be able to related. I'm in the 'I can relate' catagory and feel for you, knowing the kind of pain this diagnosis can bring.

    Hang in there, Huggy, and good luck getting everything taken care of in the best way possible, be it surgery, pain management or anything else that helps.

    Cathie
  • post wasnt there when i replied, so i now can see your other information.
    i can very much relate to your symptoms/feelings, , my spine is in a similiar state to yours

    the not being able to walk thing is really hard,and not being able to bend over, along with all the other deterioation
    yes, i have the vice like grip deep inside my spine

    for me , for now, im looking at a fusion for one area, then look at the other areas for more fusions to help this mess

    ohh, my NS also said , fusion would not releive the back pain, another dr said, in the future there may be treatments...
    i really hope you can get something that works for you
    take care , keep us posted
    flower

  • Cathie and Flower, thanks so much for your kind thoughts! It really does help to know that others can relate to the kind of thing you're going through.
  • MetalneckMetalneck The Island of Misfit toysPosts: 1,606
    I'm just the opposite .... I started with my neck 4+ years ago and am now just starting to have back issues post MVA a couple of weeks ago. I always wondered what all the back fuss was about (being a neckie only) and thought that the constant neck pain just had to have been worse than the back stuff.

    As always I have "learned my lesson" the hardway.

    I guess all thats left is for my T spine to start acting up!! (knock on wood - ptu ptu)(spit spit).

    http://www.spine-health.com/forum/neck-pain-cervical/my-bad-mri

    Not indicated is my most recent C-spine MRI with anterior and posterior stenosis at C3 just above my hardware .... here's some of that scoop just to round out the poop .... Through out both surgeries I have had problem at C3 (osteophytes and degeneration of the disc and spondolitias of the C3 vertabrae) ..... after 5 surgeris neither of my doctors (one fellowship trained neuro) and (one followship trained Osteo) did anything with my problems at C3 so guess what ... Now I have moderated stenosis at C3 piching my cord from both front and back at that level.

    I am kinda surprised and befuddled ..... its off to a new Neurosurgen now to attempt to deal with the chronic pain and radiculapathy in my shoulder, neck, left arm and arm pit, hand and sometime both thumbs go out. Why didn't they do anything with the ostephytes C3?? and what will they want to do with the lumbar stuff??

    I hear ya brotha .... I hear ya!

    Regards,


    Dave
    Spine-Health Moderator
    Welcome to Spine-Health  Please read the linked guidelines!!  (Click on Welcome to Spine-Health)
    My Story  - Click below
    http://www.spine-health.com/forum/discussion/44804/pain/neck-pain-cervical/long-and-winding-road
    I am not a doctor nor have I ever played one on TV.  Therefore any comments made are based on my experience.
  • Dave, don't jinx yourself by mentioning the T-spine! I haven't had a thoracic MRI, but the cervical MRI noted that I have disc protrusions compressing the thecal sac at T2-3 and T3-4. I'm trying not to guess what else might be going on there - I already have the top and bottom of my spine to worry about...

    Like you, I also have stenosis in my C-spine (mine is from C3 to C7, but only C4-5 and C5-6 are considered severe), and like you, I can see my spinal cord being squeezed from both sides. It's not pretty!

    Thanks for your response, and good luck with the stenosis and those pesky osteophytes!
  • I can fully understand you wanting or needing at times to collapse into a heap - been there done that - stinks big-time!

    My last Lumbar MRI is almost a year old, and I *know* lots have changed - kind of scared to get a new one if you know what I mean. Neck is front burner yet again!

    I hope you find some relief soon man. Gentle support *HUGZ* to ya!!!

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Huggy I'm sorry your having such a hard time. I would say come to the states but unless you have medical insurance here it won't help. If you have insurance or the financial means I say come. What can a fresh set of eyes hurt. We do have some awesome medical technology. Pain management here is great too.
  • Thanks, Brenda and lilac100!

    I am sure I would get better treatment in the States, and my local PM doctor recommended that I go there for treatment if it was feasible. He's very understanding, but pain management is still quite new over here in Taiwan (pain clinics didn't even exist when I had my surgery in the '90s) and his hands are tied in some respects by the government's rigid regulations on opioid medications. Anything that is Schedule II is simply not used for non-cancer pain here, and the range of drugs available (opioid and non-opioid) is quite limited (they don't have things like Lyrica, for example).

    My situation is a bit tricky - I'm a British citizen, but have lived over here for the last thirty years. My last surgery (decompressive laminectomy) was done in the UK privately. I have insurance here in Taiwan, but not in the US, obviously. The neurosurgeon I consulted in the US said he'd be happy to treat me but it would be very expensive. At the moment leaving everything here behind (job, family, etc.) when I have no insurance anyway doesn't really seem practical. I'll just have to keep looking for better treatment over here and keep my fingers crossed. Thanks again for the thoughtful replies and kind thoughts!
  • Huggy,

    I can't function without Lyrica! Holey cow! I am assuming they have other nerve pain meds over there? Wow!! Wow, that's interesting about Schedule II medications over there. Why is that? Do they have such a high addiction rate that they don't use them or something? I totally hope you find some relief! *HUGZ*

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Brenda, they do have quite a few of the antidepressants and anticonvulsants used for nerve pain, but are missing a few of the frequently presribed ones, such as Lyrica, nortriptyline, Savella, and others. Some, like Cymbalta, are available, but not at the hospital I go to (each hospital has its own selection of drugs that they use here, dont know if that's the case in the States as well).

    The situation with opioids is due to stigma and, basically, ignorance. There isn't a big problem with people abusing prescribed opioids, because they are virtually never prescribed, but doctors here immediately dismiss opioids as addictive, dangerous drugs. On the other hand, they are very casual when it comes to prescribing all kinds of sedatives and sleeping pills - people are prescribed things like Xanax and Halcion on a daily basis for years on end. I think it just comes down to the lack of understanding and education, even among doctors, of these drugs.

    Most countries have a wide selection of opioid medicines that can be prescribed for malignant and non-malignant pain. Over here there is no hydrocodone, oxycodone, hydromorphone, oxymorphone, methadone, and so on. They basically only have codeine, tramadol, buprenorphine, morphine and fentanyl. Of those, the only ones that are not CII are buprenorphine and tramadol, and it was like drawing blood from a stone getting even those at first! I had to show all my previous prescriptions going back years and years, then supply evidence of past injury and treatment, then undergo a fresh set of tests such as MRIs, EMG/NCV and so on, before they'd even consider prescribing even Schedule IV and III medicines.

    My doctor back in the UK told me I would likely need to rotate off the Temgesic (buprenorphine) at some point, at least temporarily, to another opioid. That's impossible over here, since they won't give anything else. I'm thankful for the Temgesic - it's been the medication that's helped the most over the years - but I've been using it a long time now and my back is getting worse. There seems to be no concept here of a long-acting med for constant background analgesia and short-acting meds for breakthrough pain. I've asked several doctors here whether they use the WHO 3-step analgesic ladder, and they all say 'yes - but without the opioids'. It's frustrating being a chronic pain patient over here!

  • I think your posts have made me use "wow" more than any other thread I've been in!! (G)

    I guess I shouldn't be so surprised as I have been to other countries, and "how they do business" at times can be a major culture shock for sure! Third world countries really kick you into shock mode! Food, cultures, medical, roads etc. I guess it's all something you have to adjust to if you want to live in said country - sort of like you have.

    If your back starts going south again, are you going to it fixed there, or scoot back to the UK? I didn't bring up the US, as you stated you don't have insurance acceptable over here. Did you have any surgery over there, or where they all in the UK? I know when I was based in the Bahamas, I had already decided if surgery became emergent, I would fly back to here. My agency has been (now former) known to fly our guys back to CONUS for medical needs.

    Other countries we have full US medical staff, and can cover most issues, so we would stay. Spinal too was covered many times. No more worries about that for me, as I have no interest in air travel, and hubby isn't into passenger ship trips (sniff...I wanted to do the Alaska cruise!). Here's a question for ya - if you know.

    Over there, if a tourist on Lyrica from the US visits, will they take their meds since they aren't used in that country, or would they leave them alone since they are legal from here? I know that on this side of the house, if the foreign visitor has a prescription, we didn't take their meds - even if they weren't legal here. Just curious of course.

    Stay the course Huggy. I will keep you in my thoughts, and send you much needed "pain helping" positive energy. :)

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • What did your EMG/nerve test show if any nerve compression? I hope you can find a good Surgeon for more opinions and get some pain relief soon. Saying a prayer for 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
  • Sorry I didn't reply earlier - I was hurting too much to use the computer the night before last, then yesterday I spent most of the day at the hospital.

    Charry, my EMG/NCV showed polyneuropathy, peripheral neuropathy and radiculopathy and the neurologists explained that there is clearly long-term injury to the nerves, resulting in changes in the nervous system and neuropathic pain. They said often the results are vague, but in my case there was obviously damage to the nerves. I'm going to see another neurosurgeon as soon as possible about my cervical spine issues, as that seems more pressing (forgive the pun!) at the moment, giving the pressure on my spinal cord.

    Brenda, there wouldn't be a problem with bringing in prescription meds to Taiwan. They probably wouldn't even bother to check them (I wasn't checked once in all the years I brought meds back from the UK), but it's best to have a prescription handy just in case.

    I have some good(ish) news, at last! I saw my pain management doctor yesterday and he could obviously see I was in more pain than usual. We discussed the medication I'm taking and I told him frankly that it isn't enough for the pain levels I have now, and he asked me if I would like to try something a little stronger. I was really surprised, as I was under the impression the C-II medications were not given for non-cancer pain. He said they very seldom give them, but it's not set in stone. He said he didn't want to prescribe them to me in the past because he thinks I'm too young to be taking opioids. I told him that doctors have been saying that to me for 20 years, and asked when I would be considered 'old enough'! He said if my back is still hurting this much at my next appointment he'll start prescribing me some morphine and see how it works for me. I was surprised and pleased that he's at last more open to trying something different. He suggested trying some IR morphine to start with, so I'll discuss this with him again at my next appointment. I don't know if it'll work for me, but at least it's worth a shot.

    Thanks again everyone, for your replies and wishes - I really appreciate it.
  • of thoughts
    ive self-deleted my post
    flower
  • thats good news, its not all cut n dried, compassion and leeway, thank goodness
    i hope this will bring down your pain levels

    take care
    flower
  • Howdy Huggy,

    Nodding. I bring my prescriptions when I travel regardless of in CONUS or out. Need to keep the basis covered as they say.

    Sorry to hear you had to spend some time in the hospital, bummer. But it does sound like some progress is being made though in the way of diagnosis and pain management. Please keep us posted. I will keep you in my thoughts, and continue to send you positive energy that all works out for you. :)

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Oh Huggy I am SO glad that your Dr is at least willing to try stronger meds to get you comfortable!! YEAH for that!!

    Please keep us posted as to what they try and what helps!! I will keep praying for your pain levels to go way down!!!
  • Thanks you, Brenda, Flower and Polly! I am not sure exactly how my doctor is planning to juggle the morphine with the other medicines I'm already taking. He mentioned trying instant-release morphine first, so I'm assuming he means tablets or oral solution (drops, perhaps). I'm hoping I can stop taking the tramadol, which doesn't seem to be helping much anyway. I'm also hoping I can get by on just a small amount of morphine so that I don't develop too much of a tolerance and dependence to it. Maybe I could just take it for flare-ups, and take my usual Temgesic for less severe pain. I'll have to discuss all this with him in more detail at our next appointment.

    I do wish some of the newer drugs used to target neuropathic pain were available here. I have tried some of the old tricyclics, and the SSRIs (Prozac, etc.) as well as various anticonvulsant medications (Tegretol, Neurontin, etc.) but have not tried Lyrica, Savella or Cymbalta, drugs I've noticed a lot of people here seem to have success with.
  • Huggy,

    Hopefully you two will come up with a medication plan that does give you relief. Any chance you could hop to the UK, and get Lyrica that way? It would be great to find out that so much nerve pain can go away. I've lucked out in the Lyrica and I got along on the first shot. So I haven't tried any of the others.

    Please let us know how the appointment goes. *HUGZ*

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
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