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Severe L4 pain - MRI scared

steveandbarb1ssteveandbarb1 Posts: 1
edited 11/04/2015 - 12:25 PM in Chronic Pain
For first time in my life I am on oxy, trying to take tiny dose but pain is unbearable - can't walk more than 100ft. 1 month ago I was riding bike off road for 1.5 hours (with bit of pain). I have an epidural scheduled for Wed, but my brain is thinking that I will need an l4 /5 fusion. Fortunately I live in MA, and know a top end neuro surgeon at [edit]. However I have multiple health issues including type 1 diabetes for 49 years and some asthma. never had real invasive surgery just stuff like carpal tunnel and meniscus.

Below is my MRI (main parts) am I heading for knife or could shot and good PT perhaps save me?

I have a lot to read here on this forum!

There is preserved lumbar lordosis seen, without significant scoliotic
curvature seen. There is grade 1 spondylolisthesis L4-L5 noted,
narrowing of the disc space is seen, inferior L4 and plate deformity
Schmorl's node deformity minimal accompany marrow edema is seen. No
compression fracture is noted. There is disc desiccation at L2-L3
level downward.

The distal spinal cord appears unremarkable.

At L5-S1 no disc bulge or herniation is seen no spinal stenosis, no L5
foraminal narrowing is noted.

At L4-L5 level the degenerative anterolisthesis seen, disc protrusion
is seen broadly across midline, extending posterior to the knee margin
of L5, causing moderate thecal impression, focally there is a mild
spinal canal stenosis AP dimension about 8.3 mm. Lateral recesses are
compromised, course of the L5 nerve roots is somewhat compromised. The
protrusion and anterolisthesis results in moderate narrowing left L4
neuroforamen with neural impingement, marked narrowing right L4
neuroforamen with neural impingement seen series 3 image 12. The
postcontrast images demonstrate some of the disc extrusion to left of
midline adjacent the left L5 nerve root mildly enhances, series 10
image 11, likely foreign body reaction granulation in response to the
protrusion. The nonenhancing protrusion in the L4 neuroforamen is most
evident on sagittal postcontrast images also.

At the L3-L4 level minimal circumferential disc bulging cause minimal
thecal impression. The right L3 neuroforamen is mildly narrowed by
annular bulging, series 3 image 5. No spinal stenosis is seen.

At the L2-L3 level minimal annular bulging cause minimal thecal
impression, L2 neuroforamen are not significantly narrowed. At the
L1-L2 level no significant disc abnormality

The postcontrast images demonstrate no abnormal enhancement in bone or
disc to indicate infection. The synovium at the L4-L5 arthritic
affected facets mildly enhances as expected.

No on one the Spine-Health patient forums is medically qualified to provide any advice or
or recommendations on any diagnostic test. However, the following key words can always be applied.

  • MILD Treated with conservative measures such as Physical Therapy and mild medications. Many times these situations can be cleared up and the condition can be resolved.
    MODERATE Some more treatments may be needed, ie Spinal Injections, Ultra sound and stronger medications. Always a possibility of more aggressive treatment if the conservative measures don't help
    SEVERE Need for stronger medications. The requirement for surgery may be necessary

Liz, Spine-health Moderator



  • LizLiz Posts: 7,832
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    Liz, Spine-health Moderator

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
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