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Spine and Back Health

MRI Reading

04/09/2008

Question:

Can you please explain to me what this MRI means? My lower back is extremely painfull and I personally feel that one of my nerves is being pinched. The MRI was weeks after the injury so the pain and swelling had decreased and mobility has increased some. A week and a half after the MRI, my wife and I went to the grocery store and walked around for a few hours. That night I felt alot of sharp pain and aching in my back and buttocks. The next morning I could hardly move and my whole upper body was literally bent to the left and remained that way for several days. I also felt like I would collapse when I put weight on my right leg. This time the pain was going into my right buttocks and back of right thigh and right calf. I went to the doctor and they gave me some crutches so I could get around. I saw a "bone specialist" today and he pretty much went through the same drill as the previous doctor (bend over, bend backwards, walk on toes, walk on heels, etc...) and said I was fit for full duty again. I still need my wife to help me put on my pants and boots much less go to work. I don`t want to reinjure myself. Could you please tell me what these readings mean and if I should seek further medical treatment? Thanks!

FINDINGS

For the purposes of numbering, the area of greatest angulation on sagittal images is deemed L5-S1. The angle formed is 119 degrees.

The Lumbosacrel spine is well alligned. Good preservation of both vertebral body and disk heights are noted. Minimal disk disiccation is appreciated at L4-5 and L5-S1. Sagittal images reveal a disk bulge that does not appear to compromise the thecal sac. This will be further evaluated on axial images. The conus medullaris ends at the L1-2 disk spaces, grossly unremarkable. No obvious space-occupying lesions of the central canal are appreciated on sagittal images.

A small benign-appearing hemangioma is seen within the L2 vertebral body. The imaging characteristics support a small hemangioma.

L3-4: No significant disk disease is appreciated at the L3-4 level. The AP diameter of the thecal sac is 14mm. No significant neural foraminal narrowing is identified. No nerve root impingement is seen.

L4-5: Diffuse disk bulge is identified that does not significantly compromise the central canal. The AP diameter of the thecal sac is 12mm. Mild left neural foraminal narrowing is identified secondary to mild diffuse disk bulge as well as very mild hypertophic changes at the left facet joint. No nerve root impingement or contact is appreciated at this level.

L5-S1: Diffuse disk bulge is identified at L5-S1 that does not significantly compromise the central canal. The AP diameter of the thecal sac at this level is 14 mm. The disk bulge has a slightly more left paracentral predominance. There is mild to moderate left neural foraminal narrowing identified without frank nerve impingement bilaterally. Questionable peripheral contact between the left L5 nerve root and the disk material is raised on image 35 of series 4 and image 36, also of series 4. No frank nerve root impingement is identified. Lateral recesses are grossly unremarkable.

IMPRESSION

1. No evidence of frank nerve root impingement or impairment throughout the visualized portions of the lumbosacral spine. Questionable minimal contact with the peripheral left L5 nerve root and the disk is noted as described above without frank impingement.

2. Mild diffuse disk bulges at L4-5 and L5-S1 that do not compromise the central canal or result in severe neural foraminal narrowing.

3. Mild degenerative changes as described.

Answer:

Dear Sir, Thank you for your question. Please reference the  disclaimer listed below regarding the fact that we cannot diagnose your problem or recommend any specific treatments or interventions. As far as your MRI findings, this sounds like a very “garden-variety” typical MRI of the lumbar spine that comes across any spine surgeon’s desk multiple times every week. Most people have various disc bulges and degenerative disc disease whether they have any back pain or not. I don’t see anything described here that would, in my mind, explain the severe symptoms you’re describing. Please bear in mind that radiologists do not describe clinically relevant or clinically significant findings. That’s not their job. They merely report everything that doesn’t look anatomically “normal”. The problem is, if you’re over the age of 19, hardly anybody ever has a “normal” spine.

Multiple studies have shown that a significant percentage of the general population have bulging discs, etc. and have absolutely no back pain. This is why the relevance of your MRI findings can only be interpreted by someone who has examined you and knows the rest of your history, etc. In the end, there’s nothing in this report that suggests that your symptoms couldn’t be managed successfully over time. Good luck.

Disclaimer: Thank you for visiting NetWellness. On this site, we try to answer general questions about health but cannot diagnose or recommend treatment. You appear to have some very, very specific questions about your condition, which can only be answered properly by a physician who is familiar with your history, physical exam, and test results. Your questions about the testing results you've been given or the risks, benefits, and alternatives for proposed treatments of this condition need to be directed to your treating physician(s). You should insist that they answer these questions in a way that you are able to understand before consenting to any treatment. If your physician is unable to help you understand these issues, you should get a second opinion. Take care.

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Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University