I just got the results of an MRI I had done due to almost two years of low back pain. The orthopedic doctor didn't really explain the results to me but has referred me for PT and pain management. Can someone please help me understand the findings?
I am a 41 year old female who has had low back pain and issues with frequent urination (not sure if it's related) for almost 2 years.
There is straightening of the lumbar spine lordosis and advanced Modic endplate changes at L4-L5 with discogenic disease.
-L3-L4: Mild broad-disc bulge extending 1-2 mm beyond the vertebral endplate. There is early tear of the annulus fibrosis of the right para-lateral margin. There is moderate left and early mild right neuroforaminal narrowing. Compression of the exiting left L3 nerve is suspected. Fluid is noted within the facets.
-L4-L5: Disc desiccation and significant disc height loss. Aggressive Modic endplate changes. Broad-based disc bulge extends 3 mm beyond the vertebral endplate and contributes toward moderately severe bilateral lateral recess encroachment. There is facet arthropathy and thickening of the ligamentum flavum. There is moderate bilateral neuroforaminal stenosis. Compression of the exiting bilateral L4 nerves is suspected. The budding L5 nerves appear grossly unremarkable.
An approximately 2 cm parapelvic cyst of the right kidney is identified. A 2 cm left ovarian cyst is incidentally noted.
To help you understand your report better, I would like to clarify a few concepts
Our backbones are called vertebrae and in the lower back there are 5 bones from L1 to L5 and sacrum. In between these bones, there is a cushion like material called inter-vertebral disc.
Inside these bones , there is a passage through which the nerves run. Whenever the disc bulges, it presses against these nerves, causing pain in the back or legs with or without affecting the urinary bladder. These nerves exit the vertebral column through tiny holes called foramina. Stenosis refers to narrowing of an area.
In your case the frequency of urination is not related to the disc bulge. The vertebral bones are connected and form a joint called facet, which can get filled with fluid that also results in back pain.
I will now try and explain your report to you.
Normally, the lumbar spine is curved. In your case, straightening of this normally present curve is seen. In most of the patients, this does not produce symptoms.
The top and the bottom part of the vertebral bone which interfaces with the disc is called the vertebral endplate. The Modic changes in the vertebral end plates are a classification of changes which was proposed by Modic. These changes are commonly seen as a part of the age related degenerative process. Some people with these changes have low back pain due to problems in the disc but this is not always true.
Further at L3-L4 level, a mild disc bulging is noted and the foramina through which the nerves exit are narrowed. This along with the fluid in the facet joints can lead to pain in the back.
Hope that this information helps and hope that you will get better soon.
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