help with MRI results

[CHZ]

I recently had my first lumbar spine MRI after having problems since 2001, and having my legs hurt constantly since July 2006. I was afraid that I had a pinched nerve. I saw a specialist and he said that from looking at the films, he does not think that I have a pinched nerve. He gave me pain meds and exercises to do. I am still somewhat concerned because the MRI report sounds so scary. It reads as follows:

The vertebral body heights are maintained and alignment is satisfactory. Marrow signal intensity is normal without evidence for marrow replacing process. Conus terminates at T12-L1 appears unremarkable. There is disc desiccation and loss of disc height L3-L4, L4-L5, L5-S1 most pronounced at L4-L5. The abdominal aorta tapers normally.

Axial images are obtained from L2 through S1. Disc margin at L2-L3 is unremarkable.

At L3-4, there is a broad annular bulge asymmetric to the left. Small focal paracentral disc protrusion not entirely excluded but there is no mass-effect L4 nerve roots.

At L4-L5 broad annular bulge is present flattening the anterior thecal sac. No focal protrusion, stenosis, or foraminal encroachment

At L5-S1 broad annular bulge is present. There is annular tear centrally. No focal protrusion, stenosis, or foraminal encroachment.

Conclusion:
1. Degenerative disc changes L3-4, L4-5 and L5-S1.
2. Question small left paracentral protrusion L3-L4.
3. Central annular tear L5-S1.

My main questions are:
If I do not have a pinched nerve, then what does it mean when it says "effect L4 nerve roots", and why does that one not say that there is no stenosis or foraminal encroachment like the others do?
And is it not bad to have a flattened thecal sac?

Any info would be greatly appreciated. Thank you!

[CHZ]

I can't help you with most of your questions, because I am trying to find out more about what my MRI means as well...I don't know all this medical jargon! I will tell you that my blood pressure is usually 120/70, and it has been way up in the 150s/90s and higher when I am in really bad pain. I think it is normal for your blood pressure to shoot up when you're in pain, and if you can ever get some relief for this pain, it will (should) go back down...mine did. Hope you get some help soon, and feel better!

[merlot]

hi i had back surgery on L5-S1 in 95. a dorsal colum stimulator for RSD..a bad disc at L4-S1..now i`am having really bad back pain like before i had my first back surgery at L5-S1..i did a ct scan that just came back today..ct scan of the lumbar spine  axial scans were obtained from the superior aspect of T12 down to the S2 level..coronal and sagittal reconstrution were obtained..
the vertebal bodies are normal in height.. there is an intrathecal catheter in position at the D11-D12 level and this projects posteriorly...there is bulge of the annulus of L4-L5 and L5-S1and these indent the dural sac.. there is some post surgical change at the D12 level where an intrathecal catheter has been placed... the axial views show symmetrical annular bulge at L4-L5and annular bulge at L5-S1,slightly eccentric to the left and there is some osteophytic encroachment in the left foramine at L5-S1 ... there is minimal degenerative arthritic change at the margins of L5-S1 anteriorly with some ostetephytes formed....
impressions annular bulges at L4-L5 and L5-S1 , but no large dis herniations are identifieds..in pain all the time.. i can not have any MRI`S so i have have another ct.scan this time with dye.. the last time they did not do dye like my doctor wanted.. i live 800 miles from my neuro surgeon..i have when i sit , walk or lay down.. my feet get cold but with all my nerve damage in my body it is hard to really tell... i`am 41 and now my blood pressure has been crazy only since my back pain started up..no high blood pressure ever before that.. it was always 110/60 now 150/120..i feel like crying.. it is like i went back in  time with having this pain again..what does all this mean?  s.a.m

[CHZ]

That is very interesting. I had never heard of that before.

[mike1105]

tight

[mike1105]

ght hip flexors and Lower Crosssed syndrome (look it up---see a website by eric dalton) can make your legs feel weak.

[CHZ]

Well, I am only 28 now, and I am actually very active, with fairly muscular legs. And actually it is more of a weakness that I am experiencing...I referred to it as pain, but it is more of an achey weakness type thing. So, still a little concerned, but I am glad you think my MRI doesn't sound that bad. And I will take your advice-and my doctors-about doing more exercise to strengthen the specific muscles that can help support my back. Thank you so much for taking the time to respond!

[mike1105]

YOUR MRI DOES NOT SEEM THAT BAD AT ALL. HERNIATIONS AND BULDGES ARE VERY COMMON IN PEOPLE OVER 30, AND THEY ARE USUALLY NOT THE CAUE OF PAIN. WHEN DISCS ARE THE CAUSE OF SYMPTOMS, THOSE SYMPTOMS ARE USUALLY WEAKNESS, NUMBNESS. PLUS, THE FACT THAT BOTH LEGS ARE INVOLVED MAKE IT EVEN LESS LIKELY, ESPECIALLY CONSIDERING THE ABOVE REPORT MENTIONS NOTHING OF A DISC CAUSING NERVE ROOTS BEING COMPRESSED ON BOTH SIDES AT THE SAME LEVEL. AGAIN, YOUR MRI REPORT IS NOT BAD AT ALL (I WISH MINE READ LIKE THAT !!)MORE THAN LIKELY YOUR SPECIALIST IS CORRECT- YOUR PROBLEM SOUNDS MUSCULAR TO ME TOO. MORE SPECIFICALLY, YOUR LEG PAIN CAN BE DUE TO BAD POSTURE, SITTING ALOT, HUNCHING IN FRONT OF A COMPUTER, TIGHT HAMSTRINGS. I CONSISTENLTLY RECOMMEND A WENBSITE BY JOLIE BOOKSPAN, A TRIGGER POINT REILIF MANUAL BY CLAIR DAVIES, AND A BOOK ON POSTURE BY PAUL D'AREZZO. GO TO TOWN WITH STRETCHING YOUR HAMMIES, AND TRU LAYING ON A BASEBALL OR SOFTBALL ON THE TIGHT PAINFUL MUSCLES IN YOUR LOWER BAKC (THE QUADRATUS MUSCLES ESPECIALLY). ALSO WORK ON STRETCHING YOUR HIP FLEXORS. THI ALL MAY TAKE TIME AND MAY BE UNCOMFORTABLE AT FIRST. WATCH YOUR POSTURE. DO THE STRETCHING/EXERCISES AT LEAST OTWICE A DAY IF YOU CAN.