Back pain

[suluisa]

I recently had an MRI and don't understand it.
Anatomic alignment with normal lumbar lordosis.  Mild L3-L4, moderate L4-L5, advanced L5-S1.  Type II endplate Modic Changes are present L4-L5, L5-S1.  Additionally there is a hemangioma of the L5 vertebral body.  Conus ends at L1.

L4-L5 demonstrates a small dorsal annular tear in the left paracentral region with eccentric broad based disc protrusion eccentric to the left contributing to moderate left lateral recess stenosis and mild inferior left neural foraminal narrowing.  Additionally there are lesser degrees of right sided neural foraminal narrowing from broad based disc component.  The nerve roots appear to escape unimpeded, however.

L5-S1 demonstartes a right paracentral protrusion with a small extrusion extending cephalad along the dorsal aspect of the L5 vertebral body.  This results in moderate right lateral recess stenosis and appears to abut the nerve root sleeve on the right to S1-S2 level.  There is a mild bilateral neural foraminal narrowing.

Impression:  Lower lumbar degenerative disc disease which is advanced at the L5-S1 level with L4-L5 broad based disc ptrotrusion eccentric to the left and right paracentral L5-S1 disc protrusion with a small component extruding cephalad as described above effacing the right lateral recess and appearing to abut the right S1-S2 nerve root sleeve in the lateral recess.

[CCF-Neuro-M.D.-PW]

As always with these report, they are worded with radiology jargon, as they are meant to be interpreted by other radiologists or physicians - they should provide a second report for patients!

As we get older most of us get 'wear and tear' on our back joints, which this MRI suggests. Modic changes are common age related changes of the vertebral bodies. Hemangiomas are benign blood vessels in the vertebra and are not significant. The conusis the end of the spinal cord and is in the normal position.
the tear is in the disc (the cushion between the vertebra bones), the inside is sort of mushy, so if there is a tear in the cover of the disc, it can squeeze out a bit and make things tighter in the area of the spinal cord and nerve roots. It seems to be making things tighter ('foraminal narrowing', 'stenosis') but does not seem to be compressing the spinal cord or a nerve root although it is 'touching' the S1-2 nerve root.

Ask the doctor who ordered the MRI to interpret this as well as he is the one who knows the clinical question as to why it was ordered in the first place

Good luck

[japdip]

I think they make the reports so complicated because they are meant for the physician ...... not the patient who one assumes has not been to medical school.

[scoobyww]

Me too! Why do they make it so hard to understand MRI Results?!!10 years ago, I had an ascetableoplasty to my left hip, which now needs to be replaced with a prosthetic hip; 18 months ago I had a Birmingham Hip put in my right hip, which has now failed and is about to be replaced - both due to OA. Following severe pain in back, MRI scan results received yesterday say " at L4/5 a combination of apophyseal joint OA with a broad based disc herniation is causing bilateral recess stenosis and a right sided foraminal stenosis." Can anyone explain this in clear English - and what is my long term prognosis? I am female and 41 years old! Thanks.

[Alpha Omega]

Just google some of the words and read what they are. You can then put in the meanings where the word would be and it should be easier to read. I will say this tho it reads alot like mine read and I'm assuming you have nasty flair ups that tend to last for a week sometimes??? I had fusion surgery last summer S1/L5 L5/L4 and they had to go in later to remove one of the screws in the middle on the left side. I have nerve damage in my right leg that I did not have before surgery and all kinds of twitches and cramping which they have me on anti seizure meds to try to calm things down.

I would say depending on your pain level and how active you are that if you can put off the surgery do it but if you are in pain all the time and have a hard time getting around surgery might be the answer. Take some time to think it over!! I have a feeling they will have me on the table again in the future and I don't look forward to it one bit. Good luck!

[1fanatic]

I am so disappointed this morning.  I thought for sure that I was going to be referred for a possible diskectomy but my doctor said no.  I don't understand.  Epidurals don't work.  L5-S1 has a posterior central and right posterior paracentral disc protrusion measuring 4 cm with a tear of the annulus, right posterior paracentral.  At L4-5 there is a posterior central disc herniation measuring 11 x 4 cm along the maximum craniocaudal and anteroposterior diameters. The disc obtains a subligamentous position deep to the posterior longitudinal ligament.   Disc diseccation and decreased hydration are noted at both L4-5 and L5-S1.  

I am in constant pain and with the MRI evidencing the herniations, I do not know what the possible other avenues of treatment/relief could be.  I think I should go for a second opinion although I do understand the doctor not wanting to do surgery "just yet" in a 38-year old.  But I have to have some sort of relief soon or I will end up having a nervous breakdown!!!

[ang611]

A related discussion, Don't understand MRI was started.