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MRI results and I need an answer???
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MRI results and I need an answer???

Before I get into my MRI I wanted to know if an MRI would be able to see nerves on it and moreso a pinched nerve? ... I have been having pain into my left leg a little into my right for now going on 4 months... there is tingling, odd sensations, sometimes shooting pain in the front of my left knee cap.. and parathesia all over my left leg into the sole of my left foot.. and a little bit into my right leg..there is also muscle twitching...which is all symptoms of a nerve being compressed... Here are the findings.. these MRIs were done March 4th and 9th of 2010

(Part One.)

EXAMINATION: MRI THORACIC SPINE WITHOUT CONTRAST

HISTORY: Back Pain, Rule out nerve root compression.

TECHNIQUE: T1 and T2 sagittal and stacked T2 axial sequence of the thoracic spine were performed.

FINDINGS: There is a degree of thoracic scoliosis. Alignment of the thoracic spine is normal.  Vertebral body height and marrow signal appear normal throughout.  The thoracic spinal canal is normal in size.  The tip of the conus medullaris is at the L1-2 level.  No abnormality of cord size or signal is seen.  No mass or abnormal fluid collection is seen within the thoracic spinal canal.

There is mild degenerative loss of hydration signal of the disc from T7-8 through T11-12.  No significant disc bulge or protrusion is seen at any level.  No abnormality is seen in the visualized paraspinal tissues.

IMPRESSION:

Scoliosis.  Mild chronic disc degeneration from T7-8 through T11-12.  No evidence of disc herniation or thoracic spinal stenosis.


(Part 2)

EXAMINATION: MRI LUMBAR SPINE WITHOUT CONTRAST  

HISTORY: 37 - Year old female complains of low back pain into bilateral legs times one month.

COMPARISON: None.

TECHNIQUE: FSE T2 sagittal, T1 sagittal, FSE T2 axial angled, T1 axial stacked.

FINDINGS:  There are presumably five lumbar vertebral bodies.  Vertebral bodies are normal in height, signal intensity and alignment.  Disc desiccation is present at the L3-4 and L5-S1 levels.  Moderate disc space narrowing is seen at the L5-S1 level.  The conus medullaris is unremarkable in appearance, terminating at the T12-L1 level.  The congenital size of the spinal canal is within normal limits.  Limited evaluation of the female pelvis on sagittal views demonstrates a 2.5 x 2.1 cm left adnexal cystic structure most compatible with a left ovarian cyst.

Axial images of the lumbar spine demonstrate the following:

T-12-L1,L1-2,L2-3,L3-4: No significant disc bulging, neural foraminal narrowing, or central stenosis.

L4-5:  There is a 2-mm broad-based disc bulging present.  In conjunction with facet joint hypertrophy, there is a mild proximal left neural foraminal narrowing.  There is no evidence of canal stenosis.  Mild facet joint and ligamentum flavum hypertrophy are noted.

L5-S1:  There is a 2-mm central disc protrusion with annular tear.  The neural foramen and central canal are patent.

The visualized sacrum is unremarkable n appearance.  No paraspinal masses are seen.

IMPRESSION:

!.  2 -mm central disc protrusion with annular tear at  L5-S1 levels




ok there it is...but nowhere do I read that there is ANY nerve compression??  so why now going on 4 months am I still having all this nerve parathesia and muscle twitching.  please if any professionals can answer this and let me know whether I am wrong or right I would appreciate it.  
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Avatar_f_tn
Well, I can tell you that what the MRI DOES show is a cause for how come a person might have nerve problems or neuropathy.  In the spine, it shows the bones and the disks, some of the surrounding features, and their arrangement might suggest the location of possible nerve entrapment.  It would take an MR neurography (I think that's the right word) to look at the nerve itself.  With you, you got disc degeneration in the thoracic region, and also in the lower lumbar spine you got a disc bulging, protrusion and tear, plus a nerve opening that has narrowed.  At L4-5 you've got the nerve space narrowing, and at L4-S1 you've got disc problems.  So, while the MRI may not always show what's going on with the nerves, it can tell you enough about the surrounding structures to suggest a problem with the nerves.

If a neurologist were to look at the radiology report and also the pictures, he would see that you may indeed have a nerve that is driving you nuts, as well as some disks that are also probably causing at least regional pain, and if he takes this diagnostic tool in combination with your history, and even perhaps a neuromuscular energy test (not sure on that term either), the whole ball of wax says, yes, you got a lot of discomfort coming from your lower back and down into your legs, and he should therefore have a treatment plan for you, or at the very least be prescribing some antispasm drugs or nerve pain drugs, just whatever he thinks is best for your situation.

These MRI reports are often shipped directed to the patient, when I think they ought to go straight to the neurologist who ordered the scan, so he can go over the findings with you and tell you what he thinks is going on, and give you some relief from what is apparently quite bothersome.  I hope this steers you in the right direction.  But there is nothing you yourself can do with an MRI report in the way of seeking help; you have to include a doc who knows about what these reports mean, to get you some help.
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I actually don't have two disc herniations .. only one that is what the Impression is about..  I had my doctor look at the actual films... and he said the disc is so small plus the tear it's nowhere near impinging on anything...  I don't know .. I still am curious about the neurologist.. but the radiologist is the one who dictates all this.. The doctor or PA I am seeing seems to think that the pain isn't coming from the disc that is damaged at all.. so I am still having all this nerve pain all over my left leg... so anyways.. thanks for your answer
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Avatar_f_tn
Like I suggested in another forum, an emg study would be helpful to demonstrate if there is any radiculopathy, and if so where, and what's causing it. Take care hun:)
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Avatar_f_tn
Squirt,
Thanks for giving the EMG letters correctly, couldn't think of it to save my life.

Dear Tiffee,
No, I didn't mean to say you had two disk "herniations."  My wording was "disk bulging, herniation and tear," which to clarify is, "disk bulging and disk herniation and tear."  Which is exactly what the MRi report says, if you'll look above the last impression, it says at L4-5 "disk bulging," and at L5-S1 it says "disk protrusion with annular tear."  That means you got two disks goofed up in adjacent areas.

Also, you don't tell us if your doctor commented on the additional wording at L4-5 "neural foraminal narrowing," which foramin is same thing as opening or passageway, and in this case the opening is an opening for a nerve, and it is narrowed.  This means that the space is smaller where the nerve goes thru there and may therefore be bothering that nerve.  A doc talking to a patiet cannot just look at the "impression"; he's got to also read the whole report.

All these things, the bulging, the protrusion and tear, plus the narrowed nerve opening, are all going on in the same general location, adjacent vertebral bodies,so your doctor is being remiss is saying all this damage isn't causing you SOME sort of discomfort, especially when you say it is.  If your doctor is a neurologist, he should have NEVER made that kind of error in reading the radiology report.  Whatever doc went over your pictures with you, he SHOULD have read the radiology report findings, then found them on the pictures, or else he doesn't know how to read a scan or he completely forgot what the radiologist said.  

I think the confusion here is "impressions."  The radiologist can talk all day long within the report itself at each point in the spine, labeled thusly, and those findings can have an impact on how a person is doing.  I was surprised just how much the radiologist left out in his impressions section, which pulls out the problematic problems in his report.  All I know is, I read your radiology report in its entirety and carefully, mighty interested in what it had to say since I have similar problems in my back.  Oh, I can make some loo-loo boo-boos in these here forums, but this one, I'm certain about, and if you yourself will simply READ what I have quoted here, look up what diff words means, you'll see what I am saying.

At least you had a a doc go over your pictures with you.  I cannot tell from your posts if you sat down with your family doc or a neurologist.  But even if your doc misread the radiology report, and even tho some details were not put in the impression section, or even if I did not read it correctly myself, the doctor STILL should have given  you something for your discomfort based on your complaints.  That is BARBARIC that he would just let you go and not even at the very least offer some moderate treatment options, and, as I said, he should have given you some drugs for what you not only have given him as history (which should be enough), but is also backed up by your radiology report.

You can take just the report alone, or also the pictures, to another neurologist, and ask him to PLEASE tell you if the pain in your back is just a figment of your imagination, or is there actually some evidence that it's no wonder you got pain.  Gee whiz.  These docs.  They train and train, sacrifice so much to help us out, but when they're standing on the stage and ready to perform, they freak out.  What a waste.
GG
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1277982_tn?1273381675
That's interesting because I did go over it with my doctor actually two doctors and I was told only ONE disc bulging... not two goofed up discs... the protrusion being the only one..  that is what I was told not two out of whack discs..  I haven't been to a neurologist...  I actually went back to the doctor to have her read it again.. and she said one bulging disc (the disc protrusion)  I am told that a disc protrusion is the same as a bulging disc.. so..  yeah I am still in alot of nerve pain so but thanks for your input.. Tiff
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I do NOT understand WHY they would tell me I only had ONE bulging disc CLEARLY I have TWO of the sorts.. I am going to get to the bloody bottom of this..  Tiff
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Honestly Ggreg I think it is BARBARIC that they have let me go on in pain like this .. yeah I'm not a happy camper..  this is BS... I really didn't think I had two only the one... sheesh.. yeah I am going to get a neurologist.. sheesh. no wonder I am suffering.  
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Avatar_f_tn
Good, glad you see it too!  And just to add a little more wood to the fire, in the radiology report, at L4-5, it says "facet joint hypertrophy," and that alone would cause pain.  The facet joints are the parts of the spinal bones that stick out in the back, like a butterfly, and they form a little joint that, for you, is deteriorating.  They saw that in conjunction with the narrowed nerve canal opening, which means the facet joint deterioration has likely caused the smaller nerve opening.  

And let us not stop there!  If you'll read in the "findings section," again further up before the last "impression," it says at L3-4, just above where all your trouble is, there is "disc desiccation," which while a fairly typical finding, it does mean that the little cushiony disk there is drying out, and that usually means its function, too, will begin to be lost in some manner, especially since the disc that is protruding at L5-S1 is ALSO identified as showing disc desiccation, too.  This means that eventually the disc at the L3-4 area may also start to give you trouble, and perhaps be a new source of pain.

And this isn't even talking about your thoracic spine!  Just in the "impression" alone for that part of your spine, nevermind reading to find out what is REALLY going on, it clearly says, "mild disc degeneration" from T7 thru T12.  Now, that may not cause you too much discomfort, but when you look at the whole picture, your disks in your back are almost all having some degree of degeneration, save your cervical spine, which I presume was not scanned this time.

I assume this MRI was ordered to find out what might be the cause of some discomfort you are having in your legs.  You have put up with this for four months, and by the time you see a neuro it'll be six months, it makes your legs feel funny and makes your leg muscles twitch, not to mention the "shooting pain" you got in your left knee, plus regular pain in both legs.  I wonder if you've noticed discomfort in your lower back, too, and also how all this is affecting your day-to-day life, like sleep, ability to sit still to work, and so forth.  Your regular doc can refer you to a neurologist, if you're wondering how to get in touch with one of those.  

You can make a copy of the radiology report, and on the copy, you can use diff color highlighters to separately mark all these diff things I've told you about, for illustration purposes with your next doc, hopefully a neuro guy.  And think about a couple examples of how this is ruining your days, and report that to him, too.  But let him first take over the office visit, he'll ask you some questions or his assistant will, and he'll tell you what he thinks of your MRI and what he's going to do for you.  And if you are not satisfied with what he says, then you can produce your marked-up copy and plus tell him the daily problems you're having, aside from the pain that presumably led to the MRI to begin wth.

Hopefully, at the very least, they'll give you an antispasmodic medicine like some of the gaba drugs, and perhaps physical therapy.  I can tell you this much, I have a tore-up back too, in the same places as you (thoracic and lumbar), and one thing that is easy to do and helps is to strengthen your tummy muscles...not with situps or anything so strenuous as that, but just pull them in several times a day for a count of ten, perhaps, and do that every time you brush your teeth, for example, or open the refrigerator door, just whatever will make it a habit.  The stomach muscles help hold the spine in place and prevent further injury.
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I have been in physical therapy and I don't really care for it all he is telling me to do is some stretches and gives me a little massage on my back and feet.. I have to walk alot on account of I don't have a car..  I have all sorts of meds and it just makes me more tired than anything.  I am so tired of being in pain..  the constant muscle twitching and  pin and needles tingling nerve pain I have all over my left leg and some of my right..  I just wonder if this will ever end.. Should I get another MRI done?  I am always depressed too.. I stay in my room like a hermit.. I used to be pretty active and had just started school when this happened now I am just severely depressed...  I wish that they would find out what is really going on.. Like I said the PA thinks that it's in my muscles... and I just don't think that it is... The two chiros I went to didn't think it was either.. I am just tired of being in pain
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Avatar_f_tn
I don't know what medicines you are on, but you need something stronger to make the discomfort go away, even tho they might make you tired sometimes.  Ask for better stuff.  Also, they can give you nerve block shots that usually kill pain for long periods of time, even tho they don't think anything is wrong with your back.  But if the moderate treatment path isn't helping, which is the PT and drugs, you can do as I suggested and visit a new neuro doc and they will have your old MRI pictures and report forwarded to him, and could be he would offer surgery to straighten out your lumbar spine.  You do not need a new MRI.  You just need a better doc, he can use your existing pictures and report.

Since you walk a lot, I would suggest that when you do, that you wear a little tummy wrap back support from the drugstore, it fastens with velcro in the front and has stays in the back, and that way while you walk, it should help take the pressure off that trapped nerve and keep your disks from being pushed on in any awkward way.  And when you sit down in the evening, you can put heat on that part of your back, makes it feel better on a temporary basis.

As for your depression, and this is coming from someone who has similar problems as you, when you're in unrelenting pain, it can really wreck your attitude.  The pain is frustrating, it can make you angry, and then follows sadness.  If you will make that connection in your head that your pain is causing those unsettled feelings, just understanding that will make you feel better.  But PLEZ we both know you have a mechanical bone/nerve problem in your spine, and you need better meds, maybe nerve blocks, and a good neurologist to check over your radiology report and the film for you.  Keep pushing on this issue, you WILL get the help you need eventually.  I did.
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I have an appt. with a neurologist I am on  basically state funded medical insurance and well it's just hard to get anything done even an epidural.. I just stretch like you wouldn't believe and I've already a lumbar support.. I was told to strengthen my TA brace ..  I think I might be in this for the long haul sigh I hope this is almost gone by the end of the year.. I had some minor sciatic nerve flare ups but I just stretched it out.. heat huh?  yeah I  have been trying that plus an inversion table.. oh btw I am on vicodin and neurontin they are ok... and ibuprofen..  it's gotten a little bit better but not where I used to be... cheers
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I wanted to know even tho I have two small disc problems.. should I still be able to ride my bike?   even for 10 mins it's a small kids bike I am small... I ride it to the gym well used to.. one way there the other way back?  Just wondering?  I miss riding it
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Avatar_f_tn
I cannot make that determination.  The drugs you're taking are making you think it's okay to do that.  First SOMEONE has got to SAY that based on your symptoms and the radiology report, your back is goofed up.  This doesn't take a lot of tests or rocket science.  Just someone who will (a) read the whole scan report through, and (b) know how to read scan pictures.  So, you will be going to a neurologist, and he'll tell you what I've been telling you all along, and you can work with him on deciding what you can and cannot do, as far as riding your bicycle and so forth, and also he can review your medications, and you never know, he might indeed order a spinal block, and he can discuss any surgery you might need.  

And your disk problems are not "small."  They are causing you pain for four months, the L4-5 facet joint has deteriorated enough to narrow the spinal nerve foraminal opening, which every time you move, it's gonna squeeze on that nerve, and the other L5-S1 disk has pushed out so much that it's torn.  I'm glad you're taking Vicodin, good pain killer, same thing with the Neurontin.  And I was relieved to hear you've got lumbar support, keep it on when you're up and about to protect your spine from getting any worse.  Sounds like your treatment is progressing the way it's supposed to, the neuro will hopefully be a little more studied about your situation and can now take over on this issue.  Get well soon!
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2mm isn't that much.. with the L5 S1 to have made it tear. I think that the tear is on the inside of the annulous..  i am trying to rehydrate the discs and perhaps make the discs fatten up perhaps.. I have been told that both of the discs in question the bulges are relatively small.. so I don't know I am hoping that these will heal I've been told that disc bulges can heal ..  I am trying to hopefully get to a point that I can at least be 90 percent.. anyways thanks.
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Avatar_f_tn
No, the 2mm is referring to the amount of the protrusion, and I quote, "There is a 2-mm central disc protrusion with annular tear."  The word "central" (or midline) is referring to where the disc protrusion is, which it's pushing on the spinal canal.  When you get an annular tear, yes, that is a tear in the annulous, but then that allows stuff from the inner part of the disk to come into the outer disk area in a certain place, which that alone causes pain, and that's where you'll see the disk bulge out, which in your case is bulging into the spinal canal region, or "central" area.  It will produce similar pain symptoms to what you have.  You are perhaps thinking since it said central, that it's referring to the annulus, but this is not the case, in radiology terminology.  But your neurologist will explain this to you better than I can, if you ask.

You ought to see my spine pictures.  I have NO disks in several of my thoracic vertebrae, with natural fusion of those vertebrae, I have spondylolisthesis, which is slippage, of several vertebral bodies, I have collapsed disks where they bulge out equally the entire circumference of the disk... over the years, I've learned what all this means, but the main thing is I feel profound pain, sharp pain, I don't walk normally, and I take a lot of drugs to stop the pain.  I read where you were in pain, and I just thought I'd take a layman's stab at your MRI since it is in your thoracic and lumbar regions, which is the same places as my injuries.  Well, do post back when you finally see your neuro, if you have time.  I know I lobbied a little too hard for you, it's true your injuries are somewhat minor when compared to what could happen.  But pain is pain.  Anyway, we'd all like to hear what your situation is after you visit your neurologist.  
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well I went to see a neurologist she told me I am a little bit hypoglycemic.. but she said that I had permanent nerve damage more so in my arms.. I was like WHAT??  I'm sorry I don't agree with her diagnosis..  I was only exercising when this happened.. it's now going on 7 months..  I went to see a neurosurgeon he said I didn't need surgery and that there was no pinched nerve according to the radiologist report in my MRI..  I'm still getting tested for viral infections for this.. but I am just tired of this neverending nerve pain and no doctors are giving me any answers
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oh and the neurologist wasn't interested in looking at the pictures..  or my MRI..  
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1277982_tn?1273381675
I posted to comments to you on here..just got the g's in the wrong place
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