MRI Lumbar Spine

I've had lower left back pain for over 7 months following a tri-malleolar fracture and dislocation of right ankle.  We (dr, PT, spouse, me) attributed it to my limp plus inactivity while non-weight bearing.  Finally pain severe enough to send me to dr for pain relief.  OS (for ankle) ordered MRI and now is out of the country for a month.  Here are the results and I could use help in interpretation.  Tried to research on internet but too confusing.

There is mild dextroscoliosis.  The marrow signal is benign.

Disc desiccation is present at L4/5 and L5/S1 with slight disc height loss at L5/S1.  Small Schmorl's nodes involve both endplates at T11/12 and T12/L1 as well as the inferior endplate of L1.

L3/4:  Mild disc bulge without stenosis and mild bilateral facet hypertrophy.

L4/5:  Asymmetric bulge to the left and mild bilateral facet hypertrophy.  There is mild left neural foraminal stenosis and the exiting left L4 nerve root is abutted laterally.

L5/S1:  There is 6 mm anterolisthesis of L5 on S1 secondary to bilateral pars defects.  There is also diffuse annular disc bulge with disc uncovering and mild bilateral facet hypertrophy.  there is mild bilateral neural foraminal stenosis:

[Kalvin]

I can interpret the MRI for you, but that information is really useless without knowing your history and the specifics of the pain you're having.

[marinalouise]

Hi, Kalvin
I'm 58 years old - female.  I held a very active job with the airline (running up and down jetbridges and jet stairs all day).  While on a picnic, I slipped on a pile of dirt and went down on my left side/buttocks due to breaking ankle in 3 places.  I was non-weight bearing for 2 1/2 months and in wheelchair.  Back hurt tremendously when beginning weightbearing with walker, but we all attributed it to loss of muscle, then due to limping.  

While laying down I can only raise my left leg about 30% (no problems with right leg).  Sometimes pain is bad enough that when standing, I can hardly raise my left leg enough to dress.  Also have had urine retention - I only mention that because I didn't have that problem before.  My back sort of crunches all the time when twisting to the side and pops in lower back.  

Pain is worse when standing and eases when I begin to walk.  However, I can only walk about 10 minutes before I have to bend over to stretch out my back.  I can only stand a few minutes.  After sitting, it takes me about 20 steps before I can stand upright.

Very depressing.  Working for an airline means free travel, but the thought of traveling and having to walk thru an airport is too much.  I am still off on medical leave.

[Kalvin]

There is mild dextroscoliosis.  The marrow signal is benign.

Dextroscoliosis is a form of scoliosis, which is the curvature of the spine. If the spine curves to the right, this is known as dextroscoliosis. Your finding is mild, it’s really nothing to worry about.

Disc desiccation is present at L4/5 and L5/S1 with slight disc height loss at L5/S1.  Small Schmorl's nodes involve both endplates at T11/12 and T12/L1 as well as the inferior endplate of L1.

Disc desiccation refers to the loss of water content of the spinal disc. As we age the fluid in the disc evaporates or slowly releases from the disc.  This is through normal wear and tear. It can be an early sign of DDD.

Slight disc height loss- As a result of the discs losing water the adjacent vertebra move closer together, in severe cases this can cause problems with the nerves and facet joints.

Schmorl's nodes- are defined as herniations of the intervertebral disc through the vertebral end-plate.  They may or may not be symptomatic,

L3/4:  Mild disc bulge without stenosis and mild bilateral facet hypertrophy.

Mild disc bulge- General pushing out of a spinal disc, extending the disc from its normal position. Considered a normal occurrence with age

Stenosis- Narrowing, disc bulges and bones spurs can sometimes cause narrowing of the foramen, which is where the nerve roots emerge from the spinal canal or can cause narrowing of the spinal canal.

Mild bilateral facet hypertrophy- the facet joints connect all of the vertebrae and allow coordinated movement of the vertebral column. Facet hypertrophy refers to the degeneration of facet joint cartilage and enlargement of the bones forming the joint.

L4/5:  Asymmetric bulge to the left and mild bilateral facet hypertrophy.  There is mild left neural foraminal stenosis and the exiting left L4 nerve root is abutted laterally.

A symmetric disc bulge is causing mild foraminal narrowing and is touching your left L4 nerve root on the left side. You also have mild facet hypertrophy at this level.

L5/S1:  There is 6 mm anterolisthesis of L5 on S1 secondary to bilateral pars defects.  There is also diffuse annular disc bulge with disc uncovering and mild bilateral facet hypertrophy.  there is mild bilateral neural foraminal stenosis:

There is 6 mm anterolisthesis – Forward slippage of vertebra in relation to the one below. The slippage often occurs as a result of bone fractures. There’s different grades of this, I’m not positive but I think yours is a grade 1, least serious because 6mm is only about a ¼” which isn’t a lot.

Secondary to bilateral pars defects- what this means is that your anterolisthesis is being caused by a bilateral pars defect which is a defect in the pars interarticularis, which is the weakest portion of the vertebrae.

You also have a small disc bulge at his level that’s mildly narrowing your foramina (area where the nerves come through) on both sides; you also have mild facet hypertrophy on both sides.

Okay, to sum this all up, a lot of this is age related, and it makes sense given your profession. Down at L4-5 you have a nerve that is supposedly being touched. It’s not clear from the report whether this is being caused by the disc bulge or the facet hypertrophy, because sometimes the arthritis from this can extend into the foramina as well. The type of pain this would cause would be sciatic in nature, pain into the buttock, thighs and down the leg on the left side, it could also cause leg weakness.

Given the fact that the anterolisthesis you have at L5-S1 is on the mild side, it’s very difficult to tell what if any symptoms this is causing. The problems raising your leg, walking, standing and the urine retention can be caused by this, but not generally by such a mild case. The grinding of the facets is also something that is seen with this.

You really need to see a very good Neuro or Orthopedic Spine Surgeon, not necessarily for surgery, because surgery for Grade 1 or even two Anterolisthesis is unheard of, but to help figure out where these various symptoms originate. That’s the first step, to getting back to normal. I can relate the depression, I've been there.

I wish you the best of luck with this.