Thank you Dr. Kaul,
I am also curious about what my lumbar MRI revealed at L4-L5. It stated I have a moderate diffuse posterior disc bulge and prominent epidural fat. What does this mean, and where is the epidural fat coming from? It also states that I have severe Bilateral facet hypertrophy left worst and ligamentum flavum thicking. What does this mean and is this affecting my nerve roots because I am have unbelieveable shocking pain in my legs, buttocks, knees, thighs and feet and big toe on the left side. If I push on my buttocks it hurts. Certain position that I sit in, I begin to experience pain. Why is that?
Disc bulge is an early stage of intervertebral disc prolapse. Epidural fat is normally present at the lumbar region of the spinal epidural space in anterior and posterior positions and dural sleeves enveloping spinal nerve roots. Prominent epidural fat could occur in a few degenerative and autoimmune conditions. Facet hypertrophy is enlargement of the facet joint. Ligamentum flavum thickening could occur as a normal part of the ageing process or these could occur secondary to degenerative conditions. These could potentially worsen to cause nerve root pressure causing the symptoms you have mentioned. However the MRI details mentioned by you do not describe pressure on the nerve root, and it possible that there is nerve pressure at a lower level or the symptoms to be due to an unrelated cause. It would be best to get this evaluated by a neurologist/ neurosurgeon/ orthopedician for appropriate management.
Hope this was helpful.
I have been giving you just sections of the MRI. I sent this question to Dr. Vinrod and I have not gotten a response:I had a work related accumalitive trauma injury of the neck in 2000 and then a fall in 2005(50), injurying my neck, back, and shoulder. I have had 4 neck surgeries,anterior in 2005. 2008, 2009 last surgery Aug 2010 posterior 6 level fusion(metal plate in back) and 1st, 2nd and 3rd resulted in anterior fusions from C3 through C7. I have significant limited movement in my neck due to a fused neck front and back. I will go into more detail about my neck at a later date. I am not sure if the neck is causing leg pain due to nerve sensory damage as I did have severe spinal cord compression.
Lumbar: Immediately after the fall, I had severe pain in my back shooting pains in my buttocks and pain in my back. After recovering from neck and shoulder surgery two months apart, my back was then the focus. In 2006,(51 years old) I had an MRI of the back and I had advanced mid and lower facet degeneration. L-3 through S1 Advanced facet arthropathy within a year after my fall. I had an X-ray in 2000 due to acute onset of muscular back pain which revealed views of lumbosacral spine show moderate advanced focal DDD at T-11-12, but below T12 disk space are well maintained thorught the lumbar spine. I see no acute findings. I see no significant facet joint arthritis. There is no evidence of spondylolysis or spodylolisthesis. I was given motrin and quicky recovered. I am noting this because I had no back problems up until the trauma fall. Would you agree?
I am now ambulated for 2 years due to balance issues resulting in 3 subsequent falls as a result of the weakness and balance issues. These falls and balance issues all occured before my spinal cord compression of the cervical spine. I had an MRI of the lumbar spine again in 2009 due to radiating, shocking leg pain; hip, calves, buttocks, knee front and in back of knee where leg bends, ankle swolling and big toe on the left side. MRI revealed: Multi level lumbar spondylosis and DDD Worst at T-10-11 moderate central canal and moderate right neuroforaminal narrowing secondary to diffuse disc bulge with superimposed right paracentral disc extrusion and moderate bilateral facet hypertrophy causing mild central canal moderate right and mild left neurforminal narrowing L-3-4. The posterior right paracentral disc extrusions effaces the right subarticular recess and perhaps impinges the right traversing L4 nerve root. However my pain was mostly on the left, so my doctor did not further evals. I was given epidural injections (which were not longstanding)
A recent MRI was done on 7-20-11: L3-L4 Mild diffuse annular bulge indenting the ventral apsect of thecal sac, moderate bilateral facet hyperthrophy, L4-5 moderate diffuse posterior and severe bilatral facet hypertrophu left worst(And that is where I told my Dr. all the pain is at. I can barely walkor sit for any lenght of time without getting shocking pain in my whole leg down to my feet and numbness in my toes. L5-S1There is a small diffuse posterior bulge that indents the ventral aspect of the thecal sac, moderate to severe biliteral facet hypertrophy without significant central canal stenosis or neuroforaminal narrowing. What do they mean without significant. Is that greater than moderate, but not significant. Impression multi level lumbar spondylosis and facet arthrosis with mild central canl stenois form L2-3 through L4-5. Diffuse posteior disc buldge from L3-4--L5-S1, mild right L3-4 and bilateral L4-5 neuroforaminal narrowing. Enhancement in the region of the facet joints reflect active inflammation, facet arthropathy is worst at L4-L5. Again noted is a posterior diffuse disk bulge at L4-5 and prominent epidural fat. The conus terminates at terminates at level L1-2 (what does this mean) No other bone marrow abnormality is identified. What does this mean.
My doctor read the impression and said that I have athritis from old age. I am 56 years old. At the time I fell I was 50. And at the time this whole night mare began I was 46 years old. I am very depressed. Should I get a second opinion. I can not bare to go through any more failed surgeries. All of my neck surgeries failed. I have reoccuring bladder infections, no sex drive and images are not accurate when taken on me. I had severe spinal cord compression which was significantly compressed and it state thecal sac was attenuated and in contact with cord. My doctor still did not want to do surgery. I was eating pain med like candy, i could not sleep I was in so much pain and now history is repeating itself with my back. My previous MRI's of the cervical spine showed false readings, not until my doctor went in did he find that there were serious issues. I am wonder if this is the same instance with my back.
What should I do. I am traumtized having to go through 4 unsuccessful neck surgeries because by the time that surgeries were done, I already had irreversable damage. I do not want history to repeat itself. I am trying to explain portions of my injuries beginning in 10-30-2000 to 2011. I did indicate the lower levels. Perhaps this could be the cause of my leg synthoms? And I do have reoccuring bladder infections since February 2010, constipation and no sex drive. Please help me.
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