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Can't understand MRI results...
My husband just received his MRI results for the lumbosacral spine and we can't understand them. I have tried to look them up on the internet, but I'm having no luck. I was wondering if someone could give me a good website to go to or help me understand his issues. Its almost like its in a different lang. And it looks like there is so much wrong with him. I just don't want to worry and his appointment with his doctor is in weeks. Can someone please help me? Here are his results:
FINDINGS:
L5-S1: There is a grade 1 spondylolisthesis with mild pseudo-bulging. There is mild bialateral facet joint hypertrophic change. The posterior elements are congenitally short. There is moderate bilateral neural foraminal encroachment.
L4-5: There is mild disc bulging (I've heard of this, but don't really understand it). There is mild facet joint hypertrophic change.
L2-3: There is moderate disc desiccation, mild loss of disc space height and mild disc bulging.
L1-2: Unremarkable (like they have no remark or its so unremarkable they don't know what to say??)
IMPRESSION:
Grade 1 spondylolisthesis, mild pseudo-bulge and moderate bilateral neural foraminal encroachment L5-S1.
Mild disc bulging L4-5 and L2-3 with degenerative disc disease L2-3.
FINDINGS:
L5-S1: There is a grade 1 spondylolisthesis with mild pseudo-bulging. There is mild bialateral facet joint hypertrophic change. The posterior elements are congenitally short. There is moderate bilateral neural foraminal encroachment.
L4-5: There is mild disc bulging (I've heard of this, but don't really understand it). There is mild facet joint hypertrophic change.
L2-3: There is moderate disc desiccation, mild loss of disc space height and mild disc bulging.
L1-2: Unremarkable (like they have no remark or its so unremarkable they don't know what to say??)
IMPRESSION:
Grade 1 spondylolisthesis, mild pseudo-bulge and moderate bilateral neural foraminal encroachment L5-S1.
Mild disc bulging L4-5 and L2-3 with degenerative disc disease L2-3.
Hi,
Although grade I spondylolisthesis usually is asymptomatic, it depends on the person. I started having severe low back pain when I was 15 & had it on & off until I had surgery last yr right before my 19th birthday. I also had grade I spondylolisthesis which continued to slip over the years. It's understandable that you shouldn't rely just on the MRI findings but I've been told that this condition can occasionally cause severe pain so you can't rule it out.
Has he tried an epidural?
Although grade I spondylolisthesis usually is asymptomatic, it depends on the person. I started having severe low back pain when I was 15 & had it on & off until I had surgery last yr right before my 19th birthday. I also had grade I spondylolisthesis which continued to slip over the years. It's understandable that you shouldn't rely just on the MRI findings but I've been told that this condition can occasionally cause severe pain so you can't rule it out.
Has he tried an epidural?
Every level of the spine is composed of a disc in the front and paired facet joints in the back. The disc acts as a shock absorber in between the vertebrae, whereas the paired facet joints restrain motion. They allow the spine to bend forwards (flexion) and backwards (extension) but do not allow for a lot of rotation. As the facet joints age, they can become incompetent and allow too much flexion, allowing one vertebral body to slip forward on the other. This slippage is known as a degenerative spondylolisthesis, which is Latin for “slipped vertebral body.”
Degenerative spondylolisthesis is far more common in individuals older than 65 and is more common in females than males by a 3:1 margin. It is most common at the L4-L5 level of the lower spine, but can also happen at L3-L4. It is relatively rare at the other levels. It may also occur at two levels or even three levels of the spine.
Symptoms
As the facet joints degenerate they often get larger, which can encroach upon the spinal canal that runs down the middle of the spinal column, resulting in spinal stenosis. The symptoms of a degenerative spondylolisthesis are very commonly the same as that of spinal stenosis. Patients usually complain of sciatica pain or a tired feeling down the legs when they stand for a prolonged period of time or try to walk any distance (pseudoclaudication). Generally, they do not have a lot of pain while sitting, because in the sitting position the spinal canal is more open. In the upright position, the spinal canal gets smaller accentuating the stenosis and pinching the nerve roots in the canal.
The nerve root pinching can lead to weakness in the legs, but true nerve root damage is rare. There is no spinal cord in the lumbar spine, so even for patients with severe pain, there is no danger of spinal cord damage. If the stenosis becomes very severe, or if the patient also has a disc herniation, they can develop cauda equina syndrome where there is progressive nerve root damage and loss of bladder/bowel control. This is a very rare clinical syndrome, but is a medical emergency.
Back pain and/or leg pain are typical symptoms of degenerative spondylolisthesis. Some patients do not have any back pain with degenerative spondylolisthesis and others have primarily back pain and no leg pain.
Treatment options
There is a range of non-surgical treatment options (such as pain medications, ice or heat application) that may help with some of the pain of a degenerative spondylolisthesis, but there are really three options a patient will ultimately have to choose from.
Activity modification. Patients can modify their activities so they spend more time sitting and less time standing or walking. If they want to be more active they could try stationary biking as activity in the sitting position should be tolerable.
Epidural injections. These work to help curb pain and increase a patient’s function in up to 50% of patients, and if it does work it can be done up to three times per year. The length of time that the epidural can be effective is variable as the pain relief can last one week or a year.
Surgery. For patients with severe pain and difficulty functioning, surgery can be done that includes a decompression with pedicle screw instrumentation plus spine fusion. Decompression surgery alone is usually not advisable as the instability is still present and a subsequent fusion will be needed in up to 60% of patients. Herkowitz et al did a randomized controlled study of fusion with and without pedicle screw instrumentation and found the fusion rates were much higher in the patients with instrumentation, but the clinical results were about the same. However, when Kurz et al followed these same patients up 10 years later, the patients with a solid fusion ultimately fared significantly better than those that had not fused.
Spinal fusion surgery for a degenerative spondylolisthesis is generally quite successful, with upwards of 90% of patients improving their function and enjoying a substantial decrease in their pain. The hospital stay typically ranges from one to four days. It is a difficult surgery to recover from as there is a lot of dissection, and it can take up to a year to fully recover. Usually, most patients can start most of their activities after the fusion has had three months to heal. Once the bone is fused, then the more active the patient is the stronger the bone will become.
There are numerous risks and possible complications with surgery for degenerative spondylolisthesis and they are basically the same as for any fusion surgery. There are risks of non union (nonfusion, or arthrodesis), hardware failure, continued pain, adjacent segment degeneration, infection, bleeding, dural leak, nerve root damage and all the possible general anesthetic risks (e.g. blood clots, pulmonary emboli, pneumonia, heart attack or stroke). Most of these complications are rare, but increased risks can be seen in certain situations. Conditions that increase the risk of surgery include smoking, obesity, multilevel fusions, osteoporosis (thinning of the bones), diabetes, rheumatoid arthritis, or prior failed back surgery.
Since degenerative spondylolisthesis is a condition that disproportionately affects individuals over age 60 or 65, the surgery does present some additional risk. Surgical risk is more directly related to the overall health of a patient and not his or her absolute age. Particularly in patients who have multiple medical problems, surgery can be very risky. For some patients, even if non-surgical treatments have failed to alleviate their symptoms, surgery may present too much risk, and intermittent epidural injections combined with activity modification may be their best option.
After a fusion procedure, degeneration of the spinal segment adjacent to the fusion is possible. In an attempt to alleviate transferring extra stress to the next segment, there are many different devices currently being studied that hold the promise of being able to replace the function of the facet joint without having to include a fusion procedure. It is too early to determine whether or not the results of these newer technologies are better or worse than the standard fusion procedure. For more on this topic, see Posterior Motion Preservation Spine Surgery: Alternative to Spinal Fusion
Degenerative spondylolisthesis is far more common in individuals older than 65 and is more common in females than males by a 3:1 margin. It is most common at the L4-L5 level of the lower spine, but can also happen at L3-L4. It is relatively rare at the other levels. It may also occur at two levels or even three levels of the spine.
Symptoms
As the facet joints degenerate they often get larger, which can encroach upon the spinal canal that runs down the middle of the spinal column, resulting in spinal stenosis. The symptoms of a degenerative spondylolisthesis are very commonly the same as that of spinal stenosis. Patients usually complain of sciatica pain or a tired feeling down the legs when they stand for a prolonged period of time or try to walk any distance (pseudoclaudication). Generally, they do not have a lot of pain while sitting, because in the sitting position the spinal canal is more open. In the upright position, the spinal canal gets smaller accentuating the stenosis and pinching the nerve roots in the canal.
The nerve root pinching can lead to weakness in the legs, but true nerve root damage is rare. There is no spinal cord in the lumbar spine, so even for patients with severe pain, there is no danger of spinal cord damage. If the stenosis becomes very severe, or if the patient also has a disc herniation, they can develop cauda equina syndrome where there is progressive nerve root damage and loss of bladder/bowel control. This is a very rare clinical syndrome, but is a medical emergency.
Back pain and/or leg pain are typical symptoms of degenerative spondylolisthesis. Some patients do not have any back pain with degenerative spondylolisthesis and others have primarily back pain and no leg pain.
Treatment options
There is a range of non-surgical treatment options (such as pain medications, ice or heat application) that may help with some of the pain of a degenerative spondylolisthesis, but there are really three options a patient will ultimately have to choose from.
Activity modification. Patients can modify their activities so they spend more time sitting and less time standing or walking. If they want to be more active they could try stationary biking as activity in the sitting position should be tolerable.
Epidural injections. These work to help curb pain and increase a patient’s function in up to 50% of patients, and if it does work it can be done up to three times per year. The length of time that the epidural can be effective is variable as the pain relief can last one week or a year.
Surgery. For patients with severe pain and difficulty functioning, surgery can be done that includes a decompression with pedicle screw instrumentation plus spine fusion. Decompression surgery alone is usually not advisable as the instability is still present and a subsequent fusion will be needed in up to 60% of patients. Herkowitz et al did a randomized controlled study of fusion with and without pedicle screw instrumentation and found the fusion rates were much higher in the patients with instrumentation, but the clinical results were about the same. However, when Kurz et al followed these same patients up 10 years later, the patients with a solid fusion ultimately fared significantly better than those that had not fused.
Spinal fusion surgery for a degenerative spondylolisthesis is generally quite successful, with upwards of 90% of patients improving their function and enjoying a substantial decrease in their pain. The hospital stay typically ranges from one to four days. It is a difficult surgery to recover from as there is a lot of dissection, and it can take up to a year to fully recover. Usually, most patients can start most of their activities after the fusion has had three months to heal. Once the bone is fused, then the more active the patient is the stronger the bone will become.
There are numerous risks and possible complications with surgery for degenerative spondylolisthesis and they are basically the same as for any fusion surgery. There are risks of non union (nonfusion, or arthrodesis), hardware failure, continued pain, adjacent segment degeneration, infection, bleeding, dural leak, nerve root damage and all the possible general anesthetic risks (e.g. blood clots, pulmonary emboli, pneumonia, heart attack or stroke). Most of these complications are rare, but increased risks can be seen in certain situations. Conditions that increase the risk of surgery include smoking, obesity, multilevel fusions, osteoporosis (thinning of the bones), diabetes, rheumatoid arthritis, or prior failed back surgery.
Since degenerative spondylolisthesis is a condition that disproportionately affects individuals over age 60 or 65, the surgery does present some additional risk. Surgical risk is more directly related to the overall health of a patient and not his or her absolute age. Particularly in patients who have multiple medical problems, surgery can be very risky. For some patients, even if non-surgical treatments have failed to alleviate their symptoms, surgery may present too much risk, and intermittent epidural injections combined with activity modification may be their best option.
After a fusion procedure, degeneration of the spinal segment adjacent to the fusion is possible. In an attempt to alleviate transferring extra stress to the next segment, there are many different devices currently being studied that hold the promise of being able to replace the function of the facet joint without having to include a fusion procedure. It is too early to determine whether or not the results of these newer technologies are better or worse than the standard fusion procedure. For more on this topic, see Posterior Motion Preservation Spine Surgery: Alternative to Spinal Fusion
Mike,
for some reason that email only showed up as ***@****, try and email me at ***@****
Thanks,
Cory
for some reason that email only showed up as ***@****, try and email me at ***@****
Thanks,
Cory
Cory--rahter than ramble on, Ill call you on the phone. I think I may be able to help. email me privately at ***@**** and give me your phone #. Keep in mind I am not an MD, just a very well read dentist who had similar problems and been through all the same wasted/expensive/potentially non-beneficial testing that you fear.
Mike,
I am in a similar situation. I've had pain in my right neck/shoulder/ upper back/arm/hand for 5 years now. As a freshmen in college (artschool) I did a wood carving project, fairly soon after I started having pain in my right shoulder. I had pain in my right hand on and off for a year or so, after which it became a constant hand pain. I went to my doctor, had x-rays of my hand and did physical therapy exercises for my hand for about 6 months with no results from either. Two more years of most of the time hand pain brought me into my senior year of college when the pain spread into my upper back, shoulder, arm and hand. It's been like that ever since. I've had acupuncture and massage, which seemed to help temporarily but never had any lasting affect. Running actually almost completely relieved the pain for 2 months but has stopped working, though I continue to do it. I've been reading about trigger points in Claire Davies' book and it sounds as though I have scalene trigger points and have point a very painful spot in my neck about where my scalenes should be. I have been treating them myself for about 2 weeks now but have not noticed any overwhelming results. I'm not sure if I'm doing it right or how long it should take if it is going to work. I also have had pain in my left arm (not nearly as often) that feels as though I've been holding it above my head too long, or as though it is swollen or cold and the strangest thing is my right side doesn't hurt at all when my left does. It seems like a circulation problem. I have an appointment with an orthopedist next month and am worried that I will end up getting a battery of expensive and possibly unhelpful tests (and I don't have health insurance) that may result in some kind of surgery. I guess I don't know what questions I'm asking I would just love your opinion. Thank you.
P.S. My regular doctor had suggested this was a slipped disc pushing on the nerve that goes down my arm, and that sounds dead on but if that were the case, wouldn't it hurt ALL the time? This doesn't hurt for about a half hour in the morning and occasionally I'll have a whole day (though rare) where it doesn't hurt.
-Cory
I am in a similar situation. I've had pain in my right neck/shoulder/ upper back/arm/hand for 5 years now. As a freshmen in college (artschool) I did a wood carving project, fairly soon after I started having pain in my right shoulder. I had pain in my right hand on and off for a year or so, after which it became a constant hand pain. I went to my doctor, had x-rays of my hand and did physical therapy exercises for my hand for about 6 months with no results from either. Two more years of most of the time hand pain brought me into my senior year of college when the pain spread into my upper back, shoulder, arm and hand. It's been like that ever since. I've had acupuncture and massage, which seemed to help temporarily but never had any lasting affect. Running actually almost completely relieved the pain for 2 months but has stopped working, though I continue to do it. I've been reading about trigger points in Claire Davies' book and it sounds as though I have scalene trigger points and have point a very painful spot in my neck about where my scalenes should be. I have been treating them myself for about 2 weeks now but have not noticed any overwhelming results. I'm not sure if I'm doing it right or how long it should take if it is going to work. I also have had pain in my left arm (not nearly as often) that feels as though I've been holding it above my head too long, or as though it is swollen or cold and the strangest thing is my right side doesn't hurt at all when my left does. It seems like a circulation problem. I have an appointment with an orthopedist next month and am worried that I will end up getting a battery of expensive and possibly unhelpful tests (and I don't have health insurance) that may result in some kind of surgery. I guess I don't know what questions I'm asking I would just love your opinion. Thank you.
P.S. My regular doctor had suggested this was a slipped disc pushing on the nerve that goes down my arm, and that sounds dead on but if that were the case, wouldn't it hurt ALL the time? This doesn't hurt for about a half hour in the morning and occasionally I'll have a whole day (though rare) where it doesn't hurt.
-Cory
Chris--- the findings on his MRI do not look bad at all. the biggest mistake people make is interpreting MRI "findings" as being the cause of pain. What do you think an orthopedist will do for this patient other than refer him out for PT???
People (and I learned the hard way) have to be careful about going to Orthopedists and spine specailiasts. Too often, it is the first step of a process that leads to unnecessary surgery. Too many doctors operate on "findings" and pain.
BTW What is the difference between a rehab specialist and a PT?
People (and I learned the hard way) have to be careful about going to Orthopedists and spine specailiasts. Too often, it is the first step of a process that leads to unnecessary surgery. Too many doctors operate on "findings" and pain.
BTW What is the difference between a rehab specialist and a PT?
While chiropractors and accupuncturists may offer temporary relief of symptoms, I would recommend an evaluation by either an orthopedic who specializes in the spine or a physical medicine and rehabilitation doctor. The best place to find these doctors is with the most respected hospital in your area - most orthopedics in these hospitals have private practices, or would be more than glad to refer you to an appropriate doctor.
Regarding the medication, oxycodone is not fun to be on for long periods of time, and there are often non pharmecutical options that can be helpful. Again, a qualified orthopedic or physical medicine doctor would be able to address this.
What area are you in? Perhaps I can get some names for you.
Sincerely,
Chris
Regarding the medication, oxycodone is not fun to be on for long periods of time, and there are often non pharmecutical options that can be helpful. Again, a qualified orthopedic or physical medicine doctor would be able to address this.
What area are you in? Perhaps I can get some names for you.
Sincerely,
Chris
PPS--- this is the website that saved me. Her name is Jolie Bookspan. I never saw her but I have corresponded with her many times--she took the time to PERSONALLY (thru email) teach me how to fix myself. I certainly would also recommend contacting her about possibly visiting her or taking part in her classes.
http://www.drbookspan.com/
http://www.drbookspan.com/
PS-- grade 1 sponylolisthesis is the most mild form. I am no MD (I am a dentist) but I doubt his MRI findings has anything to do with his pain. I think it's all muscular especially if bloodwork/routine testing is normal. If it's muscular, that means he can get better. But neither of you should think pills or doctors or acupuncturists will be a cure. Good therapists may point him in the right direction, but it may take months and months of painful, many times daily sessions of stretching and stengthening exercises to see results. no one else can do this but the 2 of you. The individuals I referred you to helped me incredibly, but they did so mainly by educating me and teaching me how to treat myself. You can start by getting a trigger point manual by Clair Davies and a book on posture. Keep in mind muscle trigger points take many many treatments to get better. And treating them hurts !!!
trust me. if he says he is in pain, then he is. I was in agony for 2 1/2 years with neck, upper back, and chest pain. No one believed me becasue all my tests were normal. my wife and friends forced me to see a shrink and that was BS. Turns out I had something called Upper Crossed Syndrome which is an upper torso muscle imbalance-- no need to go into that here because your husband's case sounds different. I'm sure he is depressed also if he is in pain all the time. Dont let anyone tell you that his pain is from his depression-- it is most likely the other way around although certain shrinks/therapists may tell you the opposite becasue that's how they get paid.
If all his testing is normal, he may have myofsacial pain syndrome. (what I had was an upper body version of that) Myofascial pain is real, and very painful. It comes from muscles that have been trained (posture/work habits/sports etc) to "remember" certain positions that the rest of our bodies do not like. These muscles get short, tight, go into spasm and cause all kinds of havoc. I would highly recommend two individuals 1. Sharon Sauer in Gendale, Illinois (Myopain.com), and John Barnes Myofascial Release Clinic in Paoli Pennsylvania. If this is indeed his problem, they will help him most likely. Good luck. Just remember that pain doen not happen for no reason.
If all his testing is normal, he may have myofsacial pain syndrome. (what I had was an upper body version of that) Myofascial pain is real, and very painful. It comes from muscles that have been trained (posture/work habits/sports etc) to "remember" certain positions that the rest of our bodies do not like. These muscles get short, tight, go into spasm and cause all kinds of havoc. I would highly recommend two individuals 1. Sharon Sauer in Gendale, Illinois (Myopain.com), and John Barnes Myofascial Release Clinic in Paoli Pennsylvania. If this is indeed his problem, they will help him most likely. Good luck. Just remember that pain doen not happen for no reason.
sorry he is 31 years old and has always lifted weights and is very phsically fit. we are both very honest church going people. is it possible that he is suffering from pain?
He is in continuous pain. It is a dull pain but continuous, somtimes it takes him five to ten minutes to get out of bed in the morning. His moans wake me up and he drives an hour and a half one way to work. he is an engineer/drafter. He was in a car accident about three years ago. He has been going to physical therapy, massage , chiropractor, and acupuncture. He really seems to be in pain, i can tell if he wasnt. It seems to have gotten really bad very quickly. He has trouble standing up straight and he says that his joints hurt terribly. Mainly his knees,wrists,elbows, and hands. He goes to pain management and a rhumatolagist, and they perscribe some oxycodone 30 mg x 3 a day. Will this just get worse or can this get better. He sits at a desk all day and cant stay seated for more than a hour with out standing and sretching I hope that this is making some sence to you. i thank you so much for your help.
"unremarkable" means nothing can be seen worth remariking about. spondylolisthesis is not that uncommon and basically means a vertebrae is not in perfect alignment with the other vertebrae-- ie it has slipped a little bit. Steve Nash from the Phoenix Suns has this. The rest of the report reads mild to moderate findings-- which to me should not be causing symptoms. there is no mention of distinct pinching of a nerve or compression of the spinal cord. what are his symptoms??? how old is he?? is he overweight?? what does he do for a living??? did he have an injury or accident???
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