Need Help Deciphering MRI Results!

[CWilS7]

I injured my back last September while on the job. I was a pastry cook and was bending over a counter, twisting to grab the handles of a large mixing bowl, and lifting the bowl to empty the contents into a container. Basically, I was doing everything you're not supposed to do. On top of that, my employer didn't outfit the kitchen with floor mats, so I had been experiencing back pain since I began work there in August (from what I know now, I was probably experiencing some compression). I immediately experienced pain on the left side of my lower back and muscle spasms. About a week later, I began to experience numbness in my right leg and tingling and other nerve sensations (pinpricks and bursts) in both legs. I continued working (not lifting anything over 5 pounds, but still remaining on my feet for 8 hours straight) while I went to physical therapy. I realize now this was a mistake, but I was caught in a cycle of having no money because I wasn't being payed much to begin with, so I couldn't afford to not go to work and I was worried I wouldn't be able to get another job with my injury. Long story short, I had an MRI and it definitely makes sense of why I was feeling what I was feeling. However, I want to understand it in more detail.

-There is disc desiccation at L4/5 and L5/S1.
-At L4/5 there is a left paracentral herniation with thecal sac indentation.
-At L5/S1 there is a central herniation with impingement upon the thecal sac and originating S1 roots.

What is the difference between thecal sac indentation and impingement? Is one worse than the other or just different because the impingement is also on the nerve root? I've seen other people's MRI results with modifiers like "mild herniation" or "mild desiccation." Since mine doesn't have that, does it mean that it's moderate? If it was severe, would is say? Is it possible to tell from these results how severe the herniation is? How long does it take to heal from this type of injury if you're going to physical therapy and have stopped the actions that caused it in the first place?

I'm only 25 and feel like I've wrecked my body for good. I also suffer from a sleep disorder, so I worry that my sleep deprivation will make my healing time a lot longer. Is it possible to completely heal from this? Or will I always be having to worry about my back, even if it does start feeling better?

[CWilS7]

Thank you. Best wishes to you, as well.

[philnoir]

I cannot offer medical advice on what actions you should avoid. Certainly, high-impact activities are out. Ask your doctor what he/she thinks. They know your case better than I do.

I suggest that you begin by studying the anatomy of your spine, learn the basic landmarks and functions of the vertebra, facet joints, intrathecal space, and nerve roots. Then move on to knowledge of specific treatments for helping your particular syndrome.

Physical therapy, with the right therapist, may help. I saw a few PT practitioners before I came across one who understood what I needed and helped reduce pain and increase range of motion in my head and neck.

Be relentless in your search for knowledge and treatment.

Best wishes.

[CWilS7]

What would I have to do to damage the cord or nerve roots? I'm trying to make a list of the things I used to do that were probably very bad for my back and the things I can do now, instead. That's kind of how I deal with set-backs like this (I've had a few with the sleep disorder and it's never easy when you realize that your life will never be the same, but you have to go on anyway). By constant compression, do you mean from sitting?

I would love to do water therapy. Once I find a job that pays me more than my expenses, I'm going to look into joining a gym with a pool. I would gladly wake up early to run or do lunges in a pool if it means I feel better the rest of the day. I know I need to strengthen my leg muscles, too. I'm really only strengthening my core in physical therapy because I'm there on worker's comp and they can't work on anything but my lower back.

Thank you for your responses. It always helps to hear from someone going through the same thing.

[philnoir]

You then do what I do, which is to maintain an alternating cycle of positions throughout the day -- sitting, standing, laying down, walking, stretching, etc. My pain is such that staying in any one position is difficult.

If your chiropractic therapy is helping, this is great. Some chiros are experts at manipulating soft tissue around the spine, while being very careful not to cause further injuries. Anyone who reads my posts here knows that I am a staunch advocate of non-surgical treatment. Surgery should always be a treatment of last resort. It is damaging, irreversible, and often exacerbates pain.

That said, you must be aware of two things -- save your cord, and save those nerve roots. You do not wish to damage the cord. These nerve cells do not easily regenerate. And the myelinated covering of nerve roots and the large nerves of the peripheral system must be preserved. Constant compression destroys this fatty covering, and that does not usually regenerate, either. So, be aware of this situation -- this is part of your self education.

However, if your hernia is simple, a microdiscetomy may give you immediate relief. This is where second and third surgical opinions may help you decide the proper course.

I like your attitude. Sounds like your taking the bull by the horns.

By the way, does water therapy help? Can you get in a hot tub or swimming pool? Allowing the water to bear the weight, even for an hour or two helps relieve pain for the rest of the day. It also helps the large muscles of the legs to get some exercise, allowing you better sleep, and the motion moves the back in small ways, helping to reduce the inflammation within your spine without being painful. This promotes healing.

Best wishes.

[CWilS7]

Thank you for your thorough response. I am trying to stay away from surgery if I can and have started nonsurgical spinal decompression. I've only done 7 sessions so far and I've felt a reduction in the numbness and tingling in my right leg (I never experience much nerve pain even immediately after the injury). My only concern with this therapy is that I'm only doing it twice a week, sometimes only once a week because the chiropractor isn't there and he has to be there to set it up. I worry that with so much time in between sessions, I'm not really building on the improvement from the last session, but starting over again. Does that make sense? Like, I have one session and feel better but don't have another session for a week and by the time I have the next one, I've gone back to feeling the way a l did before or only a little bit better than before. Maybe that's not really how decompression works and it'll only feel a little bit better after each one. I'm not even halfway done with the sessions, so I know I can't expect a big recovery right now. It's just frustrating not being able to do anything. My doctor told me no sitting, standing, or movement for more than 20 minutes at a time. So what does that leave me with?

[philnoir]

You probably the beginnings of degenerative disc disease. The accident may or may not have exacerbated the problem, but would not cause disc dessication. Unfortunately some of us develop this disease at a young age. I too was diagnosed in my 20s.

At L4/5 there is a left paracentral herniation with thecal sac indentation. -- here, you have damaged the discs. The thecal sac is the fluid-filled container that surrounds the spinal cord bundle. There are two tough layers called the pia and dura that is filled with fluid. This is the epidural space. The disc bulge is pushing into this area, perhaps impeding circulation of the spine. Much of the blood supply for the intrathecal space comes from the dura matter. This can be painful due to pressure placed on nerves, and also due to lack of circulation.

At L5/S1 there is a central herniation with impingement upon the thecal sac and originating S1 roots.  -- this is the problem spot that has bothered mankind ever since we started walking on two feet. The disc at L5-S1 supports the weight of the entire spine. An impingement is a little more severe than indentation. Now this second herniation is pressing against the cord and the nerve roots at L5/S1 that innervate the buttocks and legs. This nerve root is part of the sciatic nerve. If pain radiates down your leg, or if you feel it in the center of your buttocks, you are suffering from sciatica.

Sometimes physical therapy can help to move the material around and take pressure off the spine, however, with a large hernia, you will benefit from spinal decompression surgery. I rarely encourage surgery, but in your case, it may be helpful. Your doctor will tell you the risks and benefits of this treatment option.

If you opt for surgery, while the surgeon is in there decompressing L5-S1, he/she may also be able to clean up some of the L4-L5 disc and relieve more pain.

One problem with this kind of surgery is that it weakens an important ligament -- the ligamentum flavum. Scar tissue from surgery can exacerbate pain.

If surgery is recommended (find a second opinion), the pick a surgeon with a good deal of experience. It is a statistical fact that surgeons who have completed over 700 of these procedures give their patients better outcomes for pain relief and stability.  

Sorry to deliver so much bad news. Learn all you can about your condition and treatment options so that you can participate in the decisions concerning your treatment plan. This also will increase your chances of successful outcome.

Best wishes.

[CWilS7]

bump

[CWilS7]

Don't know if this makes a difference, but the S1 root impingement is "bilateral S1 root impingement."