need help understanding MRI findings?

[TwinsMommma]

L4/5-there is desiccation of the disk and some minimal loss of disk height. There is mild broad-based disk bulging and mild bilateral recess narrowing. Early degenerative disk changes w/out impingement or significant stenosis. There is degenerative facet disease at L4/5 and L5/S1, moderate
what is the difference btw minimal concentric bulge (on older mri) and broad-based bulge? does it mean worse, or indifferent?  Why does the old mri report annular fissure and new one did not? is that assumed with this type of bulge or do radiologists report in a different way?  i was hoping this new mri which is a high tech machine would show more info of tear as i'm trying to avoid a discogram. will the dr be able to see on images?   why does old mri talk about ligamentum infolding but not new one?)
L5/S1-There is severe loss of disk height. There are discogenic changes of the endplates. There is a moderate sized circumferential disk bulge. There is mild central and bilateral lateral recess stenosis. There is moderate bilateral forminal stenosis, no definate impingement. There may be contact with the extraforaminal left L5 nerve root, correlate with symptoms
do these two statements mean the same or is the latter considered worsening? "Marked degeneration of the disk, with near complete loss of disk height" and " severe loss of disk height"      why is osteophytes mentioned in old mri but not new mri? does statement in new mri "discogenic changes of the endplate" refer to osteophytes?  the biggest thing i noticed is the new mri mentiones some stenosis and old one talks about narrowing...is that a sign of worsening or progression or is it again, radiologists reporting variations related?   could this be one of the reasons i don't have leg pain " no definate impingement"?   what do they mean by this "There may be contact with the extraforaminal left L5 nerve root seen on seires 7 image 29. correlate with symptoms"?  

[Abhijeet Ghosh]

Dear Friend,
Please find my answers -

1) what is the difference btw minimal concentric bulge (on older mri) and broad-based bulge?
                  Minimal bulge signifies that the early stages of disc arthritis has begun. However, it is not speeding up. Broad base bulge means that the speed has increased and the stage is of advanced arthritis, hence the disc erosion is more.
Normally the disc are convex glass shaped, hence the base is small. When the elasticity decreases, the base convexity goes off and the broad base appears.
Hence broad base is an advanced stage.

2) Why does the old mri report annular fissure and new one did not?
           The disc is held in it's place by the annular ligaments. In the initial stage of arthritis, the annular ligaments start to break up (called as annular fissure). In advanced stage (when the disc broadens up), the annular ligaments gets fully torn and sometimes shrinks up also. Hence fissuring is not seen.

3) is that assumed with this type of bulge or do radiologists report in a different way?
         Since the annular ligaments have completely torn, the fissuring part is not mentioned.
4) i was hoping this new mri which is a high tech machine would show more info of tear as i'm trying to avoid a discogram. will the dr be able to see on images?
              Experienced doctor and view that.

5) why does old mri talk about ligamentum infolding but not new one?
            That's again related to arthritis and type of tear in the annulus.

6)  why is osteophytes mentioned in old mri but not new mri? does statement in new mri "discogenic changes of the endplate" refer to osteophytes?
          More or less, one and the same thing.

7) the biggest thing i noticed is the new mri mentiones some stenosis and old one talks about narrowing...is that a sign of worsening or progression or is it again, radiologists reporting variations related?
           Stenosis and narrowing are both one and the same thing.

8) what do they mean by this "There may be contact with the extraforaminal left L5 nerve root seen on seires 7 image 29. correlate with symptoms"?
             In the Image 29, of series -7 of the MRI film, they noted that the L-5 Root is having a contact with the Extra-formaen. Since the radiologist has not examined you, he wanted your treating doctor, to co-relate the findings with your symptoms 9like leg weakness / numbness).

I hope my answers were clear.
Feel free to discuss more

[Abhijeet Ghosh]

Presently not possible

[TwinsMommma]

oh..by the way...is it possible to email or post an mri image for u to refer to..??

[TwinsMommma]

ok, well i understand there are many treatment options...that is easy to research...i was wanting your thoughts on the symptoms and questions mentioned above...can u give me your thoughts based on what i have mentioned...i'm in the process of educating myself on all my issues at every available angle...as u probally know...patients have a limited time to discuss everything with their dr's each appt and the appt's go by so quick your head is spinning sometimes leaving with more questions than answers and next thing u know your next appt is 2-3 weeks away...it's nobody's fault...but in btw appt's i want to gather info from other's whether patients have been thru similar stuff and experts like u offering their services via the web...
i can briefly summarize what previous surgeon said and current dr who is spine specialist
surgeon---need double fusion...but thinks too young...therefore, try facet injections and rhizotomy with goal trying to put off surgury long as possible
current dr---going in next week to review mri and begin medial nreve blk diagnostic for rhizotomy
-and i will be seeing rhematologist to rule out immune disease, hoefully rule-out
-my concern with rhizotomy being that it still leaves my spine unstable from DDD hence furthuring arthritis hence con't disk pain.
therefore, may i pick your brain...from what i have mentioned on this post and above post?
thank you sooo much for your quick responses...really appreciate u taking the time to help!!!

[Abhijeet Ghosh]

Have you undergone spinal physiotherapy, in order to strengthen up your spinal muscles as weakness of the muscles is one of the main cause of low back ache and hence you need to build up your spinal / back muscles, esp you are mother of twins so lifting them, taking their care must be putting a lot of pressure on your lower back.
Please consult a good physiotherapist, yo learn the exercises.
Please let me know the inputs provided by your treating doctor.
Regards

[TwinsMommma]

i had to edit a lot out in above post be/c minium characters allowed....u mentioned feel free to discuss more...hope u still mean that b/c lately i have been concerned about possible rheumatoidarthritis and/or ankloyding spondy. (sp?) i do have appt with rhem. dr soon...but in meantime....your thoughts???

INFO ABOUT MY SYMPTOMS/AGE/PREVIOUS TREATMENTS ETC.. THAT MIGHT BE HELPFUL
-my worse pain is in the morning when i wake up....i take my meds and get ready to feed twins and pain subsides a little...but soon as i begin my daily routine involving lifting, bending etc...by changing diapers, changing clothes, cleaning etc..etc..pain comes back and pretty much stays around til night time and start all over with severe morning pain, stiffness ...no matter how much or little i do the previous day...times of day when pain is really, really severe involves taking kids somewhere...where i am putting twin 2 year olds in and out car..etc....and times when i have to do the difficult cleaning mopping, vacuuming...LATELY... I HAVE BEEN CONCERNED WITH PAIN  NOT ONLY in lower back...but in mid-back, shoulder-neck soreness and hand pain, stiffness and mild swelling.
i have had 3 epidurals and one facet injection with opiates...the next move which is next week dr begins diagnostic medial nerve blocks for rhizotomy.
i'm 37 yrs old and have had lower back pain for about 10 yrs...at first my pain would be after strenous activity (i'm a tennis/golf player)....i would describe it more like discomfort and soreness in the beginning...rather than pain, pain that i deal with 24/7 these days...anyways....each year more discomfort, pain...past couple years since carrying the twins have had persistant severe pain induced with less and less activity.