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MRI results

I finally went to get my MRI last week. The preliminary results they gave me said I have bulging discs at T 4 and T5 with arthritis. I went to see my primary Dr and the results they gave her were different. It says, T1 and T2 weighted axial studies confirm a concave disc at L1-L2, L2-L4. The L4-L5 disc is slightly flattened. There are degenerative changes of the facet joint capsules producing a mild trefoil deformity against the thecal sac. The L5-S1 nerve roots are of equal size and signal. The sagittal images show no abnormal narrowing of the exiting keyholes.
I had the MRI done mainly because of side pain. I've always had back pain because of physical jobs throughout my life. It's just something I deal with and try not to think about too much.
Since I do have something going on with all of the lumbar discs, especially T1 and T2 being so close to my ribs and side I was wondering if this could be causing my pain.
My primary Dr did recommend another Dr who specializes in Physical Medicine. I wanted to ask my question here because it could take weeks to get in to see this specialist.
If anyone could help me understand these results I would great appreciate it.
Best Answer
7721494 tn?1431627964
While PT can help, I'd see the interventional spine and pain doctor first. If facet arthritis is a primary cause of pain and the nerve ablation can help you, then the PT will be more useful afterward -- helping your muscles to learn to relax again.

Actually, PT is recommended by some of the better pain docs after a medial-branch neurotomy. I folllowed this protocol after my first round of procedures and it accelerated my healing.
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Avatar universal
Really? I wonder why any Dr would do such a thing. Especially a back specialist. They have to know their patients are suffering. If they're not trained in pain management I would think they would recommend a pain specialist so the two could work together for the patient. Maybe finding a pain specialist is up to the patient though?
I know I'm one of the few very lucky people who has a primary Dr that understands pain and is willing to help as long as I need it.
I'm always learning something new from you. Thank you so much my friend.
Helpful - 0
7721494 tn?1431627964
One caution -- one of the professional neurology groups -- the American College of Neurology (or whatever they call themselves) came out last year with a public policy statement against the treatment of chronic pain with opioid analgesics.

Don't let this doc take you off the pain meds unless he removes all the pain. Most neurosurgeons are NOT trained in interventional pain medicine. Most osteopathic surgeons are NOT trained in interventional pain medicine.

So, remember caveat emptor -- let the buyer beware. Consider your first visit with this neurologist as an interview, with you as the employer. During the first meeting, bring your MRI reports and ask questions about how he/she treats, philosophy on use of medicine in pain care, whether or not they view the doctor/patient relationship as a partnership or an S/M relationship :#)

I'll be around... thanks for your well wishes.
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Avatar universal
You are such a wealth of knowledge. You're teaching me so many things I didn't know about.
I'm going to take your advice and hopefully be able to find a spine specialist soon. I've actually found one that looks interesting. He's a neurologist/spine specialist. I think I'm going to call his office this week to see about getting an appointment.
I can't thank you enough for all the time, help and knowledge you've given me.
Please let me know how your procedure goes. I'm praying that you get pain relief.
Thank you again my friend.  
Helpful - 0
7721494 tn?1431627964
Sorry, but it is impossible to tell if that mild spinal stenosis is causing your pain.

Remember, back pain can have multiple components.

I too have spinal stenosis and degenerative disc disease, but half of my back pain was coming from those facet joints.

A couple of months after my first round of medial-branch neurotomy procedures, my pain was reduced by 50% and I was able to cut my pain medication in half.

So, please explore this first.

OK, let's talk about spinal stenosis.

Pain from stenosis is treated in a number of ways. For people with severe stenosis, spine decompression surgery can be quite effective, but this surgery destroys bone and sinew, which can lead to scarring and exacerbation of pain in the future. Surgery can create an endless cycle of surgery.

ESI or epidural steroidal injection is a procedure with a 50/50 chance of pain reduction, but comes with its risks. It is a procedure no longer recommended by neurologists and some interventional pain medicine specialists, but it may be worth a try.

Two other advanced interventional treatments, to be used as final choices, also can help. The first is a spinal cord stimulator, and I believe you know about this. The other is an intrathecal infusion pump that is implanted and dispenses small amounts of opioids and other medications directly to the spine. If you become a candidate for a pain pump, I'd say -- go for it! I wish I could get one.

Best wishes, my friend. Find those answers!

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Avatar universal
My MRI results does say something about the thecal sacs but it says it's mild. Even if it's mild can it cause a great deal of pain? I'm just trying to find out why I'm having so much pain and what to do about it. Thank goodness you're here because I wasn't sure what to do next. Of course I'm taking your advice and have started my search for a spine specialist.
I also read about the nerve ablation you're getting ready to have. How many times have you had this done? To get any relief will be a wonderful thing so I'm hoping you do get at least 50% relief.
I'm sorry for all the questions so please let me know if I'm driving you crazy with them. My Dr talked about trying Gabapentin in a couple of months if I've gotten no relief from anything else in that time. You know I don't have insurance so I have to do things in steps. Can you tell me what your take is on this medication? She did explain that if we tried it we would have to start very slowly.
Thank you so much for being there and for answering all of my questions. I greatly appreciate it.
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Avatar universal
Thank you so much for getting back to me.
You're kidding?!!! Do you know I've been having this side pain since Jan of last year with no answers? I've talked to you in depth about the tests I've had several times before I had the MRI. I've had many and have spent an awful lot of money trying to find out why I'm having this pain.
See, this is why we need you here.
I've been thinking for awhile that it could be my back and I remember telling you that my primary and GI were beginning to agree with me.
No, I will not be having any surgery. And yes, I do have a lot of homework to do.
I'm going to research the procedure you're having done. I read that you were going to be having this done soon on your page and left you a message. I pray that it will give you relief because I know that you're going through a flare up right now.
Do you think it would help or be a waste of time to see the Physical Specialist my primary recommended? Or, should I go straight to a back specialist?
Thank you so much again my friend. I'm so glad we have you here at MH.
Helpful - 0
7721494 tn?1431627964
These are the 'degenerative changes' reported.

With degenerative disc disease, discs "deflate" meaning they lose some of their inner nucleus pulposis -- the jelly in the donut - that absorbs the shock from movement. The upper and lower faces of these affected vertebra supporting the diseased disc also undergo degenerative changes, mainly calcification. These changes can present that appearance noted on film by the radiologist.

There is also note of some foramenal narrowing in the lumbar area. This is the intervertebral space where the nerve roots exit the spine to innervate the pelvis and legs. They call this foraminal stenosis. The report does not give us the degree of narrowing, but simply notes its presence. This can be causing the "side pain."

But don't let this old sheep doctor diagnose your problem. Talk over your MRI with your spine specialist in detail. Write  down those questions and push for answers.

Study the anatomy of the lumbar spine, and read up on DDD from sites like spineuniverse.com or spine-health.com.

I also like the site of DrDillin.com, a So-Cal orthopedic surgeon who's site has excellent multimedia on spine conditions.

And try all modes of treatment before considering microdiscectomy. There is a facet joint arthritis (spondylosis) that can cause intense pain at specific levels. Your interventional pain doc can treat these facets w/o surgery and give you much pain relief. I am undergoing this same procedure on all of my lumbar facet joints next week, and when completed and healed (about two weeks post the procedure), my pain is 50% gone.

So, you've got your homework to do, old friend. Get to it

Best wishes.
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Avatar universal
Thank you so much for taking the time to read these results. I really do appreciate it.
I don't understand why the discs are slightly flattened. Is this something that's common? Will PT help to keep them from bulging?
Sorry about more questions.
Thank you again my friend.
Helpful - 0
7721494 tn?1431627964
Not a serious result, but the first word in DDD is degenerative.

PT is good. So are NSAIDs (take with food always).

An interventional pain doctor can help with the pain of those arthritic facet joints.

Best wishes, old friend.

-- phil
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