MRI results
 

Hi all. I am a 30 year old male in the us army. I am an infantryman and have been deployed to Afghanistan 3 times. I am in great shape and run on my own. I have been having back pain for 4 years after falling 30 feet down a mountain with full kit and roughly a 100 pound rucksack. I have severe pain just above both buttocks roughly 1 to 2 inches on either side of my L4-5 it is very sharp and sometimes burning. I have tingling in both feet and when I stand or sit for long periods of time my legs go numb. Occasionaly I have shooting pains down the right leg. I also have a severe pressure at the L4-5 area when standing up and bending over. I have just received a copy of my MRI and it states:

There is moderate loss of disc space height and disc hydration at L4-5 and L5-S1. Schmorl's nodes are seen at the T11-12 level and L1-2 through L3-4 levels inclusive. The marrow signal is within normal limits. Vertebral body height and alignment is within normal limits. There is no abnormal signal seen in the imaged portion of the spinal cord.

At the L1-2 level there is a slight broad based annular bulge. There is no disc herniation, foraminal narrowing, or central canal stenosis.
(same thing for L2-3, and L3-4)

At the L4-5 level there is a large broad based annular bulge with a central focus subligamentous disc protrusion. Within the base of the protruded disc there is a horizontal T2 hypersignal consistent with an annular rent. The disc protrusion causes a mild concave anterior deformity of the anterior thecal sac. Mild degenerative facet joint changes are seen bilaterally with mild thickening of the ligamentum flava and the factors in concert are causing mild to moderate bilateral foraminal narrowing and mild central canal stenosis. There is no acute disc extrusion.

At the L5-S1 level there is a large broad based annular bulge with a central disc protrusion. The discogenic changes cause moderate right foraminal narrowing and mild to moderate left foraminal narrowing. The protruded disc component causes a mild concave anterior deformity of the anterior thecal sac and contacts the right S1 nerve root displacing it posteriorly somewhat. There is no frank disc extrusion. There is no frank central canal stenosis.

Impression: Multilevel discogenic changes as described above.

So could someone please explain what this means to me. Thanks for your time.

Let me see if I can help:

At L4-5 and L5-S1 your discs are "closer together" and they are drying out. The Schmorl's node is a protrusion of an elastic pulpy mass in the center of each vertebra, it protrudes into the part of the bone made up of spongy bone.

At L1-2, L2-3, and L3-4 you have disc bulges with NO herniation.

At L4-5 you have a disc bulge with disc protrusion. The protrusion causes a deformity of the thecal sac which is a membrane of dura matter that surrounds the spinal cord. The thecal sac is filled with cerebral spinal fluid.
There are degenerative facet changes - the facets are those "wing-like" things that stick out on your spine on both sides, going down your back. Mild thickening of the ligamentum flava (series of ligaments of yellow elastic tissue connecting the laminae of adjacent vertebra from the axis to the sacrum) are causing mild to moderate foraminal narrowing & canal stenosis. Foraminal narrowing-- that's the hole where the nerves pass thru to the spinal cord. Canal stenosis -- that's where the spinal canal narrows.

At L5-S1 there is a disc bulge with central protrusion. The changes cause right foraminal narrowing and mild to moderate left foraminal narrowing. The protruded disc causes anterior deformity of the thecal sac and contacts the right S1 nerve root displacing it. (ouch!)


I hope this made SOME sense. If you have any more questions, let me know. God bless. Hugs, Lee

Thank you, it does help. I have an appt with a neurologist mid jan, so I'm trying to prepare myself beforehand with knowledge. I am in quite severe pain and am taking narcotics for it, however all these mild and moderate's are concerning to me. Is this basically like sorry your getting old type things? Does this look like surgery will be required, for any of these issues. After 4 years I don't think any of these problems will go away on their own, or is it more of a lets give you drugs till it gets worse. Thanks again for your time.

This is just my UNEDUCATED opinion, but I do not think you are a surgical candidate at this time. You don't have herniations - you have bulges. And I don't see anything that indicates that you have spinal cord impingement so it doesn't sound like an emergency. Believe me, you really do NOT want surgery. For one thing, surgery does NOT relieve pain. It only corrects mechanical problems. If you happen to get pain relief from surgery, it was just plain luck. Also, when you have spinal surgery on discs, the level above and/or below will fail because they're taking on more of the load due to the surgery -- you'll end up needing more surgery. It's a vicious cycle. I've had 2 open surgeries - not the micro-surgeries that they do now - and after those, the levels above failed and more surgery was needed. Now, I'm considered inoperable due to osteooporosis -- but my spine is a wreck, and I'm disabled.

Your best bet would be to get your opinion from the Neurosurgeon, but then get a referral to pain management. They can give you more options for pain relief. Surgery just isn't the answer. Not until or IF the spinal cord is impinged. Best of luck and God bless. Hugs, Lee

Hi Wreckhur,

Your MRI findings are significant. My guess is that with symptoms down your legs, you may have calf/leg weakness and clinically, reflex and sensory changes and possibly atrophy as well that likely correlate with your MRI findings.

The good news is, one cannot say with certainty whether or not someone is surgical or not by viewing MRI findings. Progression to surgery is more dependant upon your clinical findings (MRI is done to verify what one suspects on examination) so the choice of whether or not you need surgery is dependant upon how miserable you are, if you have exhausted all other conservative measures and it has been decided between you and your surgeon that surgery is likely to help you. With retrodisplacement of a nerve root, you are more likely than not to be a surgical candidate, but maybe not. You might be compensating well.

Because you have stated symptoms coming from two levels, talk to your doc about EMG/NCV and possibly a discogram, if you are contemplating surgery, to decide which level(s) is/are more symptomatic. Also, because you have mentioned that you have symptoms down both legs, if you have any bowel or bladder changes (weak stream, loss of control) then you need to speak with your doc yesterday.

Good luck!

Thank you
 

Thanks guys I really appreciate your help. I have been pretty nervous waiting to see neuro and its nice to have some idea of what I am walking into. Thank you again.