Hi,

I am in very much concerned and worried, after my mom is said to be suffering from pain due to disc herniation . She is suffering from pain at hip and in the leg. She is also experiencing weakness in thumb of the leg with pain. I am attaching the MRI photos and the report written by the docter. Please have a look through the MRI photos and then the report. And please explain and advice me what is the problem ? I am so worried .

Help would be really appreciated. Please help

Hi
I have removed your attachments as you first need to block out your mother's name and other personal info on them to protect her privacy, before posting them to a public forum.

MRI photos and report from the docter.

Attached Thumbnails

       

Hi ~ I'll try to help

At L4-5 a central and right paracentral disc herniation compressing the thecal sac. The thecal sac is a membrane of dura matter that surrounds the spinal cord and cauda equina and is filled with cerebral spinal fluid. The nerve roots are also being compressed.

There is rear migration of the disc seen up to the L5 level causing compression of right nerve roots.

Posterocentral disc herniation at L5-S1 compressing thecal sac (see above) and nerve roots.

There is evidence of disc dessication at L4-5 and L5-S1. Disc dessication means drying out of the discs. This is normal and happens with age --everyone gets it and there is no way to prevent it. When the discs dry out the tend to flatten, and that makes them bulge/herniate.

Loss of signal of nucleus pulposus - "signal" is the basis of activity in individual neurons, the measure of activity in nerve cells.

Marginal Osteophytes -- these are bone spurs.
Mild ligamentem flavum - this is an overgrowth of tissue
There is a "note" made of a lipoma, which is a tumor of fatty tissue, and it's on the "thread-like" portion of the spinal cord below the origin of the lumbar nerves.

I hope I've clarified things a little. This does NOT look like a surgical event to me, but you should have her take these films and have them seen by a NEUROSURGEON ONLY FOR AN OPINION. Do NOT jump into surgery. Like I said, I really don't think this is a surgical event. But if a Neurosurgeon DOES mention surgery, then get 2 MORE opinions from 2 different Neurosurgeons as you never take one doctors opinion, especially when dealing with your spine!!!

Also please know that spinal surgery is only for Mechanics. It is not for pain. Most of the time you're left with the same pain or worse. Then you have to deal with what is called the "Domino Effect" and that is where the levels above/below the surgery site fail! So then you need another surgery, and again, the levels above/below THAT surgery site fail. It's a vicious circle.

I wish you the very best. PLEASE let us know how your Mom makes out, will you? We'd really like to know. God bless and please take care. Hugs, Lee

I am very much thankful for your information. Could i ask you if you are a docter ?. And I was wondering why they have bold the words 'Note is made of lipoma of filum terminale' is it a very important/serious finding and the underlined canal diameter at disc level values Mainly at L4/L5: 08.8mm, L5/S1:07.4mm (how severe are these ? ).

And i will keep updated you on her progress. She is experiencing pains early morning when waking up. Also she is trying alternative therapies like homeopathy, acupuncture. I was researching online and lots of people have said surgery isn't the best option but the last option. I have also read about Mckenzies methods. I am telling her to do them exercises as physiotherapist in India ain't the best which makes me very worrying.

No sweetie, I'm NOT a doctor and I should have told you but forgot -- my bad. I usually say that when I help people with these, but I DID forget. I'm sorry. It's just that I've done loads of research during my 28 years of spinal problems and had to learn what all this was about. I wanted to be able to understand my OWN MRI"S, so I went to work learning! LOL

No the lipoma is not serious, as its just a fatty tumor. They might be concerned because it's close to the lumbar nerves. That's all I can think of.

They may have underlined the canal diameters due to them being slightly narrowed at those levels. It's not severe.

Acupuncture may well provide her with relief. If that doesn't work, I would suggest that she see a Pain Management doctor. They can do various procedures that could probably relieve her pain.

I wish you both the best -- and yes, please keep us posted. God bless and take care. Hugs, Lee

Very much useful knowledge you got. Thanks again. And god bless you and wish you best recovery in your problems

Moreover, anyone else please comment. It would be best for me to get maximum information.

Thanks

Hi,

There is a lot left unsaid. There is nothing known of her specific complaints and more importantly, her clinical findings (reflexes, sensory findings, motor grading, orthopedic tests, etc.). MRI's are ordered in this scenario to confirm diagnostic suspicion of "some" clinical entity or working diagnosis, based off of the chief complaints and objective findings (for which we know nothing about). MRI findings without knowledge of the reason and basis (exam findings) for which it was ordered are almost meaningless. Especially since only one image (a sagittal) was thumbnailed out of 50-60 (sagittals and axials both T1 and T2 weighted images) or so that were probably produced.

That said, based off of the report there are definitively problems at L4-L5 by way of disc hernia, extruded fragment with root compression. The statement about canal diameter could be important for her as a diameter of less than 10 or 12 mm or so is termed absolute stenosis which "may" label her as a likely surgical candidate. It really comes down to her clinical findings.

So while I agree with Leesa that surgery for only lower back pain might yield a lower success rate to reduce pain (exceptions of documented segmental instability, ominous origin and a few other reasons), if her predominant complaint is radiating pain into the buttocks, leg or foot, weakness, numbness or tingling of the same and/or combined with reflex, sensory changes, motor loss or tension signs (+ straight/well leg raise), then decompressive surgery has a much higher chance of reducing that kind of pain. Cauda equine syndrome, acute or progressive motor loss, loss of bowel or bladder control are potentially emergent, surgically,

I think mom really needs to check-in with an ortho/neurosurgeon for advice; good luck to mom!

Hi All,

Thanks for your blessings, help and support. My mom is recovering and feeling much better now.


Thank You Again


Shubh