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Old 01-29-2014, 02:02 AM #1
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Default MRI Help needed.

Hi.

What a brilliant forum this is, I hope somebody will be able to help me with understanding my MRI results.

I've had lower back pain for approx 4 - 5 years, and it's really kicked in hard over the last 12 months. Walking for any length of time is difficilt along with the pain which radiates down my right leg, classic sciatica signs I'm told. My GP referred for Physiotherapy which over the course of 12 weeks didn't help much, if at all. Eventually I was sent for an MRI, the results of which are below:
  • There is degenerative disc disease with marked height reduction at L5/S1. A prominent posterior disco-vertebral protrusion at this level which is mildly indenting on both S1 roots.
  • The other disc heights and vertebral alignment are maintained.
  • Mild posterior degenerative disc bulge is seen at L4/5. Also at L4/5, there is a right-sided posterolateral disc protrusion with mild to moderate indentation of the right L4 root exiting canal.

My physio therapist suggests I should have surgery, as does my GP. I am being seen by a Neurologist in April, and have also been referred to a Neurosurgeon, still waiting for an appointment.

Obviously, understanding what the MRI says will help me somewhat to understand what the situation is before I seen any of the specialists and can make an informed decision on what to do.

Any help is extremely appreciated and I thank you in advance.

Kind regards

CookieRocks
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Old 01-29-2014, 09:52 AM #2
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Originally Posted by CookieRocks View Post
Hi.

What a brilliant forum this is, I hope somebody will be able to help me with understanding my MRI results.

I've had lower back pain for approx 4 - 5 years, and it's really kicked in hard over the last 12 months. Walking for any length of time is difficilt along with the pain which radiates down my right leg, classic sciatica signs I'm told. My GP referred for Physiotherapy which over the course of 12 weeks didn't help much, if at all. Eventually I was sent for an MRI, the results of which are below:
  • There is degenerative disc disease with marked height reduction at L5/S1. A prominent posterior disco-vertebral protrusion at this level which is mildly indenting on both S1 roots.
  • The other disc heights and vertebral alignment are maintained.
  • Mild posterior degenerative disc bulge is seen at L4/5. Also at L4/5, there is a right-sided posterolateral disc protrusion with mild to moderate indentation of the right L4 root exiting canal.

My physio therapist suggests I should have surgery, as does my GP. I am being seen by a Neurologist in April, and have also been referred to a Neurosurgeon, still waiting for an appointment.

Obviously, understanding what the MRI says will help me somewhat to understand what the situation is before I seen any of the specialists and can make an informed decision on what to do.

Any help is extremely appreciated and I thank you in advance.

Kind regards

CookieRocks
I'm sorry you are in pain and possibly facing surgery!

The pain running down your right leg - does this pain go down the back, front or side of your leg? Before I comment, that info would be helpful.
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Old 01-29-2014, 10:23 AM #3
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I'm sorry you are in pain and possibly facing surgery!

The pain running down your right leg - does this pain go down the back, front or side of your leg? Before I comment, that info would be helpful.
Hi zookester.

Thanks for your reply, the pain generally goes down the back of the leg, though at times it feels like its along the side as well. A mixture of numbness, pins and needles sort of feeling occurs too.
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Old 01-29-2014, 12:11 PM #4
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What a brilliant forum this is, I hope somebody will be able to help me with understanding my MRI results.

I've had lower back pain for approx 4 - 5 years, and it's really kicked in hard over the last 12 months. Walking for any length of time is difficilt along with the pain which radiates down my right leg, classic sciatica signs I'm told. My GP referred for Physiotherapy which over the course of 12 weeks didn't help much, if at all. Eventually I was sent for an MRI, the results of which are below:

• There is degenerative disc disease with marked height reduction at L5/S1. A prominent posterior disco-vertebral protrusion at this level which is mildly indenting on both S1 roots.

What this is saying is that you have degeneration of discs which is causing loss of height between the vertebrae and essentially squishing outwards toward either side of the vertebrae. This is causing the ‘indention’ or pressure on the S1 nerve roots. Degeneration is common and can be caused by the natural aging process, prior injuries, poor posture and even made worse by lack of exercise. Many people have degenerative disc disease and don’t even know it but because according to your MRI it is mildly pressing on the nerves this can cause pain.


• The other disc heights and vertebral alignment are maintained.
• Mild posterior degenerative disc bulge is seen at L4/5. Also at L4/5, there is a right-sided posterolateral disc protrusion with mild to moderate indentation of the right L4 root exiting canal.

This one indicates that the degenerative disc bulge is protruding more towards the backside of your spine (instead of outward or to the sides like above on S1) but, the disc height is not mentioned which indicates that as far as that is concerned there isn’t an issue. Then in goes on to say that actually the protrusion is posterolateral meaning backwards and to the side which is causing protrusion of the disc into the right side of the nerve root at L4. This along with your symptoms of right sided leg pain confirms that the pain is likely coming from the L4 nerve root.
From your description of symptoms down your leg it makes sense that you would have pain down the back and the side along with pin/needles/numbness on occasion. L4 is more likely your bigger pain trigger but, that isn’t to say that S1 doesn’t cause pain just that L4 is worse especially considering the S1 is bilateral (or both sides) but you are only commenting on the right which indicates that L4 is where one would focus first. An epidural steroid injection will likely be recommended as further confirmation that by releasing or temporarily medicating that nerve compression that your symptoms will improve or better yet disappear entirely. Some people get significant relief for many months with one or two injections, this is great because it will allow you to work diligently at improving posture, strengthen your back/core and start a regular walking (or other exercise program) daily before having surgery which will also improve your recovery time and give you the best chance of long term success with minimal surgical intervention.


My physio therapist suggests I should have surgery, as does my GP. I am being seen by a Neurologist in April, and have also been referred to a Neurosurgeon, still waiting for an appointment.
I am not a doctor but based on my own personal experience this would seem like a likely recommendation but, as always first try and exhaust all non-surgical interventions first and commit yourself to regular exercise to promote healing and less stress on the spine

Obviously, understanding what the MRI says will help me somewhat to understand what the situation is before I seen any of the specialists and can make an informed decision on what to do.
It does help to have a better understanding! I hope I was able to help you understand a little more. Wishing you a speedy recovery!!
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Old 01-29-2014, 01:00 PM #5
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Quote:
Originally Posted by zookester View Post
What a brilliant forum this is, I hope somebody will be able to help me with understanding my MRI results.

I've had lower back pain for approx 4 - 5 years, and it's really kicked in hard over the last 12 months. Walking for any length of time is difficilt along with the pain which radiates down my right leg, classic sciatica signs I'm told. My GP referred for Physiotherapy which over the course of 12 weeks didn't help much, if at all. Eventually I was sent for an MRI, the results of which are below:

• There is degenerative disc disease with marked height reduction at L5/S1. A prominent posterior disco-vertebral protrusion at this level which is mildly indenting on both S1 roots.

What this is saying is that you have degeneration of discs which is causing loss of height between the vertebrae and essentially squishing outwards toward either side of the vertebrae. This is causing the ‘indention’ or pressure on the S1 nerve roots. Degeneration is common and can be caused by the natural aging process, prior injuries, poor posture and even made worse by lack of exercise. Many people have degenerative disc disease and don’t even know it but because according to your MRI it is mildly pressing on the nerves this can cause pain.


• The other disc heights and vertebral alignment are maintained.
• Mild posterior degenerative disc bulge is seen at L4/5. Also at L4/5, there is a right-sided posterolateral disc protrusion with mild to moderate indentation of the right L4 root exiting canal.

This one indicates that the degenerative disc bulge is protruding more towards the backside of your spine (instead of outward or to the sides like above on S1) but, the disc height is not mentioned which indicates that as far as that is concerned there isn’t an issue. Then in goes on to say that actually the protrusion is posterolateral meaning backwards and to the side which is causing protrusion of the disc into the right side of the nerve root at L4. This along with your symptoms of right sided leg pain confirms that the pain is likely coming from the L4 nerve root.
From your description of symptoms down your leg it makes sense that you would have pain down the back and the side along with pin/needles/numbness on occasion. L4 is more likely your bigger pain trigger but, that isn’t to say that S1 doesn’t cause pain just that L4 is worse especially considering the S1 is bilateral (or both sides) but you are only commenting on the right which indicates that L4 is where one would focus first. An epidural steroid injection will likely be recommended as further confirmation that by releasing or temporarily medicating that nerve compression that your symptoms will improve or better yet disappear entirely. Some people get significant relief for many months with one or two injections, this is great because it will allow you to work diligently at improving posture, strengthen your back/core and start a regular walking (or other exercise program) daily before having surgery which will also improve your recovery time and give you the best chance of long term success with minimal surgical intervention.


My physio therapist suggests I should have surgery, as does my GP. I am being seen by a Neurologist in April, and have also been referred to a Neurosurgeon, still waiting for an appointment.
I am not a doctor but based on my own personal experience this would seem like a likely recommendation but, as always first try and exhaust all non-surgical interventions first and commit yourself to regular exercise to promote healing and less stress on the spine

Obviously, understanding what the MRI says will help me somewhat to understand what the situation is before I seen any of the specialists and can make an informed decision on what to do.
It does help to have a better understanding! I hope I was able to help you understand a little more. Wishing you a speedy recovery!!
Wow! I really appreciate that. Thank you very much.

I'm in two minds to be honest; on the one hand its been such a long term problem, understandably I'm quite annoyed with it all and would prefer a long term fix. All the PT that I've done hasn't really helped, at times I think its made it worse, even when I've continued the exercises given to me as often as I can. I've also tried acupuncture which although a temporary relief, its not something that I'd continue on a long term basis.

In regards to the injections, I'll be honest and say I'm not a big fan of corticosteriod injections. I've had it done before, for a different issue and it wasn't too comfortable nor did give sufficient relief to my shoulder, so I'd most likely avoid that option. I think I am probably talking myself into surgery, or at least it sounds that way.

Taking all this into account, and should it be decided that surgery is the route that is taken, what sort of surgery would be done? I've heard of Discectomy and Laminectomy, would either of these be the procedure done?

Sorry if I've swerved left field now, I guess there are just many questions that pop into my mind.. recovery period..

Once again many thanks for you help.
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Old 01-29-2014, 01:32 PM #6
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Originally Posted by CookieRocks View Post
Wow! I really appreciate that. Thank you very much.

I'm in two minds to be honest; on the one hand its been such a long term problem, understandably I'm quite annoyed with it all and would prefer a long term fix. All the PT that I've done hasn't really helped, at times I think its made it worse, even when I've continued the exercises given to me as often as I can. I've also tried acupuncture which although a temporary relief, its not something that I'd continue on a long term basis.

In regards to the injections, I'll be honest and say I'm not a big fan of corticosteriod injections. I've had it done before, for a different issue and it wasn't too comfortable nor did give sufficient relief to my shoulder, so I'd most likely avoid that option. I think I am probably talking myself into surgery, or at least it sounds that way.

Taking all this into account, and should it be decided that surgery is the route that is taken, what sort of surgery would be done? I've heard of Discectomy and Laminectomy, would either of these be the procedure done?

Sorry if I've swerved left field now, I guess there are just many questions that pop into my mind.. recovery period..

Once again many thanks for you help.
Trust me I get what you are saying!! Just keep an open mind with regard to injections. Especially when comparing a directed epidural injection vs. shoulder injection. The shoulder is much more difficult and that injections isn't going directly to the offending nerve root. Secondly along with the steroid they usually use something like lidocaine or marcaine that will or should give instant relief for a very short time (like between 15 min to at most a couple of hours) this even without the steroid should be a strong confirmation that surgical intervention is warranted and will likely prove successful. With the spine and multiple issues you want to do the least invasive procedure in the right area and sometimes because it is difficult to pinpoint where the pain is coming from these prior to surgery treatments are necessary to properly diagnose and treat. Especially when there is some overlap of symptoms. Like in your case issues with L4/5 and S1 overlap but that certainly doesn't mean both areas need surgery.. so it would be a prudent decision to allow all pre surgical treatment recommendations to confirm what should and should not be addressed. I hope that makes sense.

Let us know how it goes with your appointment. And remember that the diagnostic workup is done to help protect you from misdiagnosis or the oversight of something else causing your pain prior to undergoing risky surgery.
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Old 01-29-2014, 01:57 PM #7
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Default Hi Cookie Rocks

Welcome to Neuro Talk. Most of us came here for the same reasons...these not fun back issues. I am in no way a professional, just been here for a bit and had two spinal fusions myself.
Just a few impressions of your MRI. Most of the time if the language of the MRI says "Mild" or "moderate" the physicians try some alternative therapies before going into surgery. It is a great idea to go for another opinion or two.
You do have a mild compression or indenting on L 5-S1, on the roots. Any pressure at all on a root hurts. You also have that kind of mild compression on the L4 root. Again anything that presses on the root hurts.
Have you tried any therapies? Would like to know what you have tried so far. I know you have been in pain a long time. Anything like acupuncture?
Keep me posted on what the doctors say. Ginnie
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Old 06-16-2014, 09:12 AM #8
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Wow, it's been a fair few months since I posted here. Had other surgeries performed, so just slowly recovering from them. I finally saw a Neurosurgeon in the last week or so, had another MRI done and spoke to the consultant the very next day.

Quote:
Originally Posted by ginnie View Post
Welcome to Neuro Talk. Most of us came here for the same reasons...these not fun back issues. I am in no way a professional, just been here for a bit and had two spinal fusions myself.
Just a few impressions of your MRI. Most of the time if the language of the MRI says "Mild" or "moderate" the physicians try some alternative therapies before going into surgery. It is a great idea to go for another opinion or two.
You do have a mild compression or indenting on L 5-S1, on the roots. Any pressure at all on a root hurts. You also have that kind of mild compression on the L4 root. Again anything that presses on the root hurts.
Have you tried any therapies? Would like to know what you have tried so far. I know you have been in pain a long time. Anything like acupuncture?
Keep me posted on what the doctors say. Ginnie
Hi ginnie,

I've already tried other alternative non-surgical therapies, like physiotherapy and also acupuncture, neither of which really helped.

According to the new MRI scans, the consultant says I have two options. Either temporary injections, although they may work, they would only give me a maximum of 3, after which surgery would be the case. As I've mentioned already, I'm not at all keen on having the injections, so we've decided to go for surgery in August.

The consultant says they will perform something called a Spinal Fusion, which apparently is considered a 'Major Operation'. They will put in an artificial disc, if I understood it correctly, and then fix it with a metal plate. The very last disc is the problematic disc, and the one above it is 50/50, the rest of the discs are completely fine.

I've got actual digital copies of the MRI scan, which I will take to show another Neurosurgeon for a second opinion, but in the meantime, I've agreed with the consultant to do the surgery. Reading around online, the whole idea of a Spinal Fusion sounds a bit scary.

Am I worrying too much for nothing? Or are there any other options I should consider?

Any and all advice would be most appreciated.

Regards
CookieRocks
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