[itsback]

Hi, I am new here and get really use your help. Maybe some of you have found yourself in a similar situation.
I think first, I would like to post the MRI report for my lumbar spine prepared by the Radiologist, as well as the findings from the EMG/NCS. I would like to get your opinions on these reports and then I will tell you what has been going on with the so called experts who can't seem to agree.

MRI report:
Clinical Indication: Disc herniation, sciatica.

Findings: The lumbar alignment is normal. There is no spondylotisthesis or vertebral body subluxation. There is anterior wedging og the L1 vertebral body with approximately 25% vertebral body height loss with discontinuity of the superior endplate. No surrounding edema is seen. Findings are consistent with an old vertebral body compression fracture. There are tiny anterior osteophytes throughout the lumbar spine. There is degenerative disc desiccation at the T12-L1 and L5-S1 levels. There is also intervertebral disc space narrowing at these levels. The remainder of the discs and disc heights are normal. There is facet arthropathy throughout the lumbar spine, most prominent in the lower lumbar region.
At the T12-L1 Leve, there is a 1mm broad-based disc bulge with ligamentum flavum thickening and facet arthropathy without spinal canal or neural foraminal stenosis.
At the L1-L2 level, there is a 1mm circumferential disc bulge with facet arthropathy and ligamentum flavum thickening without spinal canal or neural foraminal stenosis.
At the L2-L3 level, there is no disc herniation, spinal canal stenosis, or neural foraminal stenosis.
At the L3-L4 level, there is a 1 mm circumferential disc bulge with ligamentum flavum thickening and facet arthropathy. There is no spinal canal or neural foraminal stenosis.
At the L4-L5 level, there is no disc herniation. However, there is facet arthropathy and ligamentum flavum thickening without spinal canal stenosis. There is minimal right and mild left neural foraminal stenosis.
At the L5-S1 level, there is a 4mm broad-based disc bulge in the right foraminal region ligamentum flavum thickening and facet arthropathy. There is no spinal canal stenosis. However, there is moderate right neural foraminal stenosis. Mass effect on the exiting right L5 nerve root is seen. There is mild left neural foraminal stenosis.

The conus medullaris terminates at the L1 level. There is mild atrophy of the distal paraspinal muscles.

Impression:
1. Chronic L1 vertebral body compression fracture with approximately 25% height loss.
2 Mild to moderate degenerative disc disease, worse at the L5-S1 level as above.
3. L5-S1: 4mm broad-based disc bulge in the right foraminal region ligamentum flavum thickening and facet arthropathy. There is no spinal canal stenosis. However, there is moderate right neural foraminal stenosis. Mass effect on the exiting right L5 nerve root is seen. There is mild left neural foraminal stenosis.

EMG/Nerve Conduction Study
Tender over lumbar PSM at L4/5 and L5/S1 bilaterally. Limited lumbar AROM. Tender over buttock and greater trochanter bilaterally.

Neurological:
REFLEXES; Deep tendon reflexes depressed at knee and ankle symmetrically
SENSATION: Decreased sensation to pinprick at L4, L5, and S1 dermatomes
GAIT/STATION: Antalgic gait
RIGHT LOWER EXTREM: Muscle strength of the major groups is 4/5
LEFT LOWER EXTREM: Muscle strength of the major groups is 4/5
SPECIAL TESTS: PSLR bilaterally

I ama female in my 50s. I look forward to hearing your take on these reports. Then I will share with you what the specialist have had to say and hopefully get some advise. Thanks for your help!

[Kitt]

Welcome itsback.

Someone will be along to help.

[Jomar]

Well the thing that jumps out at me the most is in bold -

[3. L5-S1: 4mm broad-based disc bulge in the right foraminal region ligamentum flavum thickening and facet arthropathy. There is no spinal canal stenosis. However, there is moderate right neural foraminal stenosis. Mass effect on the exiting right L5 nerve root is seen. There is mild left neural foraminal stenosis.
]
That is the one place where there is noted nerve involvement.
Of course the other issues can still cause pain & symptoms.

[Dubious]

Originally Posted by itsback

Hi, I am new here and get really use your help. Maybe some of you have found yourself in a similar situation.
I think first, I would like to post the MRI report for my lumbar spine prepared by the Radiologist, as well as the findings from the EMG/NCS. I would like to get your opinions on these reports and then I will tell you what has been going on with the so called experts who can't seem to agree.

MRI report:
Clinical Indication: Disc herniation, sciatica.

Findings: The lumbar alignment is normal. There is no spondylotisthesis or vertebral body subluxation. There is anterior wedging og the L1 vertebral body with approximately 25% vertebral body height loss with discontinuity of the superior endplate. No surrounding edema is seen. Findings are consistent with an old vertebral body compression fracture. There are tiny anterior osteophytes throughout the lumbar spine. There is degenerative disc desiccation at the T12-L1 and L5-S1 levels. There is also intervertebral disc space narrowing at these levels. The remainder of the discs and disc heights are normal. There is facet arthropathy throughout the lumbar spine, most prominent in the lower lumbar region.
At the T12-L1 Leve, there is a 1mm broad-based disc bulge with ligamentum flavum thickening and facet arthropathy without spinal canal or neural foraminal stenosis.
At the L1-L2 level, there is a 1mm circumferential disc bulge with facet arthropathy and ligamentum flavum thickening without spinal canal or neural foraminal stenosis.
At the L2-L3 level, there is no disc herniation, spinal canal stenosis, or neural foraminal stenosis.
At the L3-L4 level, there is a 1 mm circumferential disc bulge with ligamentum flavum thickening and facet arthropathy. There is no spinal canal or neural foraminal stenosis.
At the L4-L5 level, there is no disc herniation. However, there is facet arthropathy and ligamentum flavum thickening without spinal canal stenosis. There is minimal right and mild left neural foraminal stenosis.
At the L5-S1 level, there is a 4mm broad-based disc bulge in the right foraminal region ligamentum flavum thickening and facet arthropathy. There is no spinal canal stenosis. However, there is moderate right neural foraminal stenosis. Mass effect on the exiting right L5 nerve root is seen. There is mild left neural foraminal stenosis.

The conus medullaris terminates at the L1 level. There is mild atrophy of the distal paraspinal muscles.

Impression:
1. Chronic L1 vertebral body compression fracture with approximately 25% height loss.
2 Mild to moderate degenerative disc disease, worse at the L5-S1 level as above.
3. L5-S1: 4mm broad-based disc bulge in the right foraminal region ligamentum flavum thickening and facet arthropathy. There is no spinal canal stenosis. However, there is moderate right neural foraminal stenosis. Mass effect on the exiting right L5 nerve root is seen. There is mild left neural foraminal stenosis.

EMG/Nerve Conduction Study
Tender over lumbar PSM at L4/5 and L5/S1 bilaterally. Limited lumbar AROM. Tender over buttock and greater trochanter bilaterally.

Neurological:
REFLEXES; Deep tendon reflexes depressed at knee and ankle symmetrically
SENSATION: Decreased sensation to pinprick at L4, L5, and S1 dermatomes
GAIT/STATION: Antalgic gait
RIGHT LOWER EXTREM: Muscle strength of the major groups is 4/5
LEFT LOWER EXTREM: Muscle strength of the major groups is 4/5
SPECIAL TESTS: PSLR bilaterally

I am a 59 year old female who works full time. I look forward to hearing your take on these reports. Then I will share with you what the specialist have had to say and hopefully get some advise. Thanks for your help!

Hi,

Your EMG/NCV report is confusing as it does not read like a typical report would. And your clinical motor findings are also somewhat conflicted, for that matter all of your neurological findings are a little too vague. What type of doc wrote those? MRI is suggestive for right L5 and possibly S1 root entrapment. Anyway, talk to your doc about ESI. May solve your situation!

[itsback]

Originally Posted by Dubious

Hi,

Your EMG/NCV report is confusing as it does not read like a typical report would. And your clinical motor findings are also somewhat conflicted, for that matter all of your neurological findings are a little too vague. What type of doc wrote those? MRI is suggestive for right L5 and possibly S1 root entrapment. Anyway, talk to your doc about ESI. May solve your situation!

Could you please explain the conflict that you see on the report? The test was conducted by a Spine & Muscle/Joint Specialist who completed his training in Physical Medicine and Rehabilitation with a subspecialty in Spine & Musculoskeletal Medicine and Pain Medicine. I have been seeing him for a few months now.
I have received a round of steroid epidural injections from him using Fluoroscopy. It helped some but not that much. I would say it reduced my pain by about 30%. He is trained in acupuncture so I have gotten a couple of treatments from him. He prescribed specially compounded nerve/pain cream for me, but it is very expensive and my insurance doesn't cover it. I am not sure if it really works or not either.

[itsback]

Originally Posted by Jo*mar

Well the thing that jumps out at me the most is in bold -

[3. L5-S1: 4mm broad-based disc bulge in the right foraminal region ligamentum flavum thickening and facet arthropathy. There is no spinal canal stenosis. However, there is moderate right neural foraminal stenosis. Mass effect on the exiting right L5 nerve root is seen. There is mild left neural foraminal stenosis.
]
That is the one place where there is noted nerve involvement.
Of course the other issues can still cause pain & symptoms.

Okay, let me give you some more details about my situation.


The doc ordered my first MRI for me and thats when I found out that I had a bulging disc at L5. That is what was causing the pain and numbness in my leg. All of these back problems happened within a period of 2-3 months...the first time.
I was off from work for 3 months because of the fracture and did physical therapy to regain my strength and to try and repair the bulging disc. The doctor said that the pain and numbness would go away. It never did.

So I have been dealing with the pain and numbness in my leg and back pain for four year A few months ago, I was rear ended. The car behind me pushed my car into the car in front of me. My car was totaled. There was hardly a mark on the car in front of me or the one in back of me.
After I was in the auto accident, the pain and numbness went to both sides, but is worse on my right side. It goes all the way down to my foot. There have been times that I can't sleep and have woken myself up moaning in pain. The pain/numbness/burning comes from my back, down my leg, into my calves and into my foot. It is really bad in my right big toe at times. I have numbness on the bottom of my foot.


So that is my history. Here is what is happening now.
The MRI was done 2 months after the accident. My insurance company would not pay for it because I had just had an MRI done. I paid for it myself but went to the same place I always go to. The Spine/Rehab doctor I have been seeing requested the MRI.

Immediately after the accident, I went to my old doctor who is an orthopedic surgeon. He seemed like he didn't want to have much to do with it because it was an auto accident. I went to my primary care who referred me to the Spine/Rehab doctor. I read his reviews and most people really like him. I have been receiving the treatment from him that I posted in an earlier post.
When the Spine/Rehab doc was doing my EMG/NCS, he said to me that he was referring me to a neurosurgeon to talk to him about shaving the disc down. One reason I went to this guy is because he specializes in fixing backs without surgery.

The visit with the Neurosurgeon was one of the worst doctors visits I have ever had in my life! He totally ignored the report from the Radiologist who had reviewed my MRI. He first sent a resident in to talk to me. The resident said that the bulge was only 1mm and that I couldn't possibly be having the symptoms that I'm having. I asked why would the Radiologist say it was 4mm. He said he didn't know, maybe it was the angle he was reading it from. He kept insisting that the majority of people would not be having my symptoms with my MRI.
I asked him, so what are you saying that its all in my head? He said no but...
Then the "Real Neurosurgeon" came in. He had the I'm the doctor attitude and only my opinion counts.
They had asked me to send in my written MRI reports and my EMG/NCS reports before I ever made the appointment. They were supposed to have had them on hand. They did not. I had brought copies of the reports myself.
This Neurosurgeon said what the resident said. That it was impossible for me to have these symptoms based on my MRI.
He totally discounted the report from the Radiologist who read my MRI. He was adamant that there wasn't much going on with me. I brought to his attention that the EMG/NCS indicated that there also was something going on. He said Oh that! Thats hardly anything. Then he said that I should continue with conservative treatment at the pain management center, physical therapy, etc.
I don't care that he doesn't think that I need surgery. YaY! But don't try to say that there is nothing going on with my body. The MRI and EMG/NCS were done after and confirmed my symptoms.


I just want relief. I had resigned myself to the fact that I would always have pain and numbness in my leg. But since the accident, life has been hell. I am really struggling with my daily life...chronic pain is very wearing...

So to recap.
Injured back in 2009...was treated, didn't fully recover
Was injured again in April 2014
Have been treated by Spine specialist with
Epidural steroid injections
2 courses of oral steroids
pain meds, anti inflammatory, muscle relaxants...
Physical Therapy
Acupuncture

Sorry for the long post...

[Jomar]

I'm not clear on the time frame -
was the MRI showing the " Mass effect on the exiting right L5 nerve root " before or after the car accident?

Did you file a claim against the driver that rear ended you?
for injury or aggravation of old injuries..?


I would go to a doc outside of your employment circle.

[itsback]

[QUOTE=Jo*mar;1099313]I'm not clear on the time frame -
was the MRI showing the " Mass effect on the exiting right L5 nerve root " before or after the car accident?

Did you file a claim against the driver that rear ended you?
for injury or aggravation of old injuries..?



This MRI was after the car accident.

Yes, I have filed a claim.

[Jomar]

You may want to edit any personal/employer details that may come into play in the claim. Sometimes they dig and try to match up info online if a case becomes costly.

[Dubious]

Originally Posted by itsback

Could you please explain the conflict that you see on the report? The test was conducted by a Spine & Muscle/Joint Specialist who completed his training in Physical Medicine and Rehabilitation with a subspecialty in Spine & Musculoskeletal Medicine and Pain Medicine. I have been seeing him for a few months now.
I have received a round of steroid epidural injections from him using Fluoroscopy. It helped some but not that much. I would say it reduced my pain by about 30%. He is trained in acupuncture so I have gotten a couple of treatments from him. He prescribed specially compounded nerve/pain cream for me, but it is very expensive and my insurance doesn't cover it. I am not sure if it really works or not either.

Sure, here is what you wrote:

"EMG/Nerve Conduction Study
Tender over lumbar PSM at L4/5 and L5/S1 bilaterally. Limited lumbar AROM. Tender over buttock and greater trochanter bilaterally."

Respectfully, those read like clinical findings from a physical exam. EMG reports are normally written so as to discuss various wave types, needle insertional abnormalities, etc., over tested muscles and whether or not those findings are abnormal. NCV reports discuss velocity of peripheral nerve transmission usually compared to the contralateral side and whether or not there is slowing of conduction. None of it reads like a typical EMG/NCV report. Sorry! I am not implying anything at all, and am sure that your statements about efficatous treatments are true. Rather just a simple direct statement that your EMG/NCV report does not read like a conventional report or offer anything that such a report would afford (at least so far as you have offered). Can't offer advice that you seek about opinions not supplied!