I have been suffering with my back and sacroiliac joints for a long time. I have diagnosed Sjogrens Syndrome and Seronegative Spondylarthropathy. I suffer with major pain on the left side and walk with a limp. I just had an MRI of the sacroilliac joints that said the "sacroiliac joints are patent. No sacral nerve root lesions or masses are appreciated. There is no visible presacral soft tissue mass." Impression was : Normal MRI of the sacrum. and.....

MRI of the lumbar and sacral spine: "L4-5Small 1-2 mm posterolateral bulges which do not enhance are present within each posterolateral region: however, they do not cause significant canal stenosis or neural foraminal encroachment. L5-S1: A 4mm paracentral disk protrusion with mild central canal stenosis and probable right S1 nerve root impingement."

Now from this, I'm getting...no real problem. I don't understand. Can anyone enlighten me?

Billye

Silverlady, I know you were hoping there'd be something totally definitive on your MRI, and this doesn't supply you with that answer, so it's not great news to you. However, let's break it down, because I think there is some real information embedded in here:

sacroiliac joints are patent. No sacral nerve root lesions or masses are appreciated. There is no visible presacral soft tissue mass." Impression was : Normal MRI of the sacrum. and.....
Okay, your sacrum is fine.

MRI of the lumbar and sacral spine: "L4-5Small 1-2 mm posterolateral bulges which do not enhance are present within each posterolateral region: however, they do not cause significant canal stenosis or neural foraminal encroachment.
So this part, about the sacrum itself says you've got a couple of bulges (are you over 40? we all have a couple of bulges) but they are not pushing on the nerves running up and down (no stenosis) and not pushing on nerves coming out (foraminal encroachment)

L5-S1: A 4mm paracentral disk protrusion with mild central canal stenosis and probable right S1 nerve root impingement."
This level might explain your pain. There's a disk pushing into the spinal canal which is pushing against the nerves running up and down (spinal stenosis), but they think the pressure is "mild". It looks like a disk is pressing on the S1 nerve coming out. S1 supplies numerous muscles including the gastrocnemius, gluteus maximus, and semimembranosus. It supplies sensation to the butt, and lateral foot (the part with the little toe).

So, what might the doctors do to see if your pain is from S1? Well, they might do an EMG to see if it's abnormal in the S1 distribution. Or, they could do a transforaminal epidural and shoot a bit of salt water onto S1 to see if it produces symptoms which are the same as the pain you have. I'm not sure what else they might do; perhaps others here do.

Did they do bending xrays to see if you have spondylolisthesis? That's when vertebrae, because of arthritis, slip out of position when you bend. The spinal cord doesn't have much "give" in it, so if a vertebrae slips forward, it pulls the cord tight, and that, over time, damages nerves and gives symptoms that are identical with peripheral neuropathy? I'd suggest you google on "cauda equina syndrome" and see if you have symptoms of this. (I had a spinal cyst, due to spondylolisthesis, and symptoms of both peripheral neuropathy and cauda equina syndrome, and was treated as if I had "sciatica" for over a year before the diagnosis was made.)

So, I know you were hoping for something more definitive, but I do think there is the possibility here that this disk is giving you symptoms. And that would be a fairly simple thing for treatment.

Here's a link on symptoms of S1 radiculopathy. You might want to compare yourself with them.
http://www.thamburaj.com/lumbar_disc_prolapse.htm

Here's spinal stenosis: http://www.spine-health.com/topics/c...is/sten01.html

Here's an animation of spondylolisthesis :


http://72.14.209.104/search?q=cache:...s&ct=clnk&cd=3

and something about it: http://www.spine-health.com/topics/c...d/degen01.html

There's no mention of your lumbar spine here....did they really only just look at the sacrum? I mean, if you're getting an MRI, why not just look around the entire area? Nothing on the lumbar spine at all?

If you haven't had lumbar spine films done lately, you might ask for them, with the bending films to look for spondylolisthesis.

Hope this helps; I think there might be folk on this board who know more about spinal issues than I do.

LizaJane
www.lizajane.org

LizaJane,

Thank you for explaining the L5/S1! You hit the nail on the head as far as my symptoms go! On my MRI you can see the L5/S1 lying against or pressing against a nerve root. However, my MRI report ONLY speaks of facet degeneration; pretty bad on the left and mild on the right. The pain refers exactly to where you speak of; including the outer part of my feet and ankles.

What I was THRILLED to read was that you said it will mimic peripheral neuropathy. My neurologist has run a billion tests not once, but twice. The final diagnosis was idiopathic PN...which means of course; all tests negative but they don't know what caused it. She also told me it barely showed up on the EMG and QSART. So, all of this time I thought I had PN! And I thought this because I had a fusion in my neck in 2004. Six months after that fusion I had burning in my hands and feet. BUT my C5/C6 was bad too until just recently when I had it fused. Well, guess what? The PN is gone in my hands...totally. It remains in my feet but just a little. The bottom line is...instead of PN I really now believe that all of this was simply radiculopathy! I can't understand why nerve root impingement wouldn't have shown up on an EMG but it didn't. In the meantime I have also seen a podiatrist just to have him check on my orthotics. The first thing he asked, and he was a new guy I just got, was, "Do you have a pinched nerve or problem with your L5 or S1?" I had not said a word until he examined me. It was amazing! I guess he could tell by my reflexes. He told me he didn't think I had PN at all but radiculopathy instead. So, I am so hoping this is the case. I know that must sound crazy. But with idiopathic PN it was worrying me to death! Now, it seems I have an answer to what is really going on. Oh, and I also have a rectocele. So, sometimes it is difficult to determine what is what.

I see my Neurologist today and I am going to mention this to her as well as to take my lumbar MRI report.

Thanks again for clearing this up for me anyway!

Liza Jane,
I had the preceding MRI of the lumbar spine in Dallas in Jan. The Impression from it was: Shallow bulge L5-S1, Facet degenerative changes L5-S1 with Grade 1 spondylolisthesis at L5-S1.

The x-rays done in Feb of the lumbar spine were done at the facility here (same place where the MRI I am questioning is) say:
There is generalized osteopenia. This can be associated with an inflammatory arthrides like rheumatoid arthritis. Intervertebral disk degenerative changes are present at T12-L1, L1-2 and L5-S1. There is also extensive facet hypertrophy at L3-4 through L5-S1 most pronounced at
L5-S1. If there is clinical concern for underlying disk herniation, canal stenosis or neural foraminal encroachment, MRI is recommended, specifically to evaluate T12-L1, L1-2 and L5-S1.

If they had this x-ray information, why doesn't the MRI make notes of all this damage? Is there a reason not to?

Billye

Liza Jane,
I had the preceding MRI of the lumbar spine in Dallas in Jan. The Impression from it was: Shallow bulge L5-S1, Facet degenerative changes L5-S1 with Grade 1 spondylolisthesis at L5-S1. This is important. YOu had spondylolithesis on films where you weren't even bending. Spondylolithesis irritates the nerves going down because they are stretched.

The x-rays done in Feb of the lumbar spine were done at the facility here (same place where the MRI I am questioning is) say:Were these xrays done with you BENDING?
There is generalized osteopenia. This can be associated with an inflammatory arthrides like rheumatoid arthritis. Intervertebral disk degenerative changes are present at T12-L1, L1-2 and L5-S1. There is also extensive facet hypertrophy at L3-4 through L5-S1 most pronounced at
L5-S1. This is confirmed by your mri, in as much as this is where you have nerve impingement. If there is clinical concern for underlying disk herniation, canal stenosis or neural foraminal encroachment, MRI is recommended, specifically to evaluate T12-L1, L1-2 and L5-S1.Were these done? There is concern, and athey should have been done.

If they had this x-ray information, why doesn't the MRI make notes of all this damage? Is there a reason not to? Seems the Mri was only very limited of the sacrum. And not all readings are well done. I've read the sloppiest reports on my mris from the doctrs at the place that does them. Then I've brought them to radiolgoists at the hospital who re-read them, with much clearer more detailed reports.

Billye

Hope I can do this. I'm not a computer whiz.

" The x-rays done in Feb of the lumbar spine were done at the facility here (same place where the MRI I am questioning is) say: Were these xrays done with you BENDING?" These xrays were done with me on a table but I was twisted (knee accross to the opposite side each time).

" Were these done? There is concern, and athey should have been done." NO, not until this one I just had done.

I agree with your statement about sloppy work. I've decided I won't take these films to Mayo. I think it will leave a lot out. I have already sent them the last x-rays.

Yesterday I got 3 facet injections and they were at the correct levels. I don't think the doctor even looked at the new MRI results. He was looking at the x-rays. It hasn't reduced the nerve pain at all but it was easier to bend and to sit down after the lidocaine took effect. Maybe the steriod will help for a longer period of time, but I'm not optomistic because the methotrexate and Humira haven't helped either.

Thanks for your time.
Billye