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

Well...I have several herniated discs, and one with spinal cord compromise, and I have spondliosis. Had an EMG which showed polyneuropathy. Multitudes of opinions, and multitudes of answers...positive and negative. Some have said (with disdain) that I should NOT have the pain that I do...and some say YES!!! I'm positive that medecine is not as advanced as we might think it is. My pain is very, very severe....usually a 7 or 8...sometimes 9. When you find the right doctor, you will know it!!!

sallyb: Where are the herniations and what do you mean, "the cord is compromised". That's a pretty strong statement. AND, you have spondylolisthesis, which compromises the cord by stretching it.

To you I'll say what I said to Silverlady: Have you had flexion and extension films--xrays where you bend? They are important in determining how much slippage there is. I believe anything more than 3 mm compromises the cord.

Do you have spinal stenosis?

Do the levels of the herniations fit the pain distribution? Do you have any bowel/bladder problems? When you walk, do you find your legs get harder and harder to move? (Not that you tire, but that it begins to feel like you just can't make contact with them to get them to move).

You might want to google "cauda equina syndrome". It's a surgical emergency, and with so many things happening, it might be on the list.

Silverlady: I just now read that they twisted you when they took the xray. But they didn't bend you?

A sloppy reading of an mri doesn't mean the mri was blurry and can't be read well by someone concerned. So I don't think I'd leave them at home--I'd let Mayos' docs read them.

Were your facet injections done under fluoroscopy, so they really do know that they gott he facets?

Finally, you think you've got enough muscle in spasm to be pressing on nerves and causing the pain? If so, there's massage, as I've said somewhere else on teh board yesterday, afater my good massage experience. And also, that's when people say acupuncture helps. I've been hearing this a lot from patients and the alternative bodywork approach--that acupuncture helps with the muscles that have becoem rocklike. And someone told me that you can tell with one visit whether it's going to help, so you don't have to waste the effort of going for weeks and weeks before concluding it's a failure.

Acupuncture is an often over-looked asset to pain management.

And yeah, I should be asleep, but I'm insomniac tonight. It's 2 am, and I have work tomorrow. It's going to be hard.

I shouldn't even answer this, you should be in bed!!!

No they didn't bend me. I'll have to dig out the report of the old MRI. That's a good question. I don't know off hand if the old one diagnosed the spondosis, but I believe it did. So you think I should take the new MRI with me?

Yes they did the facets with a scope and I have to say that it did help. I've moved more freely today than I have in a while. The steriod is working. I've got a massage appointment on Tuesday. My husband thinks a weekly repeat for awhile might do me some good. The last one did let me sleep better for several days.

We don't have a good accupuncturist and a 50 mile drive negates the good it will do. I've tried it before.

But all in all, things are getting better, except for that dratted sit down nerve thing. I go to the pool tomorrow. That will be the real test of the injections.

Thanks,
Billye

Hey LizaJane. I answered your question by quoting Doctor Reports a couple of days ago...and then it disappeared into space! A lot of typing...but, I will try again.
****
Cervical Spine: (MRI 8/27/93) Straightening of normal lordotic curvature of the C-Spine. Heights well maintained. Posterior central herniation of C5-6 causing impression on ventral subarachnoid space. No evidence of cord impingement or foraminal compromise

(MRI 5/27/03) At the C5/6 level there is a small right paracentral disc protrusion with spondylosis causing right neural foramina stenosis. Also at the C6/7 level there is a central and right paracentral disc protrusion with spondlyosis causing right neural foramina stenosis. High T1 and T2 structure located at C5 vertebral body present consistent with a hemangioma.
***

Thoracic Spine: (MRI 8/27/93) Normal alignment...Disc space narrowing at
T1/2 level. Anterior marginal osteophytic spurring is noted as well. No herniation.

(MRI 8/7/02) Midline disc protrusion at T8/9 with contact and deformity of the thecal sac and spinal cord. Remainder of cord appears intact.

(Myelogram 12/12/02) Focal dorsal disc protrusion present at T8/9. Appears to be a small osteophyte along its superior aspect, suggesting previous study (??? What does that mean? What previous?) Peears to be an incidental vascular channel leading up tp the base of the osteophyte at an incidental finding. The results and intersect foramen as well as anterior cord displacement and mild deformity. Adequate CSF dorsal to the cord with overall mild spinal stenosis.

(Xray 4/4/06) A left curve of the thoracic spine. Minute anterolateral osteophytic formation, mid thoracic. No other significant osseous, joint, or soft tissue alteration apparent.
****

Lumbar Spine: (MRI 10/2/04) Incidental note is made of a Schmorl's node involving the superior endplate of T11. of no clinical significance. No significant abnormality.

(Xray 4/4/06) A left list of the lumbar spine is seen. Degeneration of the apophyseal joint is present at the mid and lower lumbar spine characterized by joint space narrowing, subchondral sclerosis and osteophytes. L5 pars appear sclerotic. Incidentally noted is a benign synovial herniation pit in the right femoral neck. Atherosclerotic calcific plaquing is present within the abdominal aorta. Facet arthrosis at the mid and lower lumbar spine.
****

EMG 1/5/04: Sensory studies reveal absent sensory evoked potentials. H-reflexes as well as F-waves are prolonged. There are polyphasic changes in the lunbosacral-innervated muscles affecting the L4 and to a lesser degree the L5 root bilaterally. Chronic Lumbosacral Radiculopathy. Polyneuropathy.
****
The major part of my pain is directly on the T8/9, and then I have deep pain all the way down to the top of my feet. My left leg has a deeper and harder pain than my left...along with muscle spasms. I also hurt very badly sitting down...don't know why. But, I also have Fibro, Osteoperosis, Rheumatoid Arthritis, and Osteoarthritis. Yes, I have problems with urination and also constipation. My only mobility problems are with chronic fatigue, stiffness, occasional dizziness and confusion. I do not remember any bending in any of the tests. It will be a while before I go back to a Neuro again. I am currently going to a new Rheumy who has run 16 blood tests, including for Addison's Disease. Will know more about my body in that direction next month unless they find Addison's or someother immediate problem.

I do not understand all of the medical terminology. I only understand that I hurt terribly. The Rheumy just changed my meds to 25mcg Fentanyl patches, and 60 mg Cymbalta. It is not helping much so far. She will probably increase doses on my appointment on 12/5/06...at least I hope so.
Anything you can tell me would be appreciated...........sally