How bad is it? What’s really going on? Diagnose me.?
A lil’ background: 39 yr old female. chronic back and neck pain for years, since 1991ish. Last 4 yrs: weak, tired, depression, elevated cholesterol, Osteoarthritis,menopause.
In Aug/2008 TSH was .61 & FSH @ 68.7f . Aug/2009 TSH is .27 ,T4 1.0. noduals on both sides of thyoid and goiter is present. Thyroid function at 24 hrs is 18.7%.Thyroid function of the lower aspet of normal.PCP wants me to take 25mcg of synthroid. Should I?
NOW on to the back:XRAY RESULTS>Straightening of the cervical curve, spondylosis abd invertebral disc space narowong at C5-C6: Thoracic spine=spondylosis of upper spine and cervical spondylosis. Lumbar=
5mm of posterior spondylolisthesis of L5 on S1. Marked invertebral disc space narrowing and endplate sclerosis at L-S1. Mild diffuse lumar spondylosis. Sclerosis of sacroiliac joits bilaterally.
MRI on lumbar= Conus is at L1. Impressions: Left lateral disc herniation at L4-L5 extending into the exit foramen and effacing the ventral aspect of the exiting left L4 nerve root causing left exit foramen stenosis. At L5-S1 one there is abnormal appearing signal in the adjacent vertabral body, possible degenerative arthritis change occasionally process as discitis can have similar appearance, should be correlated closely. At same level broad-based dsc bulging is present Mild bilateral exit foramen narrowing is seen.
I have been in PT for 5 wks. Helps some since I don’t have to roll of the side of bed to get up. Started steriod shots Fri and go back for 2 more w/in the next 4wks. The pain is bad and limits me to certain physical activities BUT I deal w/it and stay as active as I can.
Will I be able to avoid surgery? How “big is the hernated disc since it is hitting L4 nerve? I’ve read that it isn’t common for a disc at L4-L5 to affect L4 nerve. How fast will the osteoarthritis progress? Other than exersice, how else can I improve/slow down the process?
My right side is also affected: lumbar back, & shooting pain going up from rt scapula area to shoulder and my right hand goes cold,numb, and at times can’t pick a coffee cup.
can anyone help me interpret these MRI findings? And would disk replacement get rid of the pain?
Second MRI done Today
EXAMINATION: LUMBAR SPINE MRI WITHOUT INTRAVENOUS CONTRAST.
HISTORY: Lower back pain.
TECHNIQUE: Multiplanar MR imaging of the lumbar spine was
performed utilizing a 1.5 Tesla system. Sagittal and axial T1 and
T2 images obtained from the lower thoracic spine to below the
lumbar sacral junction.
The study is of good technical quality.
For the purposes of this dictation there are presumed to be five
lumbar vertebrae. Numbering is based upon the anatomic
configuration of the lumbosacral junction. Please correlate with
plain film radiographs prior to intervention.
Retroperitoneum: The visualized retroperitoneum is normal.
Vertebral bodies: Bone marrow signal intensity is normal.
Alignment is anatomic. There are no findings to support
spondylolisthesis or spondylolysis.
Conus: The conus terminates at T12. Visualized portions of the
cord demonstrate normal signal intensity.
L4/5: Mild settling of the disc in the sagittal plane with disc
desiccation. Shallow concentric disc Protrusion. Central/left
paracentral annular tear. The neuroforamina are patent.
L5/S1: Settling of the disc in the sagittal plane with disc
desiccation. Shallow central disc protrusion. No significant
encroachment on the thecal sac. Neural foramina are patent.
and this is the first one
LUMBAR SPINE MRI WITHOUT CONTRAST
HISTORY: Low back pain.
COMPARISON: Lumbar spine series, 29 January 2007.
TECHNIQUE: Examination was performed on a GE Signa EXCITE 1.5 Tesla
scanner. Sagittal T1, fast spin-echo T2 images were acquired through
the lumbar spine along with angled axial T2-weighted fast spin-echo
images through the disc spaces of L3-L4 through L5-S1.
FINDINGS: There is a transitional vertebral situation as there are 25
cervical/thoracic/lumbar segments on the scout images as opposed to
the usual 24. Hypoplastic ribs are noted on the inferior most
rib-bearing vertebra on the comparison plain films. For the purposes
of this interpretation, the inferior most lumbar-type segment will be
referred to as L5 and 13 rib-bearing vertebrae will be assumed.
Marrow signal of the bones imaged is normal without fractures,
contusions, or destructive lesions of bone. There is disc desiccation
at L4-L5 and L5-S1 and relative disc space narrowing at L5-S1
associated with endplate irregularity and mild signal dropout adjacent
to the endplates consistent with sclerosis with slight endplate
marginal spurring. There are several small endplate invaginations
(Schmorl’s nodes) at L2-L3 and L3-L4 not associated with adjacent
marrow edema. Alignment is normal without spondylolisthesis or focal
kyphosis of the lumbar segments. The central canal and neural foramina
are widely patent.
At L4-L5, there is broad posterior disc bulging that anatomically
appears to be inconsequential not resulting in significant central
canal or foraminal stenosis. There is, however, increased signal
amongst the posterior annulus fibrosis at L4-L5 suggestive of annular
tear which can be contributory to nonspecific back pain symptoms.
There is circumferential disc bulging at L5-S1 without significant
encroachment on the central canal, nerve roots, or neural foramina.
There is a focus of high signal amongst the anterior midline annulus
fibrosis at L5-S1 also suspicious for annular tear, again possibly
contributory to nonspecific back pain symptoms.
The conus terminates at the T13-L1 level. Portions of the cord imaged
are normal without masses, syrinx, or cord signal abnormality.
Incidentally noted on the scout images are wedge compression
deformities of T8 and T9 that morphologically are likely chronic
associated with endplate irregularity and are devoid of significant
adjacent marrow edema.
1. Degenerative disc disease changes at L4-L5 and L5-S1 with probable
annular tears at posterior midline L4-L5 and anterior midline L5-S1
which can be contributory to low back pain symptoms. No significant
disc herniations, central canal or foraminal stenoses.
2. Incidental note of wedge compression deformities of T8 and T9
demonstrated on the scout images (nondiagnostic sequence). Recommend
correlation with clinical history for thoracic spinal trauma and
review of systems for pain referrable to the thoracic spine. Recommend
correlation with plain films.
I’m not sure how much help I’ll be since I’m only a first-year pre-med student, but I’ve had my fair share of MRIs for hypermobility, instability, sacroiliac dysfunction and chronic pain. From the first one it sounded like you had mild bulging of discs at the L4 and L5. The desiccation is an early sign of disc degeneration. Have you been diagnosed with Degenerative Disc Disease? (DDD). My mom had her L3-L5 discs rupture due to DDD and ended up having partial discectomy on all three levels. That was probably 7 to 10 years ago, and I don’t really believe that it helped. She was a candidate for disc replacement, but it was still so new and in a trial state so she decided against it. It helps some people and does nothing for others. If your discs are slightly bulged now, they may correct themselves and never rupture. Or, they may get worse and rupture. That’s something only you doctor can help you predict.
Have you and your doctor talked about the artificial disc replacement? I don’t know much about disc surgery, but I wonder if you’re a candidate yet because there is only bulging. Of course, the annular tear makes it a whole different ball game.
The annular tear could definitely be causing a lot of the pain. If any of that nuclear fluid leaks out, it can cause major pain.
I don’t know how much help this is, but I hope that you find the best treatment from your issues so that you can live your life. I definitely recommend physical therapy no matter what you do. A strong back can prevent bulging and herniations in ways that nothing else can. Good luck
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