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Reading this MRI of the lumbar spine: anyone here good at deciphering results?

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  • Reading this MRI of the lumbar spine: anyone here good at deciphering results?

    My 25 year old daughter has had back pain on and off for several years related to an injury. When she was an undergrad, she was lifting weights in her room when she did it: she was bending down and forward to drop a 15 lb. dumbbell and heard something "pop".

    Her pain hasn't been bad until recently, and she finally went in for an MRI. Here are the results:

    (The Dr. suspected a ruptured disk, gave her some meds and some gentle adjustments, but it looks a bit more complicated than that, she goes in next week to have the Dr. read it and discuss the findings with her.)

    EXAM: MR LUMBAR SPINE WITHOUT CONTRAST



    HISTORY: Back pain.



    PRIORS: None



    TECHNIQUE: 1.2 Tesla open MRI imaging performed. Nonenhanced Multiple pulse sequences, MRI of the lumbar spine, were obtained in the axial, coronal, and sagittal planes.



    FINDINGS: There is normal lumbar lordosis. The vertebral bodies are normal in height and configuration. There are no acute fractures.



    L1-L2: There is no evidence of disc herniation or bulge. There is no central spinal canal stenosis. There is no significant neural foraminal narrowing.



    L2-L3: There is no evidence of disc herniation or bulge. There is no central spinal canal stenosis. There is no significant neural foraminal narrowing.



    L3-L4: Degenerative facet changes with synovial effusions. Degenerated disc with central disc protrusion. Moderate central stenosis



    L4-L5: Facet degenerative changes with synovial effusions noted. Degenerated disc containing a moderately large central and left paracentral disc extrusion. This results in central stenosis and left subarticular recess stenosis.



    L5-S1: Mild degenerative facet changes. There is no evidence of disc herniation or bulge. There is no central spinal canal stenosis. There is no significant neural foraminal narrowing.



    The conus is normal in configuration and signal intensity ending at L1.



    IMPRESSION:

    1. L4/L5 degenerated disc with a large central/left paracentral disc extrusion. Disc causes central stenosis and left subarticular recess stenosis.

    2. L3/L4 degenerated disc with central disc protrusion and moderate central stenosis.

    TIA for any insights!!
    "Hope is a good thing, maybe the best of things, and no good thing ever dies."

    "It's supposed to be hard...the hard is what makes it great!" (Jimmy Dugan, "A League of Their Own")

  • #2
    Disclaimer - I am not a neurologist or other expert in this area. My problems have been cervical spine. This is what I remember from medical school....

    The spinal cord ends around T12-L1, where all of the nerves become discrete and form the cauda equina (really does look like a horse's tail). Discs can press on these nerves, and narrowing of the foramen where the nerves leave the spine also can cause pressure. Pressure can cause pain. However, this kind of pain is often perceived as originating in the area where the nerve ends, not just in the back. Back pain could be from the degenerative changes - she has effusions (abnormal production of fluid) in the joints in the back.

    I'll be interested in hearing what the doctor says. But back surgery is a LAST resort, PT is first, PT is second, and PT is third.

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    • #3
      I used to work in radiology, and we saw DDD (degenerative disc disease) all the time, especially in older patients or people in high impact sports. I attached some pictures that explains it pretty well. In basic language, her bulging discs are pressing on nerves, causing her to feel pain. I second and highly vouch for Physical Therapy as well, and sometimes steroid injections in the back can do wonders.

      (Also as a general rule, anything they find abnormal in exams are always included in that last "Impressions" list, so that's really the only thing you need to worry about.)

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      • #4
        Like the other posters said, the pain is likely coming from some compression of the nerves.

        However, some of it could be coming from her lumbar lordosis. Even in "normal" cases, if you're tired, or have been standing or sitting for prolonged periods it can aggravate the lower back. She likely has tight hips/hip flexors and weak glutes. PT will also help with this.

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        • #5
          1.2 tesla? I'd be curious to hear what the experts say, but what a weak MRI. You have some actionable findings here, which hopefully provide direction and relief, but if not, I'd personally pursue another exam in a 3 tesla machine.

          Comment


          • #6
            Agree with Simkie and a follow on with a surgeon, rather than a GP or Chiro.
            _\\]
            -- * > hoopoe
            Procrastinate NOW
            Introverted Since 1957

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            • Original Poster

              #7
              Thanks, everyone - she is going in to the Dr. this week to discuss the results, and I'm sure PT will be the first step.

              I have my own back issues and have been through a HUGE variety of treatments myself, including (but not limited to) facet injections and radiofrequency ablation, but despite my x-rays: two bulging disks and significant arthritis at L5/S1 (decades of riding), stenosis, etc. - the majority of my pain is muscular so I now get trigger point injections (and dry needling) for the tight, spasming muscles. I am also on Robaxin, use heat, a TENS unit, use a Theracane, etc.

              I did 9 months of PT and it was a game changer; the biggest revelation was that strengthening my core would be the most beneficial "treatment", so I have devoted my life to this (along with stretching, and an inversion table), and I do this every single day, several times a day. As a result, I am in pain but pretty functional (and very active, riding, competing, teaching), but it is a LOT of work and I am very diligent - at the gym 7 days a week.

              My daughter does work out regularly and is in pretty good shape, but stretching? Dedicated core work? Not so much.

              I'm sure the PT will bring that home with her

              What concerns me is that she just turned 25; I'm 62 and my back issues are degenerative and consistent with an active lifestyle, lots of riding and horse related wear and tear - and age.

              My poor daughter will have to live with this for a long, long time. Lucky for her she has a mom who can commiserate and help motivate her! (And I turned her onto the TENS unit, along with a supportive back brace for when she is doing something that will stress her back; and yes - I know that back braces should NOT be worn all the time because the back muscles will weaken and rely on the brace )

              I appreciate the input!!

              As for the MRI, it might have been weaker? because it was an open MRI - my daughter has a lot of anxiety and is claustrophobic - she would have freaked in the regular machine...
              Last edited by Dr. Doolittle; Aug. 18, 2019, 12:33 PM.
              "Hope is a good thing, maybe the best of things, and no good thing ever dies."

              "It's supposed to be hard...the hard is what makes it great!" (Jimmy Dugan, "A League of Their Own")

              Comment


              • #8
                Originally posted by Dr. Doolittle View Post
                As for the MRI, it might have been weaker? because it was an open MRI - my daughter has a lot of anxiety and is claustrophobic - she would have freaked in the regular machine...
                The report indicates 1.2 T, which is considered a “high-field” MRI. The open magnets have come a long way in terms of field strength and image quality from when they first came out (and honestly they were pretty good for some applications, like human spine and knees, “out of the box”). While I am not a radiologist for human patients, I do keep tabs on that field as there are a lot of crossover points with veterinary radiology, and as far as I know there are no major image-quality advantages for a closed MRI vs. an open for routine lumbar spine imaging in adult humans. I speculate that it might not have the resolution OOOMPH to get good images on, say, a parrot brain, but do not know that for a fact. We had a 3.0 T at UMN when I was there and we could literally see the semicircular canals in the ears of raptors.

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                • #9
                  That's interesting, Toblersmom. I'm not in medicine but have had a lot of imaging and haven't seen anything but 3T MRI equipment in the last...ten years? I don't do open machines, and am nearly always imaged in the hospital. For hips, 1.5T just doesn't cut it, so I always confirm my test is in a 3T machine.

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