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Thread: Please help interpret MRI images & report L5-S1 large Central Disc Herniation

  1. #1
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    western massachusetts
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    Please help interpret MRI images & report L5-S1 large Central Disc Herniation

    I have a "moderately large" central disc herniation at L5-S1 and had a CAT Scan and MRI with similar but slightly different reports, just diagnosed about a month ago, subsequent to a bicycle-meets-pothole accident 8 months ago where I fractured/shattered my Pelvis (but didn't need surgery for the pelvis fracture)

    I was sent to a NeuroSurgeon out of town (since the local one was too backed up to get an appointment) last week who offered to do the MicroDiscectomy surgery on me and told me to come back when I decide that I want the surgery, and no ttme to ask questions about my condition. I really dont want surgery. Now I am waiting to get an appointment with a Neurologist, so I'm trying to find out as much as I can in the meantime. My primary care doctor still wanted me to go to the local NeuroSurgeon for a second opinion and further guidance on treatment, but I was told that they dont do "second opinions", so now I'm stuck going out of town if I ever need to see a NeuroSurgeon for this problem. (huh?, doesnt seem fair!) but oh well, I can go to Boston if I really need a NeuroSurgeon, which is probably better if it really does come to me REALLY needing (or choosing) to get spinal surgery.

    I have a referral for Physical Therapy from my primary care doctor, but noone wants to touch me without a written "treatment plan" once I tell them what my diagnosis is (which is just based on the MRI-report so far). I live in a small city with a shortage of doctors and therapists from what I can tell, (but it's only three hours from Boston) so it's taking forever to get appointments and get the process started.

    I put a few of my MRI images in my profile, and if someone wants to see them all, just email and I will give you the link to my album on Photobucket.

    My MRI report said this -----

    Findings:
    Alignment is normal. Vertebral body height is maintained. Decrease
    disc space height is seen at L5-S1.

    There is a moderate central herniation of the L5-S1 disc lateralizing
    slight to the left probably deforming the thecal sac. The foramina
    are adequate.

    L4-L5, L3-L4 and L2-L3 levels are normal.

    Impression:
    A significant moderate central herniation of the L5-S1 disc
    lateralizing slightly to the left deforming the thecal sac.

    ==============================================

    The CAT scan report said this:

    CT SCAN OF THE LUMBAR SPINE.

    Findings:
    Alignment is normal and height of the vertebral bodies is maintained.
    There is narrowing of the disc space at L5-S1.

    L1-L2, L2-L3 and L3-L4 are normal.

    At L4-L5, there is mild circumferential broad-based disc bulging with
    slight flattening of the ventral aspect of the thecal sac but no
    significant focal deviation or spinal stenosis.

    At the L5-S1 level, there is a moderately large left paramedian disc
    herniation. This results in significant deformity of the thecal sac
    and the left S1 nerve root.

    Mild facet degenerative changes are present and there is a minimal
    scoliosis with convexity to the right at the thoracolumbar junction.

    Impression:
    Moderately large left paramedian disc herniation at L5-S1.

    ==================================================


    I would appreciate any and all help interpreting the images, since the MRI and CAT Scan reports really didnt get into much detail that I often see on other readings/reports... and advice about therapies for treating my kind of disc herniation. I am a 50 year old mother of seven with mild osteoporosis, and still recovering from a Pelvic Fracture as well as dealing with these herniated and bulging discs. LOW BACK PAIN is my biggest problem.

    Thanks for being here!

    - Maggie

  2. #2
    You need to see the physician who ordered the MRI and have them interpret the films for you. We cannot make a diagnosis via the internet, nor recommend therapy. It would be unethical for us, and unwise for you to take any such advice offered based only on a MRI or the written report.

    (KLD)

  3. #3
    I agree with KLD about taking your results and scans back to the doc who ordered them *only if* that doc is a neurosurgeon. If not, get your test reports and CDs of your MRI and CT results and get to a neurosurgeon ASAP, even if it means going in to Boston.

    Don't bother seeing a Neurologist -- given the test results, it will more than likely be an expensive waste of time and leave you with nothing more than advice to see a neurosurgeon.

    Both reports indicate that your problematic discs are "impinging on" and even "deforming" the thecal sac, which is the membrane that surrounds your spinal cord. This could end up causing temporary or permanent damage to your spinal cord if left alone, so seeing a neurosurgeon as soon as you can about what this means and what options you have is in your best interest.

    Might I ask what prompted you to get these scans run in the first place -- back pain? Other symptoms?

    Best wishes in finding a great neurosurgeon and getting an appointent as soon as you're able. If you need help locating one in your area, there's a search engine through which you can find board certified docs in any specialty near where you are. Once you register for the site (required), just click on the SEARCH option on the toolbar located toward the upper right corner of the page and select 'search by specialty and location.'

    Good luck!

    Disclaimer: I am not a medical professional, just someone who has been dealing with spinal cord damage, MRIs, and neurosurgeons for decades.
    It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.

    ~Julius Caesar


  4. #4
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    L5-S1 large central herniation distorting the thecal-sac

    Thanks for the responses. I had a bicycle accident last Ocotober where I fractured my Pelvis after getting thrown over the handlebars when my front wheel got trapped in a pothole. The CAT scan they did at the Emergency Room showed multiple "comminuted" (which means crushed or shattered) regions of non-displaced fractures, so it didnt need surgery, it just hurt like I was burning in hell.

    I was in severe pain long after the orthopaedist declered my pelvis as "healing fine", and eventually I got REALLY frustrated by the pain and the way the physical therapy for my pelvis was making my pain get worse instead of better... and when my therapist told me that he didn't "understand" my low-back pain and that he had never in his 25 years of being a physical therapist had he heard of or treated anyone who found it painful to lie down flat on their back with their legs straight... which pissed me off enough to go back to my primary care doctor who believed me enough to send me for a CAT scan and then an MRI.

    Once the CAT and MRI showed this large herniation, my primary care doctor referred me to a NeuroSurgeon, but there is only one here at the local hospital, and they are so backed-up I cant even get an appointment, so she wanted to send me to the Emergency Room to get it looked at quicly, but they told her that they would just send me out of town anyhow, so I got sent out of town and got squeezed in for a quick appointment and only had to wait another week (which by then was almost a month after the MRI) , but then I only got a 4-minute appointment where it was just a quick evaluation to determine if my case was an emergency or not, and I was offered the MicroDiscectomy surgery and was told that it was not a true "surgical emergency" yet. I asked for recommendations for therapy but was just told that "there's no magic bullet" for my condition, and told me to not do things that hurt, and when I looked down at my notes to ask my second question, he was gone.

    After this, my primary care doctor still wanted me to see the local NS, but since I have seen another NS, they wont see me at all now since they dont do "'second opinions". She spent about half an hour listing all the symptoms to watch for with strict instructions to come back if any of these things get worse.

    In the month or so since I got the disc-herniation MRI results, I've done a lot of research and have decided that I dont want to choose the surgery unless it really becomes a true emergency... I want therapy! But I cant find a therapist who will take me without written doctors orders, once they hear what my diagnosis is.

    I now have a referral for a Neurologist (also out of town) and they promised to call me first thing next week to set a "long" appointment as soon as possible, but at this point I dont know if that means weeks or months. The secretary said she can't just squeeze me in because I will need a long appointment, which sounds like a good start.

    So, at this point, I am still on my own, trying to figure out what to do to help myself, which is why I came here.

    I DO appreciate the advice about going to a NeuroSurgeon first, which is the approach my primary-care doctor has been trying, but when I saw the one NS out of town, they looked askance when I filled out the intake paperwork and didn't have anything from a Neurologist.

    If I dont get in to the Neurologist (who is just an hour away) really soon, then I will probably just go to Boston and find a specialist there. If anyone has recommendations for disc-hernitation treatment in Boston, please let me know!

    In the meantime, I have just enough painkillers to take the edge off, so I am managing but still in a lot of pain, expecially if I do anything even mildy physical, like going in a car or walking for 5 minutes or carrying a gallon of milk. It hurts to lie down and after about 4 hours of sleep I wake in lots of pain and heve to get up and move around. It hurts to walk. It doesn't hurt so much to sit on a therapy ball... but I cant sit on anything hard because my tail-bone hurts too.

    A few months before the MRI, when I complained about the ongoing pain which we thought was still from the pelvic fracture, I was referred to a pain-management doctor, and I just had my first appointment there last week and got a spinal epidural steroid injection last wednesday. The MRI was done while I was still waiting to get that appointment, and just after the MRI results came in, I finally got the call with the appointment for the Pain doctor, so I think the MRI helped get me in sooner, but again it's sortof backwards since I haven't had any physical therapy yet for the herniation, but since I am 8 months post accident, it seems important to get treatment as soon as possible since I have already waited too long to get the best benefits, and the longer I wait the less chances I have of getting good results, as least that's what the pain-management doctor told me. I was given the name of a local therapy group, but when I called they said that I need a Neurologists written treatment plan before they will touch me.

    Sorry about the run-on sentences, but that's what it's like for me... none of the sentences of my life seem to have a proper conclusion, just one thing leads to another... with no 'conclusion' yet, just more questions!

    - Maggie

  5. #5
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    What are "hypointense lesions" on endplates in intervertebral space?

    My MRI showed several "hypointense lesions" in the intervertebral spaces that are in the middle of the endplates, in the disc space. They show up as "hyper-intense masses" on a Cat Scan. They are near the endplates and sticking into the middle of the discs, and at least one vertebra has these lesions both above and below the vertebra. There are some rim lesions on some of these vertebrae, but the rim lesions are on the edges of the end-plates whereas these "lesions" or "masses" are in the center of the endplates. On the axial Cat scan views, these discs show hyperintense masses in the middle of the top and/or bottom surfaces of these discs as well as some hyperintense end-plate lesions near the rim.

    These disks have minimally narrowed disk-height and do not appear 'dessicated' nor are they bulging. This area of my back does have moderate pain and tenderness. My chiropractor looked and said they might be Schmorl's nodes, but I dont see similar pictures when I look at images of Schorls Nodes that I have found online. From what I have seen, Schmorls nodes look more like degradation and changes in the vertebra whereas my "lesions" are in the disc-space at the border between the vertebra and the disc, possibly attached to the vertebra and sticking into the disc space. .

    These are CAT Scan images. On the MRI of this same region, these masses show up as dark 'hypo-intense' spots in both T1 and T2 series.

    Do you have any idea what these "lesions" or "masses" might be? I cant find any pictures online that look similar.

    Thank you for your time.

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