Dr. Young- Can you give some help understanding MRI report

[agentnum2]

Im not sure if this is the right thread, but just got back my MRI report and i was unclear of what it ment.

it says
- lose of t2 signal in the L3-4 and L4-5 disks, consisten with disc disiccation
-at l3-4 slight bulging of the disc margin and ligamentum flavum hypertropy. mild thecal sac compression is seen
-at l4-5 level, there is a left paramedian disc protrusion with moderate thecal sac compression. the protruding disc measures around 1 cm in width and about 6mms in AP dimension. Some ligamentum flavum hypertrophy is also present contributing to thecal sac compression. Mild facet joint degeneration is seen on the right.
-at l5-s1 ther eis minimal bulging of the disc margins centrally. the thecal sac is not compressed. mild facet joint degeneration is seen

OPINION
Moderate thecal sac compression at L4-5 by a protruding disc. mild L3-4 thecal sac compression.

thanks, any feedback would be great

[SCI-Nurse]

I moved this to the Cure thread to see if Dr. Young can help you.
CKF

[Wise Young]

Hi, I moved this back to Care where it belongs.

Originally Posted by agentnum2

Im not sure if this is the right thread, but just got back my MRI report and i was unclear of what it ment.

it says
- lose of t2 signal in the L3-4 and L4-5 disks, consisten with disc disiccation
-at l3-4 slight bulging of the disc margin and ligamentum flavum hypertropy. mild thecal sac compression is seen
-at l4-5 level, there is a left paramedian disc protrusion with moderate thecal sac compression. the protruding disc measures around 1 cm in width and about 6mms in AP dimension. Some ligamentum flavum hypertrophy is also present contributing to thecal sac compression. Mild facet joint degeneration is seen on the right.
-at l5-s1 ther eis minimal bulging of the disc margins centrally. the thecal sac is not compressed. mild facet joint degeneration is seen

OPINION
Moderate thecal sac compression at L4-5 by a protruding disc. mild L3-4 thecal sac compression.

thanks, any feedback would be great

Dear Agent,

I am not sure what you do not understand and therefore will start by defining some of the terms and then comment on the findings:
• Anatomy. L standards for lumbar cord vertebral segment (the bony segments that make up your vertebral column) while S standards for sacral. The spinal cord is located in the spinal canal from C1 (first cervical vertebra) to L1 (the first lumbar vertebra). The lumbar spinal cord is all situated from T10-L1 (the tenth thoracic vertebra to L1). Below L1, there are spinal roots going from the spinal cord to exit from openings between the vertebraes. For example, the L4 vertebral spinal root descend from the spinal cord at the L1 vertebral segment down to the space between the L4 and L5 vertebral segments.
• Discs. These are tough rubbery cushions that sit in front of the spinal canal between vertebral segments. Through wear and tear, these can be damaged and herniate to compress spinal roots that are exiting the spinal canal between the vertebral segment. The word "dessication" or "dessicated" (the word means loss of water) refer to apparent shrinkage of the disc and reduced signal, suggesting of damage. T2 is the MRI signal, and loss of signal suggests diminished water water.
• Ligamentum flavum. There are three major ligaments that hold the vertebral segments together, as illustrated below from a McGill University web site: the supraspinous ligament, the interspinous ligamnt, and the ligamentum flavum. It is called flavum (yellow) because it is yellowish in color. Located just above the foramena (the holes through which the spinal roots exit the spinal canal, hypertrophy (enlargement) of the ligamentum flavum can compress roots. The hypertrophy may result from mechanical stress, injury, or inflammation.


So basically, you have damage to your L3/4 and L4/5 disk. The L3/4 disk does not appear to have herniated very much but you have a serious herniation of the L4/5. About a centimeter of the disc has herniated backward and is identing the thecal sac (the dural sac that holds the spinal cord and roots) just left of the midline. Note that there are only spinal roots called the cauda equina) from L1 to S5. The disc may be pressing on the spinal roots. You also have some mild bony degeneration.

Wise.

[tylersway]

i was hurt at work 1 year ago ,i work construction . my mri said i hve a herniated disc.this was in nov 2006,i just recently had another mri .one doctor sad in his notes i have a herniated disc.another doctor said there is a small central to left paramedian disc protrusion with associated samll annular tear.however there is no evidence of central stenosis or neural foraminal narrowing. i am confused one doc says i have herniation and one says different ,how bad is this and do you think it would be wise to go back working construction with such a injury

[Wise Young]

Originally Posted by tylersway

i was hurt at work 1 year ago ,i work construction . my mri said i hve a herniated disc.this was in nov 2006,i just recently had another mri .one doctor sad in his notes i have a herniated disc.another doctor said there is a small central to left paramedian disc protrusion with associated samll annular tear.however there is no evidence of central stenosis or neural foraminal narrowing. i am confused one doc says i have herniation and one says different ,how bad is this and do you think it would be wise to go back working construction with such a injury

All three doctors are basically saying that you have a herniated disc. The last doctors just gave more details. A herniated disc means a disc protrusion. It means that the disc is sticking into the spinal canal. The words "central to left paramedian" means the protrusion is towards the center and left of center. Central stenosis means narrowing of the spinal canal... it is good that you don't have that because usually if it means that you have some room. Neural foramen refers to the hole through which spinal roots come out. So, you don't have narrowing there.

Altogether, it suggests that you do have a herniated disc. It is the only problem that you have. Much depends on whether that disc is compressing the spinal cord, what level is it at, and what your symptoms are. So, let me go through the scenarios where treatment is advisable and you should not work until it is fixed:
• If you have neurological loss, such as loss of sensation and weakness. This means that the disc is pressing on your spinal cord. In such cases, if it is compressing your spinal cord, it should be fixed surgically
• If you have such severe pain that you cannot walk or work. In most cases of pain alone, surgery may not get rid of the pain. In most such situations, the doctors recommend conservative therapy. Some doctors recommend doing things like laser therapies which are less invasive but also cannot do as much as surgery would.
• If you have progressive pain or loss of function. This needs to be taken care of urgently.

Herniated discs, particularly those that result from bending and lifting, when there is no other underlying disease, will often resolve and heal by themselves. You need to exercise and protect the back.

I don't know if this helps.

Wise.

[scngagirl]

All of my medical treatment is done through the veterans hospital and very frequently they do not want to put the right impressions on peoples files. I obtained the copy of the MRI after they just gave me the impressions results. To me this sounds worse than they say. I have severe pain in my lower back and buttocks. Feet and lower legs fall asleep frequently and no feeling in top of left foot. My hips and knees hurt frequently also. Could someone help interpret so I can possibly get proper treatment.

The findings are as follows: Anatomic alignment of the spine. The vertebrae and disc spaces are normal in height. There is disc dessication at L4/L5. There is a small cyst of the left L4 facet. Facet and ligamentum flavum hypertrophy of L4/5. Mild compression right side thecal sac. There is facet and ligamentum flavum hypertrohy at L3/4 and mild compression of both sides of the thecal sac right greater than left. No disc bulges or herniations. The neural foramina are patent.
Impression:Mild degenerative disc disease L3/4 and L4/5.

[Wise Young]

Originally Posted by scngagirl

All of my medical treatment is done through the veterans hospital and very frequently they do not want to put the right impressions on peoples files. I obtained the copy of the MRI after they just gave me the impressions results. To me this sounds worse than they say. I have severe pain in my lower back and buttocks. Feet and lower legs fall asleep frequently and no feeling in top of left foot. My hips and knees hurt frequently also. Could someone help interpret so I can possibly get proper treatment.

The findings are as follows: Anatomic alignment of the spine. The vertebrae and disc spaces are normal in height. There is disc dessication at L4/L5. There is a small cyst of the left L4 facet. Facet and ligamentum flavum hypertrophy of L4/5. Mild compression right side thecal sac. There is facet and ligamentum flavum hypertrohy at L3/4 and mild compression of both sides of the thecal sac right greater than left. No disc bulges or herniations. The neural foramina are patent.
Impression:Mild degenerative disc disease L3/4 and L4/5.

The ligamentum flavum is a ligament on the dorsal (back) side spinal canal. When it is hypertrophied, it is thickened. The thecal sac is the dura that surrounded the spinal cord.

The important statements in the MRI report are: "No disc bulges or herniations. The neural foramina are patent." These mean that there is no operable disc herniation or compression of your spinal roots. You have mild degenerative disease of L3/4 and L4/5. The key word are "mild". I don't think that they account for your symptoms.

The pain in your knee and hips are likely to be joint and not spinal related. Some of the symptoms that you have, such as your feet and lower leg "falling asleep" sound like they may be vascular. The loss of sensation on the top of the left foot may be due to damage to a peripheral nerve. I am not sure about your back and butt pain. There is no finding on the MRI report that would explain this pain.

Wise.

[Sue Pendleton]

Originally Posted by Wise Young

The pain in your knee and hips are likely to be joint and not spinal related. Some of the symptoms that you have, such as your feet and lower leg "falling asleep" sound like they may be vascular. The loss of sensation on the top of the left foot may be due to damage to a peripheral nerve. I am not sure about your back and butt pain. There is no finding on the MRI report that would explain this pain.

Wise.

This sounds very much like my Dad's symptoms before he first had stents and then femoral artery bypasses in both legs. A good test to start with involves taking blood pressures in both ankles to test for PAD. When the cause is fixed early recovery is rapid. Dad's one foot went totally numb before the bypass and he spent several months dealing with drop foot. Thankfully that resolved on his own. Causes can be hereditary but most cases of PAD are due to high cholesterol levels, smoking and high blood pressure.

[Cherbears]

Dr. Wise-I had a L5-S1 herniation and annular tear which is now not seen on my second MRI-only mild loss of height and mild DDD throughout lumbar spine. x-rays flex/ext. lumbar in Jan. 2010 and they showed many issues with L1 disc space narrowing loss of height, mild foraminal narrowing, facet joint hypertrophy, and ligamentum flavum hypertropy. I think I need more tests like contrast MRI or discogram. I'm unable to work as an RN for 2 years and 4 months. Can barely walk around the block with my cane. Am getting 6 ESIs this year total I've had 8 and facet joint injections and S1 and hip injections. Do you think I could be a candidate for surgery? thanks. Cher

[Wise Young]

Originally Posted by Cherbears

Dr. Wise-I had a L5-S1 herniation and annular tear which is now not seen on my second MRI-only mild loss of height and mild DDD throughout lumbar spine. x-rays flex/ext. lumbar in Jan. 2010 and they showed many issues with L1 disc space narrowing loss of height, mild foraminal narrowing, facet joint hypertrophy, and ligamentum flavum hypertropy. I think I need more tests like contrast MRI or discogram. I'm unable to work as an RN for 2 years and 4 months. Can barely walk around the block with my cane. Am getting 6 ESIs this year total I've had 8 and facet joint injections and S1 and hip injections. Do you think I could be a candidate for surgery? thanks. Cher

Cher, I am so sorry to hear about your pain. What you have is what many surgeons are unwilling to operate on. From your description, you definitely have a problem with L1 disc pathology but nothing that clearly indicate surgical intervention. That is very likely the reason why they keep sending you for more facet joint injections. Surgery may aggravate the problem.

Wise.