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Can Anyone Decipher This For Me?

From: FaithAdele - on 01/26/2011 8:44pm

Hello. My name is Faith and I'm a 35 year old wife and mother of three young children. I began having severe lower back and leg pain in February of 2009. It is now two years later and I'm still in pain. I have tried physical therapy, chiropractic care, epidural injections, arthritis medications, muscle relaxers, and I own a tens unit. Over the course of these two years, I have yet to have a doctor sit down and explain exactly what is wrong and what the MRI's mean. I am due to see an orthopedic surgeon this Friday. Can someone please help me to decipher what this MRI means?

L3-L4 There is minimal disc bulge. The spinal canal and foramina are patent.

L4-L5 There is disc dehydration and minimal disc space narrowing. There is posterior protrusion centrally and towards the left with flattening of the anterior thecal sac centrally and towards the left. There is slight interior extension of the protrusion. There is increased signal along the posterior protruding disc margin which could reflect a small annular tear. There is slight effacement of the proximal left L5 nerve root. The foramina are patent bilaterally. The spinal canal is sufficiently patent.

L5-S1 There is disc dehydration. There is posterior lateral disc bulge with mild central protrusion. There is slight asymmetry of the disc bulge towards the left posterolaterally. There is some mild to moderate inferior foraminal stenosis on the left.

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23 Responses

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on 01/29/2011 7:00pm

It's already Saturday and you wanted comments before you went to the doc yesterday. But let me know if you still want an opinion. I'm not a doctor and actually asked for MRI opinions on my 1st post in this community, but didn't get any replies. I have been educating myself on spine issues over the past 3 months and understand what your report says. Keep in mind this is the internet.

PS: You should start drinking water, 2 quarts per day.

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on 01/29/2011 10:48pm

I would absolutely love to hear what you make of the report. The orthopedic surgeon didn't give me much insight. He is sending me for more tests.

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on 01/31/2011 10:22am

Ok..Here goes it. Keep in mind, I'm not a doctor, only an engineer.

L3-L4:
You show minimal disc bulge..This is good The term "The spinal canal and foramina are patent" is also a good thing. The foramina is the opening in the spine where the nerves pass and most people have foraminal narrowing which can be caused by arthrytis, etc. Doctors love to use latin and the word "Patent" , really is "paten" in latin. Which means "open", Patent is good. Basically the Radioliogist is saying the openings in which the nerves pass through are open.
My uneducated opinion is L3-L4 is normal for 35 year old female.

L4-L5:
There seems to be some disc dehydration. It's hard to tell on an MRI that a disc is "drying" out. I would think they need to look for variations in shading and grainyness of the disc, but maybe this Radiologist can spot stuff like dehydration. I would be most suspect of this diagnosis. Your discs get hydrated by your body fluids, soo drink plenty of water, and stop smoking if you do. Check out disc dehydration on the internet to learn more.

Report Findings:
"There is posterior protrusion centrally and towards the left with flattening of the anterior thecal sac centrally and towards the left. There is slight interior extension of the protrusion"

Posterior means the back side of your spine, anterior means the stomach side. The protrusion is the disc is squeezing out and maybe flattenning or pressing against the thecal sac. The thecal sac is where the nerves are and contain spinal fluid.

Report Findings:
" There is increased signal along the posterior protruding disc margin which could reflect a small annular tear.
Your L4-L5 disc may be torn.. not familiar with the fix.

Report Findings:
"There is slight effacement of the proximal left L5 nerve root. "
Effacement means thinning. The left side of the nerve root may have been rubbing on the disc at one time. Swelling probably has gone down, so the report doesn't mention any nerve impingement at this time

Report Findings:
"The foramina are patent bilaterally. The spinal canal is sufficiently patent"
Good things, no arthrytis that can narrow or block openings.
.

L3-L4
Report Findings:
" There is minimal disc bulge. The spinal canal and foramina are patent"
One again, a good thing

L5-S1
Report Findings:
There is posterior lateral disc bulge with mild central protrusion"
Your disc is bulging..LOL

Report Findings:
"There is slight asymmetry of the disc bulge towards the left posterolaterally.
The radiologist is just giving details of what's bulging and where it's bulging

Report Findings:
There is some mild to moderate inferior foraminal stenosis on the left.
This is some arthrytis on the opening where your nerve roots exit the spine.

My overall opinion:
You work too hard and overuse your back, probably don't bend your knees when picking up those 3 beautiful children. Always bend your knees and get down low before you pick something up. Drink plenty of fluids. If the radiologist is right about the dehydration, this is the best way to rehydrate.

Possibly think about another steroidal.anti imflammitory injection for L4-L5. This is probably the area causing the most pain.

I would think very closely if they want to fuse any vertabre. My wife had it done and it only limited her mobility and didn't solve any problems.

If any doctor contradicts this advice, then forget what I said, and go by his recommendations

Good Luck to You

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on 01/31/2011 4:53pm

Thank you, Phil! You are correct. I do work hard and I rarely bend my knees. Of course, it's extremely hard to bend now. It breaks my heart because I can't even bend over the bathtub to bathe my children. The doctor is sending me for an EMG and NCV. I'm having that done on Thursday. Thank you so much for your input.

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on 02/01/2011 5:43pm

Tthere's no reason for you to be in that kind of pain so tell your doctor about it. Some people feel funny about bringing up the issue, but there is nothing wrong with being honest. I would have thought they would give you a script for Vicodin or Percocet so at least you could move around and do your daily work without being in pain.

I know for a fact that some doctors do not believe in painkillers because of liabilities from addiction and abuse. 99% of the people sufferring because docs avoid dispensing high liability medications are caused by the small 1% of people that abuse it. Most small practices are now managed by big organizations that provide marketing, billing and liability insurance and most of these organizations mandate doctors do not provide narcotic pain relievers because of liabilities so basically they are playing it safe by avoiding liability at the expense of your quality of life.

Your original post said nobody seems to listen or explain what's going on, this is the 1st thing you have to change. Make sure you ask questions and provide details of how you feel and when yu feel it. My mind usually goes blank when I go to the Drs office, so I started writing down exactly what hurts and when. The doctor really started taking me seriousely when I pulled out that list.

Please keep us informed of how things work out.

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on 02/03/2011 2:15pm

Hello again, Phil. It is Thursday and I just walked in from the appointment with my neurologist. He did an EMG and a NCV today. When he completed the tests, he said that I have severe L5 nerve root compression. He says that is why I'm in so much pain and my left leg and foot are so weak. I'm due to go back to the orthopedic surgeon in the morning. Any ideas on what they do for nerve root compression? By the way, I have been prescribed very few painkillers over the course of the last two years. I have suffered but there's nothing that I can do. There have been many times that I wanted to cry and scream at the same time. I just don't feel like doctors actually get it. I'm sure that drug seekers don't make it easy on people that do have real pain.

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on 02/04/2011 5:11pm

Update...
I went to the orthopedic surgeon today. I am having a laminectomy in two weeks. He said that he is hopeful that it will give me immediate relief in my leg. Keep your fingers crossed!

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on 02/04/2011 8:09pm

I really don't know what to say and stared at your response wondering to just say "Good Luck" , "Hope it works out for you". I'm not a doctor and have no right expressing my opinions, but have spent 3 months reading and understanding about spine problems, treatments and results. I wish some others here would comment on their results for this procedure, not an ortho surgeon, but ordinary people.

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on 02/04/2011 9:54pm

Phil, do you think this is a bad idea? I want your honest opinion. Please, don't hold back. I don't know a whole lot about the different surgeries. I only know about the pain I've experienced and the conservative treatments were not effective. The surgeon did tell me that I will stay have pain in the back. He said that the main goal of the laminectomy is to relieve the pressure on the nerve, so I can feel my foot again. I'm not having any type of fusion. I really value your opinion. You are the only person willing to talk straight to me. I just really need some relief. It doesn't have to be 100 percent relief either. I would settle for 40 percent relief at this point. The injections didn't work at all, and made me sore on top of the original pain. Arthritis medicines are a joke. The physical therapy worked, but was only a temporary fix. Of course, my insurance won't pay for year-round physical therapy. It won't pay for year-round chiropractic care either. It doesn't matter to me if you are a doctor. If you've been researching this, then you are probably smarter than most of the doctors I've seen. Don't feel like you don't have a right to give me your opinion.

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on 02/05/2011 12:14am

Let me write up a list of concerns over the weekend. The last thing I want t to do is get you worried but surgery should be considered a very last resort and something that can not be taken back.

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on 02/05/2011 11:45am

Faith:
I didn't know about not being able to feel your foot, which puts things in a different light and confirms nerve inpingement

About the surgery:
There are 2 different procedures, a lamenectomy and a lamenotomy. You mentined a lamenectomy which is more serious because they remove a piece of bone called the lamina which is pressing on your nerve and affecting your leg and foot. A lamenotomy is where they trim down the lamina to make room for the nerve. Depending on how much they remove, your spine could be weakened and require pins and hardware...I think they call it instrumentation. They can also fuse L4-L5 if the spine is weakened from the procedre. He may me saying Lamenectomy because this is a more used term and sounds like he is triviolizing the procedure, so maybe it's only a minor trim and opening for the nerve.

I would avoid any hardware placed in your back. You are too young for this. Years from now this hardware will attract arthrytis and scar tissue. You not only want to pick your kids out of the bathtub, but also want to pick up your grandchildren. If you were over 50, then it might be ok. Many people have claimed they went in for what they thought was a simple procedure and came out with pins and screws or fusion.

Ask your doctor if you will be put under general anesthesia. If he says yes, this is a sign of a more invasive situation. A local is a good sign.
Ask him abouit the scar size...4-5 inches is a fairly invasive procedure. 1-2 inches is a good sign
Ask him to guarantee or promise no pins or screws will be installed, or no fusion. Tell him you want to avoid this because you are so young.
Ask who exactly will be doing the procedure.. an assistant? a staff ortho at the hospital?
Ask him what the recovery period is.. I've read about 1-3 day hospital stay which is a lot
Ask him about follow up treatment....more physical therapy
Ask him if this will decrease back pain or only address the leg/foot pain.

Run like hell if he says he will not know the outcome until he "gets in there". With today's imaging there is no excuse for this. A good surgeon with a current education and technology knowledge knows exactly what to do before he starts. Hopefully he's using an MRI that isn't 6 months or older.

My opinion:
I would do it only if it's simply making room for the nerve by removing a small amount of material and he can guarantee that.
See a pain management specialist. This doesn't mean pumping you full of pills or pain patches, but also includes very specific injections which act differently, injections like nerve blocks, etc.. You should try at least 3 of these and oral pain relief.
Check your doctor out on the Internet, see if he's board certified and has published papers, check out his education and credentials. If he's and "older gentelman", he may only know traditional open back procedures and not familiar with the latest less invasive procedures.
I don't know where you live, even if you're in the USA, but good doctors tend to setup near metropolitan areas.

You seem to take a lot on faith, but need to ask him more questions. There is an old saying that when all you have is a hammer, everything looks like a nail. Surgeons fix by cutting you open, physical therapists fix by excersize and stretch, chiropractors fix by adjusting everything. Pain docs fix with meds and injections. It's rare that one type of doctor will tell you that something else is better. It's up to you and your GP to agree on a plan.

If you want, I will check out your doctor, but don't give his name here. I'll give you a secondary email address I use for coupons and other high risk spam sites...just let me know. If you're afraid to ask questions, I'll call and ask and tell him I'm your older brother or something. You hit a nerve (no pun intended) when I read about you not able to take your kids out of the bathtub. All the memories of my wife doing the same thing came right back. Making scrubbies in the tub is supposed to be fun times. Most of my favorite photos are my kids in the tub with bubbles all over.

Phil

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on 02/05/2011 1:11pm

Phil, you are awesome. I'm so sorry about your wife. You are right. Bath time is supposed to be fun for mom and kids. Unfortunately, in my house it's a painful event. Okay, here's what I know and what he told me at our last visit. I will go under general anesthesia. He said that he will make a three inch incision and remove the lamina to get a full view of the nerve and what is compressing it. He said that he will remove the fragments of disc and bone spurs that are compressing the nerve. He said he will then close me back up. He made no mention of fusion at all. He said I will be in the hospital about a day and a half. He said it will take about six weeks to reach full recovery. He does have two offices in metro areas and one in our local area. I live in a rural area, so I go to his local office. The surgery will be performed at our local hospital, but it is a branch of the higher end hospitals in the city. He said I will have no staples or stitches that have to be removed. He said they will all dissolve on their own. He is in his mid-forties. I have to have a full work-up two days before surgery and see him on the same day to go over the procedure one last time. He had me bring him my most recent films from November. He said he needs them to look at and map out the procedure. He also has the written report from my MRI and the most recent findings from my EMG and NCV. He did tell me that there is no guarantee that the lower back pain will subside, but he's hopeful that decompressing the nerve will allow my foot to regain feeling and strength. I am totally open to emailing back and forth. Please let me know.

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on 02/05/2011 2:48pm

I'm glad you recalled all the details and I actually feel better for you knowing that he explained everything. I'm sure you will get relief and also glad you understand this will only help, not cure everything, and also glad to hear the doctor actually say this. The follow up tests before the surgery shows he wants to target the specific area and not just dig around and then decide what to do.
Just stress the fact whenever you talk to him...Please no pins or screws, I'm too young for that. You can't say this enough. He may think twice after hearing you say it a few times if he has an option while doing the procedure.

I know I said there are many people complaining of follow up pain, but you mostly hear about the bad stuff on the internet and rarely people comment when problems are fixed. They just move on with their lives. Let's hope this is your path also....

You still need to start taking better care of yourself, avoid bending or lifting without bending your knees and read up on disc dehydration and how you can reverse it, obviousely water, but maybe stuff like Mona Vie' although it's expensive, or other joint "stuff". Pain may still come and go depending on how well you clean your kids (LOL). I'll never learn and actually laying down hardwood flooring this weekend.

I Hope you have a good partner or friend to stay by your side and to hold your hand, not that I'm trying to get you worried or you need that... Please continue to tell me (us) how things are going. I'm sure there are plenty of people having similar procedures and feedback may help others understand.

Phil

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on 02/05/2011 11:04pm

Thank you so much for your input and support, Phil. I will definitely keep you posted. I hope that what I have gone through will help someone else. I hope that I can be one of the people that comes back with a success story. I'm definitely going to take your advice on the water intake. I think I am also going to discuss a low-impact exercise program with my surgeon. I think that after surgery, exercise will be a great help. I know I won't be able to do it right away, but it's an option that I would like to look into. I was in the Army many years ago, and I often fantasize about being able to PT like that again. Of course, I know that will not ever happen...LOL! I think that is the saddest part of all of this. I keep thinking about what I used to be able to do. I need to start thinking about what I can still do. I do have a husband that is very supportive. He cannot help me like he would like to because of work, but my sister is willing to give me a hand. It is nice to be able to come to a forum where people understand my pain and frustration. My family is great, but they don't have any of these conditions so they can't relate. Thanks for all of your input and advice. It is greatly appreciated.

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on 02/10/2011 9:02am

Faith,
If your Surgeon was not going to put you under I would run as fast as I could. Can you imagine the damage that could be done if you moved while he was cutting the around your spine?
I had a laminectomy done in Dec 09. I am still in severe pain but I am glad I had the surgery done. At least I know I have done every thing I can. I am seeing pain management and going to try a Nurostimulator to reduce the pain. I hope it works.
You do need to understand what your MRI means. The bast place I have found ishttp://www.chirogeek.com/003_CT-Axial_Tutorial.htm at this site you can learn how to read the films of the disk depending on which media your MRI is on.
Unless your spine is unstable there is no reason for instrumentation of Fusion. As your DR hasn't mentioned fusion I would think he is not considering performing any fusions. Your Dr is a lot better source of information than anyone on this site or any other. They are the ones that have gone to 8+ years of school and then an internship. They have the knowledge that we (the patients) wish we had, three months of research does not come close to what your Dr knows. If you have doubts don't hesitate to get a second opinion from another Doctor. You wouldn't let someone from this site perform the surgery would you?
This site is the best site I have found for encouragement and understanding. I have learned a lot from this site however for the real medical advice I trust me Doctor. If I have trust issues with my Doctor I find a new Doctor

Larry.

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on 02/12/2011 3:01pm

Larry,
Thank you for your feedback. I am definitely taking all of my surgeon's advice. I sat down with him again yesterday, and he sees no need for fusion. Thank God! My surgeon and neurologist are both very confident, so I feel at ease with their expertise. I understand the risks and I also understand that it may or may not help. At this point, I just need to try. Two years is a long time to deal with such severe pain. If I can reduce it at all, I'll be happy. If not, like you, at least I'll know I've tried. Thank you again....I'll update after surgery.

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on 04/10/2011 11:20pm

I was looking through these posts tring to find information when I ran across your post and could not belive the similarities. I have two young children, and was in a car accident two years ago which caused three bulding disc's, two with tears. I have a nerve canal L5-S1 which is filled with fluid. The neurologist did a facet injection which provided relief for about two weeks. My neurologist now wants me to go on to a surgen and says he may want to do the same procedure with cutting out a small area to provide relief and is also talking about doing a rizotomy or nerve Cauterization as well. Although I have not made it to a surgen yet so nothing has been discussed in any detail as the surgen would be the one with the information. I was wondering if they had done the procedure yet and the results of those or anything that may help me in my situation. I have the same issue where the pain goes in my right knee and shin. I cannot work either. Pain meds hasn't helped. Have you found anything to help with the pain? I would also like to thank everyone for their comments on your post and for explaining the mri as it was increadibly helpful as they were really similar. Any information will be very appreciated

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on 04/11/2011 8:13pm

It's been 2 months since her surgery. I wonder how she is doing....If she's not posting then she is probably fine. Good luck to you Bridget

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on 04/11/2011 8:13pm

oops... double clicked and left 2 messages

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on 04/11/2011 9:15pm

Thanks for getting back to me phil. I hope it went well also.

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on 04/12/2011 10:04pm

Bridget,
I was in a rush the other day and left a short post and apologize for not commenting on your situation. Out of all the surgical procedures, laminectomy, rizotomy and nerve cauterization is the least invasive and doesn't involve leaving screws, pins, hardware in your back that could give you trouble years from now. Any fusion type repairs require careful movement and constant awareness for the rest of your life and it sounds like you have a chance to get this taken care of and live "normally". One of the things you will have to deal with is a few weeks of recovery and PT, but well worth it in my opinion.

Phil

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on 06/14/2011 1:10pm

WHY WOULDN'T YOU CONSIDER THE X-STOP?? Granted the people who are leaving some advice are against it. But I know of one specialist neurosurgeon who has done this minor surgery and it does NOT mean cutting anything out of your back.

Talk to a specialist and see what they say. Get several opinions.

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on 06/14/2011 1:10pm

WHY WOULDN'T YOU CONSIDER THE X-STOP?? Granted the people who are leaving some advice are against it. But I know of one specialist neurosurgeon who has done this minor surgery and it does NOT mean cutting anything out of your back.

Talk to a specialist and see what they say. Get several opinions.

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