Have Back Pain, got MRI, what now?

[Tormoni]

I've been having some serious back pain that's been getting worse and worse over the last two years or so. It's to the point now where I'm missing work because I'm in too much pain to even get out of bed. Laying down seems to be the only way to be somewhat comfortable. The more physical activity I do, the worse the pain gets.

I've been to a regular doctor and she gave me an order for a Thoracic and Lurabar MRI. I don't have insurance so I called around for the cheapest place to get an MRI done and I was able to get the lurabar scan done. I've searched the forums and I haven't been able to find anyone with similar results as mine and I was hoping someone could give me some insight as to how to read this MRI report. It reaRAB as follows:

L1-2: Annulus is normal and symmetric without focal protrusion/herniation. The central canal is preserved. The foramina are patent bilaterally. Facets are within normal limits.

L2-3: There is no disk protrusion. There is a 4 mm synovial cyst projecting posterior to the left facet.

L3-4: Annulus is normal and symmetric without focal protrusion/herniation. The central canal is preserved. The foramina are patent bilaterally. Facets are within normal limits.

L4-5: Annulus is normal and symmetric without focal protrusion/herniation. The central canal is preserved. The foramina are patent bilaterally. Facets are within normal limits.

L5-S1: Annular protrusion centrally and to the left with mild left foraminal narrowing. This could touch the descending S1 nerve root in the canal on the left but does not displace it.

IMPRESSION:
1. Consistent with synovial cyst at L2-3 on the left behind the facet, likely not causing nerve root impingement.
2. Annular protrusion L5-S1 as detailed above.

I know I still need to get the other MRI done yet, because I have middle back pain also and I want to know what's causing it. I've talked to my dad, who also has had back back problems all his life, and he goes to a pain management doctor and swears by it. He warns me against chiropractic methoRAB. I just want the pain to go away.

From looking at this MRI, does anything on there explain why I have lower back pain? And is that protrusion it's talking about cause back pain? Also is it what's causing pain in my left leg and nurabness on the front of my left shin? I could care less if I have to be on pain medication, if it makes the pain go away, I'll take it.

Someone... please advise...

 

[maltluver]

Hello tormoni and welcome to the board. Yes, it is possible that the disc protrusion is causing your pain....especially the leg pain. The L5-S1 is the disc that most commonly causes problems and the study shows that your bulge is putting pressure on a nerve. That compression is likely to cause your leg pain.

You did well by seeing your regular doctor as a starting point. I would advise you to now make an appt with an Orthopedic Spine Specialist or a Neurosurgeon who limits his practice mostly to spinal issues. Perhaps your regular dr. could give you a referral. These specialists are the very best at reading your MRI results and at knowing what might be the most helpful treatment. It does NOT mean you have to have surgery! It means that you will be in the hanRAB of a doctor who knows the spine and all the intricacies involved. It is also good to get a second opinion, especially is surgery is recommended at a first step.

Pain management may be recommended by the doctor, but pm is not the right place to start in my opinion. You should first get a solid diagnosis and if the dr. thinks that pm would be helpful he will recommend it to you. I also swear by my pm doctor, but my surgeon is who I trust to diagnose me if I have a problem and need an MRI or ct scan.

I hope you will find this helpful in deciding your next step. Oh, yes, you mentioned pain medication and I meant to let you know that the spine specialist would most likely give you a prescription.

Please stay in touch and let us know how you are doing.

Carol

 

[tmorgan813]

I am sorry you are going through all this. I know how bad the pain can be. It appears to me that your results are saying that you have a herniated disc at L5-S1. This can cause severe pain in the lower back as well as the middle back due to the muscles in the back over compensating for the lower back issues. It can also cause the pain to go into your butt and/or leg due to the herniated disc hitting the sciatic nerve. However, I would still recommend (if you can) to get the MRI of the middle back done as well.

I have had chronic back pain for 16 years now, and I see a pain specialist as well as a chiropractor. I swear by my chiropractor as I do get relief from it. As for Pain Specialist, they will normally say to have injections in the problem area. This has helped me in the past. However, because you do not have health insurance, I would ask your PCP to give you a steroid pack to see if that gives you any relief as it could bring down the swelling. I've had luck with these early on with my back and my father was lucky enough to ONLY have to take that for long term results.

Now, here is the "what if" There is an issue called stenosis (sp?). It is a narrowing of the nerve canal and can cause horrible pain as well. The test for this is VERY painful but the surgery is not that invasive from what I hear.

I hope this information has helped you a little and that you are able to feel better soon. Oh, I forgot...this REALLY helps me...DO NOT USE HEAT to relieve pain! It helps while it is directly on the area, but once the area cools, the muscles become even tighter and begin to spasm more. I use an ice pack on my back numerous times a day and though it doesn't take away the pain completely, it does help. Some people swear by applying heat and then ice...you will just have to see what works for you. Again, good luck and I hope you get some pain relief soon.

 

[tetonteri66]

As the other posters implied, none of us has medical training, so at best, you are getting your fellow spineys' impressions of your MRI based on what we've learned from our own experiences. If you can manage it, it would be a good idea to see a spinal specialist as Carol mentioned for an accurate diagnosis.

If you enjoy doing some research, run a search for a dermatome map. The dermatomes provide a "road map" to help medical professionals determine which area of the spine may be damaged and thus, causing pain. Each spinal nerve provides sensation (including pain) to a particular area of the skin -- the lurabar spinal nerves innervate the area below the waist.

For example, the S1 nerve root, in most people, starts high up in the buttock, runs down the back of the leg, down the outside of the calf and into the little toe. L5 runs next to S1 but on the outside of it, going down the side of the buttock (hip), down the side of the leg and then at the knee, it ventures more toward the front-side of the calf, down the top of the foot and into the 3 middle toes. And L4 runs into the big toe.

Obviously none of our bodies are as clearly divided up as the chart indicates, but in general, when you have pain running down the back of the leg and into the outside of the calf and foot, a good place to start looking for problems is at the disc located between your lurabar 5 and sacral 1 vertebrae.

Your MRI confirms that the bulging disc is irritating the S1 spinal nerve...so your doctor will pay particular attention to this segment when he examines you and talks with you. The nerve is not being badly compressed, at this point, as the MRI indicates that the S1 nerve is not being displaced.

Regarding stenosis, it is readily seen on MRI imaging. Stenosis is a narrowing, and it can be clearly seen in two main areas: the central spinal canal and the foramina (which are "openings" at each pair of vertebrae where the spinal nerves exit the spine). Your MRI report indicates that there is no sign of stenosis at these areas. It states "The central canal is preserved." It also says "The foramina are patent bilaterally." If this were not the case, it would be noticeable and reported on the radiology report.

In all likelihood, it is not necessarily the disc herniation that is causing your pain, but the irritation of the S1 nerve, which is caused by the disc herniation. The spinal nerves are VERY sensitive. Pain results when the nerve is either compressed (pinched) or irritated. The nerve remains irritated as long as there is disc material touching it, or in the case of a ruptured disc, there can be a chemical irritation as well. When the problem with the disc is resolved either through conservative methoRAB or through surgery, the nerve usually recovers and the leg pain resolves.

This is a simplistic explanation, but I hope it gives you some idea why there is a problem in your lower lurabar spine, but you have pain in your leg/foot/hip areas. I hope you can get some medical care and that your pain will be resolved for you soon.

Please let us know how you are doing.