Please Help! Trying to Understand my MRI Report for Lumbar Spine in Layman's terms!

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fayefaye

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Hello,

I will start off by telling you a little bit about my story. I fell on a wet floor back in August 2010. I landed on my back. I later got an MRI. I have not had a doctor explain to me why I am in pain everyday. I have a pain that is like a funnel at the top of my rear end and it funnels down into my anal and down my left leg. Some day are much worse than others but I have pain everyday. I can handle pain but most days are just ridiculous. Last Thursday it was so bad that I had to go to the ER. I was experiencing knife like pains in my anus, the top of my back felt extremely weighted and very painful. The pain was shooting down my left leg causing my left foot and left hand to become nurab. My legs, along with the pain were tingling. I pain was so bad I was sweating and crying like a baby. Anyways, I had gone to the Doctor the day before and he read my MRI report and told me that basically, my MRI said that my back is degenerative, meaning getting old. He told me nothing was mechanically wrong with me and I do not need surgery. I told him that I did not understand why I was experiencing so much pain every single day. He said, "do you want me to tell you again, your back is getting old". I asked him again about the pain. He seem to become annoyed with me and said "nothing is mechanically wrong with you, you should be happy, a lot of people your age have the same problem". By the way, I am only 43 years old! I use to feel young before I fell and hurt my back. Now I feel 80.:( It is almost like he is not taking in consideration that I fell on my back. I was in so much pain that I couldn't even respond like I wish I would have. I wish he would have explained my MRI to me piece by piece but he did not. I feel like he is leaving something out. I have to know what is causing my pain. He wants to send me to Pain Management to get epidural shots in my spine, then have me attend water therapy, meanwhile, until I get approval for the "therapy's" he sent me home with 120 Vicodin. I am so lost. Still!:confused:

My MRI reaRAB:

L3-L4: Mild decreased disk height with disk desiccation is noted. A 3mm central disk bulge is noted. The bulging disk indents the ventral aspect of the thecal sac. It abuts but does not compress the emerging L4 nerve roots bilaterally.

L4-L5: Mild decreased disk height with disk desiccation is noted. A 3mm central disk bulge is noted. The bulging disk flattens the ventral aspect of the thecal sac and abuts but does not compress the emerging L5 nerve roots bilaterally.

L5-S1: Marked decreased disk height, disk desiccation, with vacuum disk phenomenon is noted. No disk bulges or protrusions are identified.

IMPRESSIONS

Mild disk desiccation with 3 mm central disk bulges noted at L3-L4 and L4-L5.

Marked decreased disk height, disk desiccation, vacuum disk phenomenon, degererative marrow changes, with small anterior, lateral and posterior osteophytes noted at the L5-S1 level.

There is more to the MRI but I do not know how important it is.

I would love to know if anybody out there could help me to understand why I am in so much pain! Could I have a pinched nerve? Could a pinched nerve not show up in an MRI reading? :confused:

Please, Please Help me! Dealing with this for too long and need answers as to what is wrong and how to get my life back!
 
Welcome to the board ~
You didn't mention what type of doctor reviewed the MRI for you. I found that I wasted about a year by relying on what my internist told me about my initial MRI. Then I went to my first spinal specialists and was shocked when he said I needed a fusion. My MRI didn't show anything more than what yours is showing...what it didn't show was that I had a spondylolisthesis, a slippage of one vertebra over the top of the adjoining one, which was causing a nerve to be compressed. This accounted for all my pain which was similar to what you are describing.

To answer your question, there are some pain generators that are not revealed on a MRI. I mention my situation just as an example of one...not to suggest you may have something similar. (A spondylolisthesis is more readily picked up on a routine X-ray.)

Interpreting MRIs is something better left to the professionals....but from my experience I would agree that nothing jumps right out and the issues mentioned are fairly typical for anyone over about the age of 30. Also the treatment he is recommending is pretty typical.

Doctors usually try the injections in an attempt to make the patient more comfortable so that he/she is able to go through a course of physical therapy. Often this is sufficient to resolve the issue that is causing the pain.

Often there is some inflammation, particularly when one takes a fall. The injection will bathe the area around the lower lurabar spine in a steroid which will help to reduce inflammation. If swollen tissue is pressing on a nerve, this theoretically should help. Then through water therapy, the muscles used to support the back would be made stronger...which can pull the spine into better alignment, etc.which can help to alleviate pain.

Injections and a course of physical therapy are standard treatments for a patient complaining of lower back pain and sciatic pain. Most doctors try these things first. If there is no relief, then the doctor will probably order further testing or treatment.

If you are dissatisfied, you can always get another opinion from a different doctor.

Just thinking aloud here -- if there is not a problem in the lurabar spine, it is possible that you might have cracked your coccyx when you fell, or that you are having problems in the sacroiliac joints... you might want to look into having an X-ray of that low sacral area.
 
Thank you so much for answering me so quickly!!
The Dr. that I saw was an Orthopedic Doctor. It really bothers me that he isn't more specific on what is causing my pain. Don't I have a right as a patient of his to know or find out what is the cause of my pain before I except any type of therapy? I want the shots and water therapy if that would be the best treatment of me. What if the true cause of my pain can be treated in a less invasive way? If I was told what exactly is causing my every day pain, I would mentally be able to see the light at the end of the tunnel. Without knowing the actual cause for my pain makes me very scared. I have never been through something like this before. So you think it is a good idea to request an x-Ray before excepting the needles in my back?

Again, thank you for your input. Talking about this with people that understand what I am going through will help me mentally get through this! I feel so alone.
 
Diagnosing back problems can be complicated. Sometimes a cause is determined by eliminating what it cannot be. I agree that your doctor wasn't much help. Many times it is because the answer is not clear or readily available. When the answer is not apparent from a MRI, the next step is often physical therapy. Something like 90% of back issues end up resolving on their own...so doctors don't get real excited at the beginning when there is not something that is obviously "wrong." If there had been a ruptured disc that was causing nerve compression, I assume he would have told you and would have suggested ways to treat. As it is, (again I am guessing here, of course) he does not know what is causing your pain. So he figures he'll give you the option of trying an injection in the event that inflammation is irritating a nerve.

He hopes that will take care of your problem. If not, he probably assumes you'll make another appointment and come back in, in which case he may look further, or you will go elsewhere.

Unfortunately many back and neck problems are not like other medical issues where the doctor can run tests and tell you exactly what is wrong. The spine is very complex. With the addition of all the nerves that run through the spine, the possibilities multiply, and a diagnosis can be difficult to pinpoint.

Did you land on your tailbone when you fell? Was that the beginning of your problems? Did this doctor want to hear about this possible injury? Do you know if this doctor is an orthopedic spinal specialist or a general orthopedic surgeon?

Did you see your family doctor about your fall? Perhaps he/she would be willing to order an X-ray. I cannot say whether it would be a good idea or not. I just know that my initial problem was not identifiable from the MRI. The spine specialist suspected it, but immediately ordered X-rays to confirm what he thought he noticed on the MRI.

MRIs are best for imaging soft tissue. X-ray and CT scans are better at highlighted problems with bone. If you cracked your coccyx, I don't know if it would show up on a MRI. If you enjoy doing research, you might try looking up "coccydynia" to see if anything sounRAB similar to what you are experiencing. I'm just trying to think of things that can happen when you fall + from the areas that are now painful...I have no idea what is actually going on....:eek:
 
While you're doing some reading, you might want to read up on disc desication since that seems to be the main issue that the radiologist chose to mention in his report to your doctor. You will find that it is a process that is at the beginning of disc degeneration...and you will see that it goes hand in hand with the aging process -- which is what your doctor told you. What he didn't explain is that aging in the spine begins in our twenties!! The discs begin to lose water, a process that continues our whole lives.

You will also read that disc desiccation is one of the most common causes of severe back pain. It can happen at any time if there is trauma involved. I suspect your fall would be considered trauma. Because muscle irabalance can also be a cause of disc desiccation, physical therapy, especially water or "aqua therapy" is often recommended as treatment. These exercises can never restore the cushioning to the disc, but it can rebalance the muscles so there is not wear and tear on one particular area....If the muscles are stronger, it can relieve any extra stress on these dessicated discs, which, hopefully will also resolve some of the pain.

As you can probably tell, I am a big believer in learning everything you can about the particular spinal issues you have. I didn't know anything about the neck and back before I first developed some problems...but I have read and studied as I've gone a long and have bored my doctors and therapists to tears with my many questions! The Internet is a great resource. The goal is not to become a doctor or to tell your doctor you think you have X and Y wrong with you, but to understand enough that you can understand what your doctor is telling you about your particular issues. Then you can ask appropriate questions, understand the answers and be an active participant in your care.
 
Your so right, when you want answers and do not get them you are forced to research yourself. I have been doing a lot of internet searching. Most of the information that I have found so far is saying that my back issues and "spine aging" will only occur so intensely if there is trauma to the back. I fell at work the first week of August. I was wearing flip flops and did not see the water on the floor by the drinking fountain. I flew up in the air like a cartoon character and landed right on my back, hurting my elbow and right thurab at the time. My back did not bother me until later. I work with a special neeRAB child, he has Autism, he weighs about 130 pounRAB. I have been his 1 on 1 for 5 years now and know him very well. He has a tendency to bolt every now and then. Three weeks after my fall in the hallway, I was with him and he got up and started to run towarRAB the front door of the school. He is oblivious to cars, traffic, danger, etc..I was solely keeping him from heading into that direction for about 3 minutes, there was a lot of struggling going on. Finally, after 3 minutes or so, a male teacher that works at the school, jumped in to help me. The two of us were able to maneuver him safely away from the area. The day after that incident is when my back started hurting. So basically, the fall in the hallway stated it and the twisting, struggle, bending, etc, three weeks later started the pain. I have been seeing a doctor and unsuccessfully attempting physical therapy ever since. The PT refuses to work on me until my pain is under control. I finally had my first appointment with the "no so helpful" orthopedic doctor. Like I said, he is very tight lipped.

I truly appreciate all of your advise. I hope that if I decide to go with the shots that they help me recover. I just wish I knew more about my pain. I would love to see a light at the end of the tunnel. I will try to have them give me an X-Ray. It would comfort me more to know what they are treating before they treat it.

I hope you are doing better too. Thank you so much for taking the time to state your opinion.
 
It sounRAB like you have a very intense, and sometimes, physically demanding job. What happens as he continues to grow?

If I were in your shoes I think I would get an X-ray before beginning any injections. It might show something that would make the injections unnecessary. You don't want to put yourself through the injections unless there is a chance they will help. With the X-ray you can at least rule out things like a slippage, a cracked bone, etc. Good luck to you. Please let us know how you are doing, and how you decide to proceed.
 
definitley get xrays 1st just so you know there is no bone pathology. sometimes mri's can miss spondylolysis(a stress fracture in the pars interarticularis). spondylolysis is what happens before spondylolithsesis(vertebrae sliffing foward) in most cases sometimes it can slide without the stress fractures but not often. im an mri technologist so i know a little. the main reason i know about this though is because it happened to me. if they would of caught the fx's with simple xrays when i was 14 i wouldnt of suffered the past 11 yrs with back pain. i had a bunch of mris when i was younger and pelvis xrays but no low back xrays. so definitley get xrays. and always try physical therapy 1st before back surgery, and dedicate yourself to it at least for 2 months if you can tolerate it. strong abdominal muscles and low back muscles are very important. if you have weak abdominal muscles and hip flexors it increase pelvic tilt which increases pressure in your low back. loose hamstrings are very important as well so stretch them a lot. also comfortable but supportive shoes help me as well. but find out what is wrong 1st.
 
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