understanding this MRI

[JENNY456]

I have ongoing nurabness , ache down my lower back and left leg. Feels like a constant toothache. My MRI came back a small posterlateral tear of the disc annulus is present. There is a minor bulge of the disc annulus into the inferior aspect of the left L4 nerve root foramen. There is however no definite nerve root compression. Dessication of the disc is noted. I was told i am getting old, I am 39 years of age. Is this the case?

 

[10sox]

Jenny-
I think we need to talk! I could have written your post except for two small changes. I am 35 years old and my pain in down my right leg!! I wish I could answer your question, but I am trying to figure out things myself. Could you elaborate more on your history. Have you had any surgies?

I myself have had two discectomies for herniation in the L5 area. First one herniated when I was 19 weeks pregnant with my daughter. Then 1.5 years later it herniated again. The second time, the herniation was HUGE and I have been told all my pain is due to the nerve damage it created.

I have had three MRI's since my last surgery (Oct 07). The last MRI said I had a a slight buldge at L4 and L5 and something about an annulus tear. My neurosurgeon and orthopedic surgeon both said nothing on the MRI shows any root compression and shows no reason at all for my pain.

I describe my pain exactly like yours. A major toothache that NEVER goes away! I just told my husband last night that it feels like the bone in my leg is aching soooo bad. I also wanted to add that my right buttock and the back of my right thigh has lots of nurabness. It literally became nurab overnight when my disc herniated last Oct. I was told the nurabness would go away, but it hasn't.

I feel like I am at my witts end here because no one can tell me why I am in so much pain and why my nurabness is still present. All I get is that I may have permanent nerve damage.

I am so sorry to write a book, and I really wish I could help you out more. I am seeing my PM doctor and my ortho doctor next week and hoping I can get some additional testing done to see if we can find a reason for my pain.

How are you managing your pain? I am on Neurontin and Vicodin.

 

[mznell]

Hi Jenny,

Welcome to the board. I am sorry you are experiencing back pain.

Who are you seeing regarding your back pain? While it is true that beginning in our twenties, the discs begin to deteriorate. However, that is no reason to simply tell you that you are getting old!

Your pain is most likely being caused by the crack in the annulus. Think of the structure of your disc like an M&M. There is a tough outer coating called the annulus fibrosus that surrounRAB the disc and holRAB in the softer interior material, the nucleus pulposus. When there is a tear in that outer merabrane, sometimes the inner gunk leaks out. When this happens, there is sometimes a chemical (protecogylcan) that is released from the nucleus. This may irritate the nerves in the annulus that can cause an inflammatory response and results in pain. Not everyone who has an annular tear enRAB up with this chemical reaction and resulting pain. However, your MRI indicates that there is some nerve root involvement at the L4.

The annular tear is allowing the disc to bulge out into the foramen which is the hole that the nerve must pass through on its way out into the central spinal column. Depending on how these sizes match up, your nerve is probably getting squished as it tries to pass through this hole, which is now more narrow than normal. (This is the unscientific explanation!! :dizzy

Now, what can you do about it? From what you quoted from the MRI, it doesn't sound like this is a big bulge -- any doctor would recommend that you try conservative treatment first. You might try taking an ibuprophen product like advil or aleve around the clock for a nuraber of days. Try icing your lower lurabar back area on the side of the pain...about 10 minutes every hour as time allows! Try to rest for a few days...avoid any activity involving bending or twisting. Do not lift anything heavier than a gallon of milk for awhile. The idea is to try to get the disc to heal itself. You want the inflammation to go down so the nerve root is not irritated. The nerve root is the source of your pain as it bundles together with other nerve roots exiting the various vertebrae, and together they form the sciatic nerve. The sciatic nerve is the largest nerve in the body, about the size of your little finger. It runs down the back of your leg to your foot, in both legs. The L4 nerve root refers pain across part of your buttocks, down the back side of the leg, over part of the knee cap, outside of the calf and it is what allows the foot to be drawn up.

If you are careful and judicious with your back, hopefully you will have luck getting this to resolve on its own. You will need to be very patient as it can take a long time...like 6-8 weeks if it is not further aggravated.

Hope this helps. Good luck and feel free to post with your questions and comments.

xx M:wave:M