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On January 4th of this year I fell on an icy driveway and fractured my sacrum. Below is a timeline of events that had led to where I am today. I welcome any knowledge/insights from anyone who can better help me understand my diagnosis and possible treatment options.

Please note that on Aug. 5th I changed my Primary Care Dr. As I read the second MRI report I was surprised to see the following “similar to previous study of 1-14-11.” The only information I was given from my 1st Dr. was that I “essentially fractured my sacrum”. He never at any time indicated to me that there were any other issues with my back. I asked him why he never told me about these other issues when I had contacted him over the the last six months, his response was “you didn’t have these symptons before now.” I changed Dr.’s immediately.

[B]Jan. 11th[/B] 1st appointment to family Dr. for pain.

[B]Jan. 14th[/B] [B]MRI[/B]

[B]Findings:[/B]
There is T1 and T2 prolongation within the inferior sacrum at segments S3 and S4 with surrounding increased T2 signal in adjacent soft tissues. It is possible this represents a nondisplaced fracture. Slight ventral cortical defect is seen at the S3 level. Disc spaces are preserved in the lumbar spine. Conus terminates normally. No stenosis.

[B]Impression:[/B]
Possible nondisplaced fracture at S3 level with adjacent edema, but no definite bony displacement apart from the possible ventral cortical break.

My Dr.’s explanation to me was “essentially” you fractured your sacrum. It takes 6 – 12 weeks to heal. You can return to work after 4-6 weeks

[B]Jan. 17th[/B] Contaced my Dr. to ask him what my limitations are. His response “if it hurts don’t do it.”

[B]Feb. 22nd[/B] Contacted Dr. because the pain was still severe asking when it might begin to subside. He responded “it could take months.” Asked me how much pain medication I was taking and told me that I was under medicated for this type of injury. Advised continued rest and more pain medication. At this point I was taking Ibuprofin as needed.

[B]Mar-24th[/B] Contacted Dr. again because the pain was still severe asking when it might begin to subside. Dr. gave me same advise on my visit on Feb. 22nd.

[B]April 29th[/B] Contacted Dr. again, eliminating from the bladder “felt” different. Slower stream, didn’t always feel as though I was able to eliminate fully. Dr. said let him know of any significant changes, wait and see.

[B]June 15th[/B] I contacted the Dr. because I was still having pain and concerned about the change in regards to eliminating. I requested a referral for Physical Therapy.

[B]July 29th[/B] On 4th physical therapy visit my PT had me lie flat on my back, knees bent, tilt pelvis toward floor, hold the tilt, slide right heel out and back in, left heel out and back in, release pelvic tilt. Rest repeat 10 times.

[B]Monday Aug. 1st[/B] Numbness both legs from knee caps down, back pain, groin pain.

[B]Friday Aug. 5th[/B] [B]MRI[/B]
Findings: The distal conus terminates at the approximate TL2-4 level. Previous signal abnormality within the sacrum at the S3 Level has resolved since prior study of 1/14/11, consistent with interval healing of the sacral fracture. Decreased signal intensity is again noted at L2-3, L3-4 and L4-5

At L1-2, there is again no significant disc protrusion, canal stenosis, or foraminal stenosis.

At L2-3, there is generalized disc bulging and spondylosis, SIMILAR TO THE PREVIOUS STUDY OF
1/14/11. Central spinal canal is borderline in size at this level. There is mild narrowing of the inferior neural foramina. There is AGAIN bilateral facet arthropathy.

At L3-4 there is AGAIN generalized disc bulging and spondylosis. Central spinal canal is borderline in size. There is mild narrowing of the inferior neural foramina.

At. L5-5 there is AGAIN focal T2 hyperintensity at the posterior disc margin, compatible with annular tear. There is disc protrusion which is slightly eccentric toward the left, ESSENTIALLY SIMILAR TO THE PREVIOUS STUDY. No high grade canal stenosis is seen. No foraminal nerve root compression.

At L5-S1 no disc protrusion, canal stenosis, or foraminal stenosis is seen. There is partial sacralization of L5.

[B]Here are my questions from the first MRI:[/B]
What is T1 and T2 prolongation? What is increased T2 signal in adjacent soft tissues? What is Slight ventral cortical defect is seen at the S3 level?

[B]Second MRI[/B] – I would love for the whole report to be put in laymen terms. Easier for me to understand.
Anyone who has had similar issues I would love to hear about your prognosis, treatment and rehabilitation.

I am currently laying on my couch waiting to get in to see an excellent Neurosurgeon. I would like to have as much information as possible before I meet with him.

Thank you,

Dismayed
Welcome to the board. I'm sure you know that on this particular forum the members do not have professional medical training, so you must always take that into consideration when reading posts....I can give you a general idea of the main points of your MRI just based on my experiences with my own MRIs...it will give you some general ideas of what you may be discussing with your doctor.

I'm a bit confused by the first MRI. Was that the extent of the findings or did you just copy the part pertaining to the sacrum? If you want to learn about T1 and T2 I suggest you look on the internet for an article on MRI basics. These terms pertain to the physics of the magnetic imaging process, and not to your spine. They concern the amount of detail and contrast in the image, with T1 being a higher resolution. One is better for some things. For example a T2 weighted image is better if the doctor suspects degenerative disc disease or problems with the disc. It has to do with T2 showing watery substances as bright white and dessicated areas (those with a low fluid content) as black. One shows fatty tissue better than the other, etc. This is all technical stuff that is way beyond my level of knowledge. That paragraph in the report is basically talking about the quality of the tissue at the S3 level.

Your questions can be answered by the "Impression" comment and my "help" is very much put in simple non-scientific terms!!:[B]Possible nondisplaced fracture at S3 level with adjacent edema, but no definite bony displacement apart from the possible ventral cortical break.[/B] The T1 and T2 prolongation comment indicates there may be some possible changes at the S3-S4 level of the sacrum on the inside side of it....there is a possible fracture at S3 with swelling in the adjoining area. If there is a fracture, it is more like a crack in the bone rather than broken in pieces...The bone is not dislocated, but it might poke into the ventral cortex...cortex is like an outer membrane; Ventral refers to the side nearest the abdomen (what I think of as the "front" side, as opposed to the side closest to the skin on the back.)

So basically from what I can tell, the MRI has little information in it. Other than the possibility of a nondisplaced fracture at the S3 vertebra, and adjacent edema, the report indicates that the discs in the lumbar spine are normal and the spinal cord ends at the level that is common for most people...and that there is no stenosis. It does not indicate that there are any other issues in the lumbar or sacral spine.

As to the newer MRI, it obviously uses the word "again" often...so I can only assume that you only copied off part of the first report.

It indicates that there may be an annular tear at the L4-L5 disc and the disc is protruding slightly. I can't say whether this is a small or large protrusion as it says it is similar to the last study.

Otherwise there is general disc bulging at the other levels, but it sounds like it is nothing to be particularly concerned over. Most people exhibit some disc bulging as they age...and the aging process for the spine begins in our 20s.

Spondylosis can be one of those umbrella terms that doctors use to indicate some degenerative changes, or arthritis of the spine, or even low back pain.

The report indicates there is no nerve compression.

Truthfully, your MRI isn't all that bad. Most of the issues mentioned in the new MRI are mentioned because they were noticed and indicate that you don't have the spine of a teenager...but nothing jumps out as being a big pain generator. The only red flag to me would be the L4-5 level where they may be an annular tear of the disc and depending on the size of the protrusion, that could be causing pain.

Keep in mind that MRI is but one piece of the diagnostic puzzle. The spine specialist will look at these results along with a physical exam, a basic neurologic exam and an oral history of your symptoms and will then put all the information together to form a diagnosis and a plan of treatment.

Do not panic over words like herniated discs (and a bulging disc is not as big a concern as a herniated disc), spondylolsis, stenosis, etc. In a couple segments you have enough going on that it is mentioned but the report does not indicate it is enough to be of particular concern...UNLESS you are reporting symptoms that would make the doctor take a second look.

Try to be patient until you have your appointment with the neurosurgeon. He will be able to compare your symptoms to the MRI and hopefully figure out what is causing you to be in continued pain.





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