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Back Problems Message Board


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First, thank you for your service, and welcome to the board. I can give you a general idea of what the wording of your MRI indicates, but know that the MRI is but one piece of the diagnostic puzzle. The doctor will correlate whatever information it provides with what he finds in a physical exam, a simple neurologic exam and listening to you describe your symptoms in detail.

The report indicates that there is a problem at both the L4-5 and the L5-S1 segments of your spine. At L4-5 the disc is herniated; the location is toward the central part of the disc near the spine. It is bulging out of its space and pressing on the dural sac, but the bulge is not sufficiently large to also cause compression of the adjoining nerve roots. (The dural sac is a tough membrane that contains the lumbar spinal nerves. Technically, the spinal cord ends around the Lumbar 2 level. Beyond the point, the lumbar nerves collect and co- mingle after this point, and are called the "cauda equina." These nerves are contained in the dura.)

When the disc bulges into it, it can result in pain as the lumbar nerves carry signals out to the legs....you might feel pain in your groin, hip, buttock, leg and foot. But it is not compressing the immediate spinal nerves that exit the spine right at the L4-5 level.

At the next segment below, L5-S1, there is what I interpret to be a mistake in the writing. I can't quite tell what the writer means. There is an annular tear in the disc and that the disc is also protruding. It goes on to say that it protrudes, causing compression of the dural sac..but the next phrase says it is not compressing the dural sac or the right S1 nerve root. The facet joints at this level are fine...nothing noticeably wrong with them.

Generally speaking, if the herniation is really bad, the radiologist uses the word "severe herniation" (as opposed to mild, or moderate). That word is not used in your report so I would conclude that the bulges are noticed but probably not in need of surgical intervention.

Of course your doctor will examine you and may discover things that are not clear from the MRI...so whatever I said above, it is just a general restating of the report. (and you know members do not have formal medical training...we are laymen that share knowledge gained from our own personal experiences.)

Hope this helps a little bit...If you have questions, I or another member who sees your post can try to answer them.
I would say that you may have some pain from muscle spasms, but your radiology report has nothing to do with muscle spasms. What is described in the report are degenerative changes that have occurred in your lumbar spine.

I suspect that your spine took a great deal of abuse when you were deployed and your MRI is reflecting the results of that stress and strain. When we think of words like degeneration, we tend to associate it with old age, but the spine actually begins to age in our twenties. Often discs are described as being similar to a jelly-filled "bismark" doughnut. The center of the disc (the nucleus) is a soft, gel-like substance. It is contained by a tough, outer ring of fibers that is called the "annulus fibrosis." This outer ring will sometimes bulge out due to wear and tear, (among many other reasons). It can also tear...and then it is called an annular tear. Sometimes when there is an annular tear, a chemical from the inside of the disc leaks out and is irritating to the adjacent nerves.

In the case of a bulging disc, it can press out into space that would normally be occupied by the spinal nerve, leaving less room for the nerve to function properly. This can cause the nerve to become compressed and leads to nerve pain. Either of these situations can be caused by wear and tear to the spine, or commonly, by a twisting type injury to the lower lumbar spine

The best type of doctor for an accurate diagnosis would be a spine specialist. This could be either an orthopedic spine surgeon or a neurosurgeon who limit their practice to issues of the neck and back. Other doctors have a limited knowledge of the spine. A patient can end up getting an incorrect diagnosis from them, and end up wasting quite a bit of time. I don't know what type of doctor you can get but they must have some orthopedic surgeons, at the very least!

When I first started out in the wonderful world of spine problems, my internist told me for over a year that I was fine... eventually he got tired of me complaining and ordered a MRI. Results came back; he read them and told me my back was just fine, for someone my age. I finally went to see a spine specialist who looked at my MRI for about a minute and told me the good news was I didn't need a fusion right away...the bad news was that there were no other options. Imagine my shock...going from thinking I was perfectly fine to being told I needed a lumbar fusion surgery.

You can find lots of information online pertaining to degenerative disc disease. It isn't actually a disease, but an easy way to categorize a bunch of changes that occur in the discs due to wear and tear, aging, and living. You might want to do a little reading so you will better understand what the MRI indicates is going on in your lumbar spine.
I agree totally. Although I think the medical consensus is 50/50. My primary care doctor is a self-admitted complete moron when it comes to spine problems. Not the only veteran who deals with her, I've heard the same thoughts about her from other people who have her. Dealing with the VA you don't have much choice unfortunately and the doctors are often moved around the country. One week you might have a good one and the next week an idiot. I do deal with some spine specialists now and dealt with a variety of chiropractors when I could afford it so have heard varying opinions. The problem is getting one to put anything in writing. Of course many doctors don't accept chiropractry as a legitmate science even though they deal with spines, necks, arms and legs daily. Some of the best PT exercises/stretches I still do came from chiropractors, not just PT people.

Keep an open mind and get more than one opinion if able as some therapy won't be as effective as others for each person.

Yes, four more aquatic therapy sessions to go and a follow up at the end of month with the VA spine specialists. Hopefully, I can get them to continue this therapy but hard to say. I am having to go to outsourced pool/therapy and not sure how much the VA is willing to spend on me. I feel much better after the water therapy sessions vs. land therapy exercises. The therapist today even commented how I tend to turn my hips outward and I could feel the difference in the muscles by turning them inward for more proper alignment. That's a small adjustment, but i noticed it right away. I have doubts that six water sessions will "cure" me of pain, but if it helps I'm all for continuing.





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