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Back Problems Message Board


Back Problems Board Index


Hello,
I, like many others, have never posted anything online until now but I am in a position that has me wondering what is the right direction to take. It will be easiest to put the Impression section of my MRI report here so if anyone has or has had the same problems can share their story with me. The Impression is as follows:
1). L3-4 disc osteophyte complex with circumferential disc bulge and right paracentral/foraminal/lateral disc protrusion and bilateral facet joint hypertrophy. Findings cause right lateral recess narrowing and moderate right neural foraminal narrowing and likely touch the exiting right L3 nerve root.

2). L5-S1 disc osteophyte complex with circumferential disc bulge. Grade 1 anterolisthesis of L5 on S1 and geometric distortion of bilateral L5-S1 neural foramina raise the possibility of underlying L5 pars interarticularis defects. Findings combine with marked facet joint hypertrophy at this level to cause moderate to severe bilateral neural foraminal narrowing but no significant central canal narrowing.

3). L4-5 mild disc bulge causes mild bilateral neural foraminal narrowing.

I was going to my chiropractor for treatment but the treatments seemed to make the pain worse each time so he referred me to a Orthopedic surgeon who specializes in spinal surgery. This particular surgeon has operated on my Chiropractor's wife twice, once Lumbar spine, the other cervical spine. I feel that this is a good referral because of my Chiro's personal experience. The surgeon looked at my MRI and the report and basically said I need surgery to stabilize my spine... said I would need 3 pins. My wife and I are going to the surgeon tomorrow for a consultation. I also have an appointment with a Neurosurgeon on Wednesday. I am concerned about my condition because my Dad had degenerative disc disease and ended up in a wheel chair and also had a halo because his neck was so bad. I sincerely DO NOT want to find myself in a similar ending senario. I would appreciate anyones thought's on my condition. Thanks in advance!
I think based on your MRI findings, and particularly due to your family history, it will be important to find a spine specialist to handle your case on an ongoing basis.

Disc osteophyte complex at several levels is an indication that the spine is weakening or that there are degenerative changes going on. It is important that someone with the highest level of schooling and training in the spine be involved in your care as you go forward. As you mentioned, this can be either a fellowship-trained orthopedic spine surgeon or a neurosurgeon whose practice is limited to the neck and back.

At several levels there is some narrowing of the foraminal openings which can result in nerve compression or irritation, which may or may not be causing pain. Perhaps of greater concern are the issues at l5-S1:

[B]L5-S1 disc osteophyte complex with circumferential disc bulge. Grade 1 anterolisthesis of L5 on S1 and geometric distortion of bilateral L5-S1 neural foramina raise the possibility of underlying L5 pars interarticularis defects. Findings combine with marked facet joint hypertrophy at this level to cause moderate to severe bilateral neural foraminal narrowing but no significant central canal narrowing.[/B]

The anterolisthesis is a type of spondylolisthesis at the l5-S1 level. This is a condition where one vertebra slides or slips over the top of the adjacent vertebra. In this case, it is sliding forward and the slippage is anywhere from 1% TO 25%. Spondylolisthesis can be caused by several different things, but, in your case, the reporter is suggesting that there may be a pars defect at L5. Basically this means a crack in the pars which is allowing the slipping to occur.

You will notice that there is also a problem with the facet joints at this level which is also an indication of the degenerative or arthritic process. The facet joints are the synovial joints at each level of the spine that allow for movement; they make it possible to bend forward and backward and to twist, without allowing the spine to go too far, which would result in us falling on our faces!

The anterolisthesis combined with the facet joint issues result in "moderate to severe" narrowing of the foramen. The foramen are the openings from which the spinal nerves exit the spine at this level. Another term for this narrowing is stenosis. One way to picture this is to think of a lead pipe that becomes filled with gunk (mineral deposits, etc.) through the years, becoming more and more filled in until water can barely flow through. In this case, the opening becomes overgrown with bone spurs and other gunk that reduces the size of the opening until the nerves get scrunched and pinched and can no longer function freely.

One option to treat this condition, is for the surgeon to go in there and do a "roto-rooter" process where he/she cleans out all the bony overgrowths and makes room for the nerves. This "un-pinches" the nerve which usually results in the pain symptoms resolving.

The spondylolisthesis is a bit more difficult to treat. If it is causing instability in the spine, and conservative measures are not helping, the surgery of choice is to fuse the segment so there is no more movement. However, I would caution that just because a person sees the word spondylolisthesis (or arterolisthesis or retrolisthesis) on a MRI report, it does not automatically mean that he/she will need surgery. Many situations are stable and do not require treatment.

A MRI is just one piece of the diagnostic puzzle. The spine surgeon will correlate it to information he gathers from the physical exam, basic neurologic exam and your history and report of your symptoms and how it is affecting your daily activities. So we can't tell you if "it is really all that bad." But you do have some issues that are of concern and you should be under the care of a talented spine specialist.
I wanted to put the Findings from my MRI in here so you can make any comments if you want.
Findings:
Straightening of the normal lumbar lordosis. There is grade 1 anterolisthesis of L5 on S1 secondary to degenerative changes. Bone marrow signal is diffusely heterogeneous. Thpe 1 Modic endplate degenerative changes are present at L3-L4. Scattered foci of T1 and T2 hyperintense signal within the L2 and L3 vertebral bodies may represent focal fat versus hemangiomas. There is diffuse desiccation of the lumbar interverebral dis with moderate loss of height at L3-4 and L5-S1.

Conus medullaris terminates at the L1-2 level.

L1-2: No significant central canal or neural foraminal narrowing.

L2-3: Circumferential disc bulge and infolding of the ligamentum flavum. No significant central canal or neural foraminal narrowing.

L3-4: Disc osteophyte complex with circumferential disc bulge eccentric to the right with superimposed right paracentral/foraminal/lateral disc protrusion which measures 3.7 cm ath the base X 5 mm AP. Findings combine with bilateral facet joint hypertroghy to cause mild central canal narrowing, right lateral recess narrowing and moderate right neural foraminal narrowing. Findings likely touch the right exiting L3 nerve root.

L4-5: Circumferential disc bulge and bilateral facet joint hypertrophy cause mild bilateral neural foraminal narrowing.

L5-S1: Circumberential disc bulge and bilateral facet joint hypertrophy. Geometric distortion of the bilateral neural foramina raised the possibility of underlying bilateral L5 pars interaticularis defects. Findings combine with anterolisthesis and uncovering of the posterior disc to cause moderate to severe bilateral neural foraminal narrowing. No signigicant central canal narrowing.





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