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Back Problems Message Board

Back Problems Board Index

Welcome to the board. Please remember that none of us have formal medical training, so please keep that in mind when reading.... MRIs and any imaging are just one piece of the diagnostic puzzle. The doctor will correlate what he/she sees on the images with what is found upon physical exam, a basic neurologic exam and after listening to your medical history and description of your symptoms.

Since you are new to the wonderful world of back problems, I am going to be rather basic in my attempt to help you understand the language of the report.

First, there are specific adjectives that are used in radiology that give the doctor an idea "how bad" something is like a rating system from 1 to 4: minimal, mild, moderate and severe. For the first two categories, a doctor will general either ignore the finding or just decide to watch it. Moderate can fall into that category, or it can signal more of an issue and severe means severe and probably requires treatment, either conservative and/or with surgical intervention.

Second, there are two primary areas of the spine that develop stenosis: the central canal and the neuroforamen, which are the openings through which the spinal nerves leave the spine. When either of these areas gets clogged up, the amount of room available to the nerves is diminished. Result: the nerves get "squished" or compressed. This causes the pain the person feels as the spinal nerves carry pain signals out to the a compression of the L5-S1 may not produce any or minimal pain in the lower back, but the person may have pain in the 3 middle toes (L5) or the little toe (S1). The spinal nerves carry their signals in predictable patterns -- the area that is innervated by a particular nerve is called a dermatome. You can find a "dermatome map" online that will show you the typical pattern for any of the spinal nerves...makes for interesting reading and is very helpful to the doctor when trying to figure out what is the pain generator.

You will notice that at L4-L5 you have a bulging disc. It is pushing out of the disc space into the right adjoining foramina. Probably causing more of a problem is this:

[B] severe hypertrophy of the right articular facets and mild hypertrophy of the left articular facets are observed.[/B]

The facet joints are synovial joints that connect one vertebra to another. They are covered with articular cartilage and are subject to the same arthritic changes and deterioration that can occur in other synovial joints like the knee, ankle, hip, fingers, etc. Hypertrophy means sure sign of arthritic changes in the facets. I can go into much more detail about how this happens and what it means, but for our purposes suffice it to say that you have degeneration and arthritic changes going on in the facets at this level -- and this can cause instability and can cause pain.

This is the level where the doctor told you there was spondylolisthesis. I think he was basing this on what he saw on the X-ray. I'm guessing it wasn't mentioned on the radiology report because the degree of it is minimal or it just didn't show up on the MRI. (When I had my first lumbar MRI, for a year my doctor told me everything was fine. When I was still in the same amount of pain and insisted I see a spine specialist, he took one quick look at my MRI and sent me across the hall to have a flexion/extension X-ray which revealed spondylolisthesis at L4-L5. It was not obvious on the MRI, but the spine doc who was used to looking for this spotted it, subtle though it was on MRI. It was very obvious on the X-ray.) If your spondy was severe, the reporter would have mentioned it.

Moving on to L5-S1, you have some of the same things going on. There is a slight disc issue with it bulging, causing minimal stenosis in the adjoining foramina, but this time on the left side. The facets are showing signs of degenerative change. In addition [B]the thecal sac and nerve roots appear moderately attenuated with hypertrophy of the epidural fat at the L5-S1 level, as seen with epidural lipomatosis.[/B] This means that there is a slightly more than normal layer of epidural fat at this level that is having a slight effect on the thecal sac which contains the nerve roots.

I imagine the main pain generator for you is the narrowing of the foramen at both the L4-L5 and L5-S1 which is probably compressing the nerves at these levels. The problem is worse at the L4-L5 segment. You can check a dermatome chart to see if your pain runs along the dermatomes for the L4, L5 and S1 nerves, just out of curiosity! The radiology report does not specifically mention compression of any of these nerves....

In addition to my spondylolisthesis, I had severe stenosis in both the central canal and the foramen. What should have been a good sized opening in the foramina was reduced to a pin-***** sized opening. Needless to say, every time I was upright, walking or standing in particular, I was in agony. The only thing that saved me was that I had relief when I lay down. Otherwise I never would have lasted as I did before having surgery to decompress the nerves.

Hope this helps you understand your report. If something isn't clear, please ask. I never know how much detail to go into....This will help you understand the language, but the doctor may have other things to add once he really examines you and correlates it with the imaging.

Please let us know how your appointment goes.

Spondylolisthesis does not always appear on MRI. Did you have flexion/extension x-rays?

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