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1. slight retrolisthesis of L1 vertebral body relative to L2. Lumbar AP vertical alightment stature and marrow signal intensity otherwise within limits.
2. Multilevel lumbar disc degeneration and generalized disc bulging at all lumbar levels, more pronounced at L1-L2. There is mild to moderate ventral sac deformity.
3. Mild central canal stenosis L3-L4, L4-L5 due to bulging discs, bilateral ligamentum flavum thickening and facet hyperthrophy.
4. Evidence of active inflammatory facet arthropathy at L4-L5 blaterally associated with small bilaterial facet joint effusions.
5. Mild bilateral neural forminal narrowing L1-L2 thru L4-L5 due to disc bulging, vertebral osteophytes, and hypertonic facets.
6. Normal appearance on conus medullaris and cauda equina.
7. Sagittal survey images reveal ACDF and c6-C7 level - multi-level cervical and thoracic spondylosis deformans.
8. Medium sized left midline disc protrusion at T11-T12 level causes mild ventral sac deformity.

Although I am somewhat familiar with some of the medical terms, I have no idea how much I should be concerned when reading my results, so I'm hoping someone on this board can give me some help! My doctor's appt at the pain clinic isn't until 4/9. I worry that I'm going to go in there and the doctor say that nothing is wrong! I am 53, and know that there are spine changes as we get older, but I have had a rapid increase in pain in the last year in the lower and mid back, as well as gradually increasing neck pain (ACDF in 2005 due to car accident). Also pain and stiffness in both hip/leg joints, right wrist, elbow and forearm. Muscle spasms in shoulders, and left arm near elbow. Tingling and numbness in fingers, hands, feet and numbness in lower left leg.

THank you for taking the time to read this - I hope someone will help me figure this out!
While it looks like there are many issues, you will note that many of them are described as "mild." In the language of the MRI report, there are standardized adjectives that are used to describe "how bad" a particular issue is. The words used are minimal, mild, moderate and severe.

Doctors tend to ignore the first two categories. They are worth noting on a report as the spine is not "perfect" but they are usually not something that will be treated. Moderate is the gray area and when something is severe, it usually ends up meaning that conservative treatments will not be able to address the issues, so the possibility of surgery is raised.

Most of your issues indicate that there are degenerative changes going on in your spine...which is not unusual for any of us beyond our 20s.

There are several issues going on at L1-L2. Retrolisthesis is a spondylolisthesis that is slipping toward the back. This is a condition where one vertebra slips over the top of the adjacent vertebra, in your case, sliding toward the back. There is also a disc bulge at this level that is pushing into the thecal sac.

There is also disc degeneration a disc bulging at all the other lumbar segments...... This is causing some stenosis (narrowing) of the central canal at L3-L4 and L4-L5. In addition to the discs, the ligamentum flavum is thickening and the facet joints at these levels are showing signs of enlargement. When the ligamentum flavum begins to show signs of degeneration, it begins to lose its elasticity and can harden, which results in it thickening. These three things go hand in hand to take up space that is needed by the spinal nerves to function normally. This causes the canal to become more narrow (just like an old iron pipe that loses is diameter due to mineral desposits and gunk that builds up on the walls of the pipe). This narrowing is called stenosis. It can occur in the central canal as it does here...

or, [B]5. Mild bilateral neural forminal narrowing L1-L2 thru L4-L5 due to disc bulging, vertebral osteophytes, and hypertonic facets.[/B]

it can occur in the neural foramen, which are the openings through which the spinal nerve exits the spine and goes out to the limbs or other parts of the body. As you see there is some narrowing of these openings at each lumbar segment starting at L1-L2 and going down through L4-L5. In your case the foraminal openings are made narrow by the bulging discs, by little bone spurs that grow on the bony vertebrae and by the enlargement of the facet joints.

The facet joints are synovial joints that are located at each segment of the spine, that link one vertebra to the next. They are subject to arthritic changes just like any other synovial joint in the body like the ankle, knee, hip, etc. as the disc degenerates, the body senses that the spine is becoming unstable, so the body begins to manufacture more bone in an attempt to stabilize the segment. This can result in osteophytes (bone spurs) and in the facet joint enlarging. That is going on here: [B]4. Evidence of active inflammatory facet arthropathy at L4-L5 blaterally associated with small bilaterial facet joint effusions. [/B] This is resulting in the joint at L4-L5 undergoing arthritic changes which are causing the joints to enlarge and to lose some of their fluid, which is occurring on both right and left sides.

The spinal cord terminates at the appropriate level and it, and the cauda equina are of normal appearance.

Then regarding the thoracic and cervical area, the report indicates that there is "spondylosis deformans," which is the growth of bone spurs (osteophytes) or bony bridges around a degenerating intervertebral disc in the spine. It is just another sign of the degenerative disc disease that is present.

I don't see anything (and, of course, I do not have formal medical training ;) ) "BIG" that jumps out and screams "This is what is causing all your symptoms." Rather, there are degenerative changes going on throughout the spine, some worse than others. Facet arthritis can be very painful, although it is harder to pinpoint than say, a herniated disc that is causing specific nerve compression.

I imagine the doctor will start you on some oral medications to help with any inflammation and pain. You may undergo a course of physical therapy to strengthen the back and core muscles that will help to support the spine, and he may want a series of epidural steroid injections. Nothing screams "surgery" to me.

Hope this gives you enough information so you will understand what your doctors tells you at your next appointment, and so that you can participate in a discussion of an appropriate plan for treatment.

Good luck.





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