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Options after MRI
Jun 27, 2013
I just got my MRI results and after going over them with my Dr. along with the work restrictions he suggested and I am considering going on leave from my job for about a month to do the PT, steroid shots and nerve conduction testing needed.
Here's the results from the MRI:
Findings: There is L4-5 anterolisthesis. The L4 pars apear to be deficient and pars defects are suspected. No acute fractures, aggressive osseous lesions are identified. The conus and the cauda equina appear unremarkable, and no paraspinous masses are grossly evident. On axial image #5, sagital image #8 there is a 12mm X 12mm oviod fluid signal intensity lesion which is located along the posterior margin of the right L2-3 facet joint complex that has homogeneous increased T2 signal and T1 hypointense signal, most likely reflecting a synovial or ganglion cyst.
At L4-5 there is disc desiccation with loss of disc height with a mild disc bulge resulting in mild foraminal narrowing. There is a small punctate left paracentral high intensity zone. There is no significant facet arthropathy.
At L5-S1, disc desiccation is present. There is a very small paracentral disc protrusion with high intensity zone which comes into close proximity with the proximal left S1 nerve root.
Impression: L4-5 grade 1 anterolisthesis, most likely secondary to suspected bilateral pars defects with intervening advanced degenerative disc disease.
L5-S1 degenerative disc disease with a very small left paracentral disc protrusion with high intensity zone which slightly contacts the proximal left L1 nerve root.

Am I over-reacting to this or am I going in the right direction?
Have you had a flexion-extension x-ray to check that the anterolisthesis is stable or unstable?

What type of doctor ordered the MRI? I hope you are seeing a spine specialist. If not, at this point, now that you have the MRI results, and can see that there are several issues going on, it would be a good time to find one. This would be either a fellowship-trained orthopedic spine surgeon or a neurosurgeon whose practice is limited to the neck and back.

You can get going with the PT while waiting for an appointment as this will probably be the first thing any doctor will suggest.

It depends on what type of job you have...but quite frankly, one month won't be enough time to accomplish the things you mentioned. ESIs have to be at least ten days a part and are usually not given that close together. And physical therapy usually goes on longer than a month.

As to the MRI, the anterolisthesis is a spondylolisthesis which is slipping forward (toward the interior of the body). This can be a situation that has moved, but is no longer unstable...or, it can be active and has the potential to move further...the MRI indicates the amount of spondylolisthesis as being Grade 1 which means from 1 to 25%.

There is degenerative disc disease at L4-L5 and L5-S1, with small disc bulges. The one at L5-S1 is probably coming in contact with the S1 nerve root on the left side.

At the L2-L3 level there is a lesion that the reporter suspects is a cyst...and this should probably be investigated further to find out for sure. These are almost always benign and usually are not a cause of pain.

Only you know the circumstances of your life...but I wouldn't think you'd need to miss a month of work for treatment unless you aren't able to take time off from work for appointments.

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