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Hello, the last time I was on this board was for my husband who has had many back problems/surgeries. Well, now it seems it is me that is having the problems. I am going to post what my lumbar MRI said. Any insight would be appreciated. Thank you!

Findings: The vertebral bodies are intact with maintained height and slightly patchy but predominantly decreased T1-weighted marrow signal. The signal remains higher than the surrounding paraspinal muscles compatible with red marrow conversion. At L5/S1 the subcortical marrow is high on both T1 and T2-weighted sequences compatible with Modic type II degenerative change. On the T2-weighted sequence there is decreased signal of the intervertebral discs compatible with disc desiccation. There is moderate to severe disc height loss at L1/L2, moderate loss of L2/L3, and essentially complete disc height loss at L5/S1. There is 3mm retrolisthesis of L2 on L3. The alignment is otherwise maintained. The conus terminates posterior to L1/L2. In the visualized portion of the abdomen note is made of a small umbilical hernia containing intra-abdominal fat.

L1/L2: A circumferential disc bulge indents the thecal sac. No spinal canal or neural foraminal narrowing.
L2/L3: A circumferential disc bulge indents the thecal sac. This along with facet joint arthropathy causes mild to moderate right and mild left neural foraminal narrowing.
L3/L4: Endplate spurs and facet joint arthropathy causes mild to moderate left neural foraminal narrowing.
L4/L5: A circumferential disc bulge indents the thecal sac. There is a small focus of high T2-weighted signal with the posterior aspect of the disc compatible with a small annular tear. This along with ligamentum flavum hypertrophy and facet joint arthropathy gives a triangular appearance to the spinal canal without significant narrowing. There is mild to moderate bilateral neural foraminal narrowing.
L5/S1: Endplate spurs and circumferential disc bulge indent the thecal sac. This along with facet joint arthropathy causes mild spinal canal narrowing. This narrowing is greatest in the bilateral lateral recess with at least abutment of the descending bilateral S1 nerves. There is moderate to severe bilateral neural foraminal narrowing.

Impression:
1. Neural foraminal narrowing is moderate to sever at L5/S1 bilaterally. Other levels as above.
2. There is mild spinal canal narrowing at L5/S1 greatest in the bilateral lateral recess with at least abutment of the descending bilateral S1 nerves.
3. Disc desiccation throughout the lumbar spine with disc height loss greatest at L5/S1 which is essentially complete.
4. Small annular tear of the L4/L5 disc.
5. Mild grade 1 retrolisthesis of L2 on L3.
6. Red marrow conversion indicates a hypoxic state of the body with differntial considerations including smoking, obesity, and anemia.

According to blood work I had last winter, I was not anemic and I quit smoking 8 years ago. I am overweight. I am confused with number 6 as far as what that might indicate.

Thank you!
It is bad enough that I would imagine you have quite a bit of pain when standing or walking, and pain radiating down the leg. It is not a situation that requires immediate medical attention, but you will probably want to have it evaluated by a spine specialist for an accurate diagnosis and plan for treatment.

Briefly, you have problems with every lumbar disc, with the last segment (L5-S1) looking like it is causing the most pain. This is an indication that there is degenerative disc disease, which just means that there are changes in the discs that occur as a result of aging, wear and tear and/or injury. A bulging disc does not necessarily cause pain. This happens when a disc is affecting a spinal nerve, which are incredibly sensitive and do not like being touched or irritated by anything.

You'll notice that the report refers several times to a "narrowing." This means that there is spinal stenosis, which can occur in two places: the central canal, and the foramen (sometimes called neural foramen). These are little openings that occur at each spinal segment, one on either side, that allow spinal nerves to pass from the central canal out to the body. Either of these areas can become narrowed, which makes less room for the nerves and can result in a nerve getting "pinched" or compressed. So, any time you see that word "narrowing" or stenosis, you can almost count on some nerve irritation or compression. It may be just a little or it can cause numbness or tingling, or severe pain.

Disc dessication is an early indication of disc degeneration. It means the disc is losing moisture, and as a result, it is no longer able to provide a cushion between the bones (vertebrae) as well as it did early on. This is mentioned in # 3...where it is noticed at all levels, worst at L5-S1 where the disc is almost flat, bringing the two bones close together, and referred to as "loss of disc height." This becomes a problem when a nerve ends up getting squished in the process. ("squished" -- a highly technical term used by lay people like myself to describe nerve compression...)

There is stenosis at L5-S1 in both the foramen and in the central canal, so you have three opportunities to have resultant nerve pain. It is described as moderate to severe on both sides, which means there is little space for the nerves to function normally. (This level usually results in what we think of as sciatic pain.)

At L3-L4, the stenosis in the foramen is caused by arthritic changes in the joints and by little bony spurs growing on the endplates...these are the ends of the vertebrae that nestle up against the disc. Again, something that shouldn't be there is clogging up the foramen....causing mild to moderate narrowing.

You will need to discuss # 6 with your doctor. "6. Red marrow conversion indicates a hypoxic state of the body with differential considerations including smoking, obesity, and anemia."

Basically as we age, red marrow is replaced with yellow, fatty marrow...this is the normal process. In your case, they are seeing yellow marrow being converted back to red marrow, which means the body, for some reason, is calling for more red marrow. In your case, since you ruled out the other two things, this may be caused by your being overweight. As to its significance, I couldn't say...but it is not a typical finding, but probably nothing much to worry about.

Because the MRI caught a bit of your abdomen, it saw a small umbilical hernia.
Thank you! I appreciate the time you took to explain my MRI. That definitely explains my sciatic pain and lower back pain overall. I have an appt with my primary this afternoon to discuss all of this, but I am glad to know more about it prior to seeing her.
Please let us know what she has to say.
Referral to a neurosurgeon. I will let you know what he says.





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