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Hello,

I recently went to the dr for mild numbness in left foot in the S1 area. My doctor called and said the MRI showed a bulging disc in that area, and recommended physical therapy. I got a copy of both tests and saw some things that concerned me and that weren't mentioned by the dr. Im hoping these findings sound scarier than they are and maybe are commonly seen and thats why it wasnt mentioned to me. Can anyone help shed some light on what these results may mean?

MRI-
Alignment of the lumbar spine is anatomic. Vertebral body heights are maintained. Mild disc space narrowing and dessication is seen at L5-S1. A focal marrow signal abnormality measuring 12mm by 6mm in the axial plane is seen in the posterior aspect of the L2 vertebral body. This lesion demonstrates homogeneously increased T2 signal, heterogeneous T1 signal, and increased STIR signal. No additional marrow abnormalities are identified.
The conus terminates at L1-L2. Spinal cord caliber and signal are within normal limits. The cauda equina images normally. Mild epidural lipomatosis is noted beginning at the superior endplate of L5.
Impression:
L1-L4-no spinal neuroforaminal stenosis.
L4-L5-Concentric disc bulge is demonstrated. There is mild spinal stenosis predominately secondary to epidural lipomatosis. No significant neuroforaminal narrowing is evident. Focal bone marrow abnormality in the L2 vertebral body as described above mist likely represents an atypical hemangioma. In the absence of localizing pain over L2 or progressively worsening back pain, this can be followed with MRI in one year to confirm stability.

EMG results:

Normal NCV of both lower extremeties: Emg needle examination of left lateral gastrocnemius muscle reveals moderate chronic denervation/reinnervation which despite the normal NCV values suggests possibel S1 radicular compromise.

Please help me understand these findings.
It most likely sounds scarier than it is.

First off you have the issue in the l2 vertebral body. As it says in the report this is normally due to hemangioma, a benign tumor that can show up in the vertebrae. This is a pretty common finding in adults with between 10-15% of adults having one or more. Generally, they are asymptomatic although about 1% do eventually cause issues.

Next is mild spinal stenosis and disk bulge at L4/L5. The radiologist attributes the narrowing of the spinal canal (spinal stenosis) to epidural lipomatosis. I had to look that one up :) It's an abnormal deposit of fat on the outside lining of the spine. It is pretty rare but more predominant i men, especially those who have used steroids over a long period of time. The key word here though is "mild". There is no indication in the report that this or the disk bulge is pressing on any of the nerves that could cause issues like the numbness you are experiencing.

The radiologist notes mild disc dessication at L5/S1. The vertebrae are separated by spongy discs that are about 90% water. Dessication is basically the drying out of these discs and happens to prety much everyone over time. This dessication can lead to the disks slipping out or bulging and occasionally bursting which can cause problems, but so far that hasn't happened in your case. There are no other problems listed, so it is unlikely your problems in the S1 dermatome are due to any current disc issues at L5/S1.

Now, the EMG. That is basically indicating at some time in the past, the nerve that ennervates (gives signals to the muscle to move) the gastrocnemius muscle had some damage. This is predominantly S1 as pointed out in the study. The fact that there are no signs of *current* denervation, indicate that whatever caused the damage is likely not happening now, but in the past, and is probably "healed" now. BTW: did they test more than the gastrocnemius muscle with the needle?

You don't have a bulge at L5/S1 but rather at L4/L5 and that doesn't seem to be causing issues anyway. But, you did have some damage to S1 at some time in the past. So, how long has this numbness in your foot been there? The general rule is it takes ~4 months for chronic changes to show on EMG but that is just a guideline.

My guess, is that you had something happen that caused some nerve damage, then largely resolved leaving some sensory issues in it's wake. That something was possibly a disc issue but it appears to have resolved if that is the case since the current pathology in your spine seems largely benign. There are other possible scenarios as well. I wonder if a consultation with a neurologist may be in order to get to the bottom of this. At any rate, bottom line is that your spine seems to be in ok shape. You may benefit from PT in terms of slowing down degeneration in general, but I doubt it will do anything to help the numbness in your foot (assuming the radiologist report accurately reflects the state of your spine).

Good luck and let us know how you get on...





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