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Spinal Cord Disorders Message Board


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I'm a 39 year old male. Probably abouty 4 to 5 stone overweight, mostly put on gradually over the past 10 years or so. Borderline Type 2 diabetic.

I have been struggling with a bad back on off for 15 years. Nothing too bad.

About 5 months ago my back got very bad with pain one day when on the treadmill ( I have been trying to lose weight ) and I could feel some sudden numbness and tingling on the inside of my left foot (inside and top of big toe and underside of left foot). Wasn't better much after a month and so went docs. Usual anti inflammatory and pain killers from GP, come back if no better etc etc. Went back 2 months later and GP referred me to a back specialist, who ordered an MRI scan 2.5 weeks ago.

MRI results come through in post today ....... can anybody please translate this into English for me!??!?

MRI Spine cervicothoracic : See below
MRI Spine thoracolumbar :
There is moderate loss of disc height and hydration at L4-5 and L5-S1. Slight loss of normal lordosis. Normal conus medullaris and cord. The higher lumbar discs and facets are normal.
Moderate central bulging L5-S1 with slight bilateral impingement on the transiting Si nerve roots. Minor facet arthrosis.
L4-5 shows a large inferocentral disc extrusion impinging on the anterior thecal sac and transiting L5 nerve roots. There is slight bilateral lateral recess narrowing
There is a slight long curve thoracolumbar scoliosis convex to the left. Normal epidural space. Moderate degenerative endplate change L4-5. No significant abnormality on fat-suppressed imaging. Normal cervical medullary junction. Slight loss of normal cervical lordosis with moderate disc degeneration and slight bulging C5-6 and C6-7 just impinging on the anterior thecal sac. The upper thoracic discs are normal.
C2-3 shows moderate broad disc osteophyte. C3-4 shows extensive broad disc
osteophyte with right foraminal osteophyte impinging on the right C4 nerve root.
C5-6 shows shallow disc osteophyte.
C6-7 shows moderate right lateral disc osteophyte impinging on the anterior thecal sac and right C7 nerve root
C7-T1 shows moderate left lateral disc osteophyte impinging on the anterior theca! sac and left C8 nerve root.

Many thanks

John
It helps to know just a bit about basic spinal anatomy. Your spine consists of bony vertebrae that protect the spinal cord and nerve roots. The vertebrae are separated by spongy disks that allow movement but provide cushioning. The discs are made of about 90% water, and over time they can dry out leading to loss of disc height. This can make the discs easier to herniate (push out) or can lead to the vertebrae rubbing on eachother causing bone spurs or osteophytes. These herniations and/or osteophytes can move into the space behind the vertebrae where the spinal cord is located and compress the cord or the nerve roots or move laterally and impact the nerve roots where they exit the vertebrae to provide sensory and motor pathways to the muscles of the body. The spine is generally broken into sections, cervical (first 7 vertebrae), thoracic (next 12), lumbar (next 5), sacral (next 5), cocyx (last 4), the last 9 being fused. There is also a natural curve to the spine known as lordosis.

In your case, you have a slight loss of lordosis in both the lumbar and cervical regions. This could be due to postural issues or other things but probably isn't an issue at this point.

In your cervical spine from the top down you have :
C3/C4 - pushing right into the space and impinging the right nerve root at the exit from those vertebrae (cervical nerve roots are C2 - C8, labelled for the bottom most vertebra where the exit)

C5/C6 - disc bulge impinging the thecal sac which is the sac surrounding the spinal cord filled with cerebral spinal fluid.

C6/C7 - osteophyte impinging on thecal sac and the right exiting nerve root (C7 root).

C7/T1 - osteophyte impinging on thecal sac and left exiting nerve root (C8 root)

You don't mention symptoms in your upper body which is where you'd expect to feel any issues stemming from compression of the cervical nerves. Also, the radiologist doesn't give any indication as to how bad the "impingement" is. Impingement can mean "encroaching on" as in getting close to or it can mean touching. It appears from the report that the radilogist is using impingement to mean "just slightly touching" but that's a guess. It's important to distinguish as nerves that are compressed are likely to cause symptoms whereas if things are approaching them, no symptoms are likely.

Now for the lumbar spine :
At L5/S1 there is a disc bulge impinging on the both the left and right S1 nerve roots.
At L4/L5 there is a disc extrusion. This means that the tough outer material of the disc has broken open and the inner material is leaking out. This bulge impinges the thecal sac and L5 nerve roots.

You have the same issue with the word "impinging" again.

You don't mention where the pain is located. If I were to guess I'd say down your leg radiating from your back. That and the numbness and tingling you felt is most likely to be caused by the disc extrusion at L4/L5. The substance that is leaking can irritate the surrounding nerves and cause symptoms like those you describe. That I would guess is your main symptom generating issue.

You also have some degenerative changes in your cervical spine. From what you describe, and what I can make out of the report, those are not causing issues now but could in the future if the osteophytes or bulges get worse.

I would suggest that you get under the care of a spine specialist . That is either a neurosurgeon or orthopedic surgeon that has specialized training in treating spine ailments and limits their practive to issues with the spine. If your "back specialist" meets that criteria, that should be fine. They can help correlate your symptoms with findings on the MRI. They would likely do their own interpretation so the vagueness of the language wouldn't be an issue. They could then recommend appropriate treatment which would likely start with conservative treatment such as PT. They can also monitor the issues that are not yet causing issues but may in the future.

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





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