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  • Big nerve
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    Hi Dr CORENMAN
    I have heard of what a great service you provide I was wondering if you could explain my lastest Mri results in easy to understand explanation as I can not undestand the report
    MRI LUMBAR SPINE
    TECHNIQUE TSE(T1 AND T2 WEIGHTED)Sequences were performed
    Report: At the L3-4 level grade iv signal change is present with a mild posterior narrowing of the disc.A right subarticular disc protusion is present,this is associated with a disc extrusion measuring about 12mmx6mm which has extented superiorly. Thecal sac is deformed on the righr side, with dorsal displacement and compression of the right L3 Nerve root. A mild dorsal displacement of the right L4 NERVE ROOT IS ALSO NOTED.Facet joint margins are thickened at this level.
    Mild posterior narrowing of the L4-5 disc is noted grade iv signal change is also present. No evidence of the disc protrusion at this level.Facet arthrosis is noted with thickening of the ligamenta flava.
    L5-S1 disc is narrowed with grade v signal change.There is irregular thickening of the endplates,Small paradiscal areas of type II signal change present. Discophytic spurring in the right foraminal region has resulted in narrowing of the vertical dimensions. Mild facet arthrosis is noted.
    upper two lumbar discs are of normal height with grade II signal change. There is a faint linear hyperintensity present in the posterior margin of the L2-3 disc suggesting a circumferential fissure.
    Central canal dimensions are adequate.Conus is at L1-2 level cauda equina defines normally.
    CONCLUSION:At the L3-4 level a right subarticular disc protusion/extrusion is noted.This has extended superiorly and measures about 12mm x 5mm in size.
    There is a mild discophytic narrowing of the right L5-S1 intervertebral foramen.
    Doctor I hope this report is not serious but it is very painful have numbness
    in the front of my thigh also my knee is achning also and my groin just throbs when I am in bed just can not get any sleep look forward to your reply thanks in advance

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    Your symptoms of “numbness in the front of my thigh also my knee is aching also and my groin just throbs” is the dermatome (nerve distribution) of the L2-4 nerves.

    Your MRI notes a large disc hernation at L3-4 compressing the L3 and somewhat the L4 nerves. This fits your current complaints. You have some other degenerative changes but your primary pain generator is most likely this large disc herniation.

    If you have pain as your only symptom and not motor weakness, then a good therapy program and an epidural steroid injection would be the first steps in treatment along with some temporary medications.

    If you have motor weakness, in my opinion, you need a surgery to decompress this nerve root. See lumbar microdiscectomy on this website.

    You can test your strength at home with these two simple tests. If your quadrates femorus muscles are weak (the ones in the front of the thigh that straighten your knee), you will know by this test. Stand next to a counter facing it and rest your hands on the counter. The hands are not to be used to hold yourself up unless you feel like you are going to fall.

    Lift up your painful leg and do 10 deep knee squats standing only on your good leg. Try to squat down with the knee bent at least 90 degrees. You will then understand what a normal response to this test is with your good leg.

    Try the same activity with your painful leg. If you have motor weakness, you will find that after one or two of these squats, you will be “stuck” and not be able to rise up unless you use your hands to help you. This is why you need to make sure the your hands are on the counter as falling down is common without additional support.

    A positive test (inability to rise up after a number of these squats on your bad leg) is an indication of motor weakness and the need to contact a spine surgeon.

    The other test is toe raises on the bad leg. If the L4 nerve is affected, you might have weakness of foot dorsiflexion (the inability to raise your forefoot up). Position yourself just like you did to test the quad muscles but this time, do 10 forefoot (toe) raises with your good leg. Then do 10 of the same with your bad leg. If you cannot complete ten with your bad leg, you have motor weakness of this muscle.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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