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First off, Dr. Corenman, I just want to say that your site and videos have been extremely helpful in understanding what’s going on in my spine, and helping to give me more confidence when working with my doctor and specialists. Thank you.

I have searched all over, and I am having trouble finding information about some of the things mentioned in my latest Lumbar MRI. I am in that great stage of limbo called ‘waiting for the appt to the spine specialist’, so I’m trying to use my time wisely and make sure I’m fully prepared for my appt, and have a better understanding of what’s going on. I am told they will probably do xrays, but I don’t know what they’d be looking for that didn’t show up on the MRI.

I have had back issues since 2003, and 5 MRIs since then, the latest being a few weeks ago. They have showed pretty steady degeneration, but things have gotten worse lately, and I think the MRI shows it. I also have Ehlers-Danlos Syndrome Hypermobility Type (a connective tissue disorder – I’m very bendy and have joints that dislocate or sublux), and bilateral hip dysplasia. I have been told before that I was not a candidate for surgery, but as things have progressed, I want to make sure nothing is overlooked to be able to get help with this. I’ve had many years of PT, a soft band/brace, epidural shots (did not help), and too many medicines over the years. Until about a year ago, I walked with forearm crutches to help with pain and hip dislocations, but after years of that, I developed shoulder dislocations, so that is no longer an option.

Here’s the MRI from this month. There are many phrases in here I’ve never seen, or at least never seen in my previous reports.

Findings:
Five lumbar-type segments are assumed, S1 is a trapezoidal shaped vertebral body, there are minimal partial lumbar features suggested on the right. There is a small S1-S2 disc. Inferior tip of the conus medullaris is positioned at the interior L1 level. There is a L1 cavernous hemangioma. Focal marrow fat versus a small cavernous hemangioma is present at L3. There is slight dextroscoliosis, apex at approximately the L4 level.

There is a decrease in T2 and STIR disc signal at the L3-L4 through L5-S1 levels, decrease in the disc height is also present at the L4-L5 and to a lesser degree L5-S1. No spondylolysis or significant spondylolisthesis is seen.

At the T10-T11 through L1-2 levels, the central spinal canal neural foramina are adequate on sagittal views. There are minimal disc bulges.

At L2-L3, there is a minimal disc bulge. The central spinal canal and neural foramina are adequate. There is a slight prominence of facet joints and ligamenta flava.

At L3-L4, there is disc bulge. A central and right paracentral annular fissure is present, disc is contained by the posterior longitudinal ligament complex. Minimal subligamentous extension of disc along the posterior aspect of L4 suggested. There is mild effacement of the ventral thecal sac, no significant central spinal canal stenosis or significant neural forament encroachment is seen. The left neural foramen is mildly narrowed. Facet joints and ligamenta flava are mildly prominent, there is slight facet degeneration.

At L4-L5, there is diffuse disc bulge, superimposed, there is a broad-based left lateral and far left lateral disc protrusion – osteophyte plaques versus asymmetric left sided disc bulge. There is a mild relative narrowing of the central spinal canal without significant central spinal canal stenosis. Lateral recess narrowing is present at the on the left without marked encroachment on the region of the L5 nerve root. There is moderate narrowing of the left neural foramen. Correlate for L4 and/or L5 radicular findings. The right neural foramen is mildly narrowed.

At L5-S1, there is there is a right paracentral and lateral broad-based disc protrusion. This effaces the ventral aspect of the thecal sac centrally and on the right. There is blurring of perineural fat at the ventral-medial margin of the right S1 nerve root, correlate for right S1 radicular findings. This finding is not described on the prior report (prior outside lumbar sine MRI report from Polyclinic dated 12/14/20058 describes centralized disc bulge without any effect on nerve roots L5-S1). Correlate for possible right S1 radicular findings. Neural foramina are mildly narrowed without significant encroachment seen on the exiting L5 nerve roots. There is mild facet degeneration.

Visualized paraspinal muscles appear unremarkable. There is a nonspecific subcutaneous dependent edema signal.

There is fluid signal in mildly prominent small bowel (up to 2.4 cm in diameter), projecting to the left of the left psoas muscles at the L3-L4 level. Other visualized small bowel is nondilated. This lumbar spine MRI study is not a diagnostic evaluation of the small bowel. Suggest correlation.

Impression:
1. Right paracentral and lateral disc protrusion at L5-S1 with some mild effacement of the right S1 nerve root, correlate for possible right S1 radicular findings. Findings are superimposed on degenerative disc disease at this level.
2. Degenerative disc disease at L4-L5, there is an annular fissure component. The left neural foramen is moderately narrowed. There is some lateral recess narrowing. See discussion in the Findings section.
3. Degenerative disc disease at L3-L4 with disc bulge, a small annular fissure is present. No significant encroachment on the neural structures identified.

If it helps, here is my report from 2008:
At T12-L1, mild bulging annulus and facet hypertrophy.
At L1-2, mild bulging annulus and facet hypertrophy.
At L2-3, mild bulging annulus and facet hypertrophy. There is a small disc bulge into the left foramen without any definite effect on the nerve roots. There is a signal change in the L1 vertebral body suggestive of a benign vertebral hemangioma.
At L3-4, there is a mild broad-based disc bulge with facet and ligamentous hypertrophy. There is mild foraminal stenosis. There is mild central canal stenosis.
At L4-5, there is a mild broad-based disc protrusion. There is facet and aligamentous hypertrophy. There is mild foraminal stenosis bilaterally and mild central canal stenosis.
At L5-S1, there is a centralized disc bulge without any effect on nerve roots. There is facet hypertrophy present. There is a mild foraminal stenosis bilaterally. Sacrum appears grossly intact.

And one from 2005, to show progression:
At L1-2, disk height and signal appear well preserved, with no evidence of significant disc herniation or stenosis.
At L2-3, disk height and signal appear well preserved, with no evidence of significant disc herniation or stenosis.
At L3-4, there is a disc desiccation, though disc height is well preserved. Mild circumferential disk bulging has not changed significantly in the interim, though the posterior anular tear does appear more conspicuous. No evidence of significant central canal or foraminal stenosis.
At L4-5, the disc is desiccated, with minimal disc height suggested. This has not changed significantly in the interim. Mild increase in the circumferential disc bulging is suggested, with greater conspicuity of central canal or foraminal stenosis.
At L5-S1, there is a disc desiccation and mild interim loss of disk height. New small posterior central broad-based disc protrusion does not cause significant central canal or foraminal stenosis. It does not appear to cause mass effect upon the descending S1 nerve roots. Moderate bilateral degenerative changes of the facets have not changed significantly.

Any insight to the latest reading or anything that sticks out as something I should make sure to ask the specialists about, would be so helpful. Thank you again.

Dear Dr Corenman,

Thank you for a most excellent and informative website and forum.

I have been suffering from sciatic pain down the back of my right leg for about a month now. I have had backache issues over many years. The pain comes and goes but has been better over the last year or so since I started working out and losing weight. My backache was mainly lower back, right of centre.

PAIN / PERCENTAGE / INTENSITY / WEAKNESS
The sciatic pain starts at the right buttock, down the hamstring, behind the knee and down the calf. The pain is not at all those areas at the same time, but is often at the hamstring area and at the other areas mentioned down the leg at different times. Pain is most prominent when I stand up after sitting down. There is a sharp pain mostly at the hamstring area and I have to clutch it tight for almost 15 – 20 seconds in order to calm it down. Once the pain subsides, walking is only mildly painful, although there is sometimes a slight pain / pull. There is no lower back pain. The pain, therefore is around the 70 (buttocks / hamstring) / 30 (leg) range. I do not feel I have any numbness on the soles of my feet. I may have a slight weakness or limp but that, I feel, is more due to the pain.

I cannot bend forwards to touch my toes without there being a sharp pain down the right leg. I can’t keep my right leg straight when I bend as such. Coughing or sneezing results in a sharp shooting pain mostly in the hamstrings area. I would say the pain using the VAS scale is around 6 -8 when I first stand up after sitting down or when I have moved into a twist or a position that stretches the leg in a way I cannot do so for now. Therefore, the pain is sharp at that stage.

Sitting is not very painful, although the hamstring area still has some bearable pain. There is just the discomfort factor.

ACTIVITIES
Until about 10 days ago I was running at a slow pace on the treadmill. It got progressively more painful so I have had to stop that. I still try to cycle (stationary), which is more manageable and walk. I have also now started some swimming.

TREATMENT
When the pain first started, I went to see a physiotherapist a few times, for TENS, ultrasound and heat massages. These help but only briefly. I then went for an MRI, the results of which are :

– Straightening of the lumar lordotic curvature. Small marginal osteophytes seen at multiple levels.
– Minimal retrolisthesis of L5 vertebral body.
– Degenerative disc desiccation seen at multiple levels. Mild left foraminal disc portrusion at L3-L4 and L4-L5 level, indenting the ventral thecal sac and compressing left exiting L3 nerve.
– Marked right paracentral disc extrusion at L5-S1 level, effacing ventral epidural fat planes, attenuating the right lateral recess and markedly compressing right descending S1 nerve with moderate compression of right exiting L5 nerve as well. Mild bilateral foraminal compromise also noted at this level.
– Tarlov’s sacral cysts noted at S2 vertebral level.

The conclusion of the MRI is :
– Mild left foraminal disc portrusion at L3-L4 and L4-L5 level.
– Marked right paracentral disc extrusion at L5-S1 level.

I went to see a neurosurgeon about the MRI findings and I was told that the extrusion at L5-S1 means that a part of the disc has “broken away” from the disc and it is that extruded part that is compressing the nerve and causing the sciatic pain.

I was advised the options I have are conservative to start off with (medication), and if not successful then injections and finally surgery.

A week ago I was put on Gabanerve (Gabapentin – 300mg & Methylcobalamin – 500mcg) Tablets, twice a day. I have had no significant benefit in terms of pain reduction and I have now been advised to take Lyrica 75mg twice a day instead of the Gabanerve.

I am also still seeing the physiotherapist a couple of times a week.

I would respectfully request your opinion or advice on the above. The pain has “taken over my life” and I cannot enjoy the things I used to. I can send you a couple of pictures of the MRI scan showing the extrusion at L5-S1 if you would like to see them.

Thank you very much indeed.

I was recently got over a 3 month painful bout of cervical radiculopathy in the left arm. After 3 months I had about 1 month almost pain free up until last week. My arm pain is back at about 40% of what it was initially. I am taking ibuprophen again and scared to death it will come back to full blown pain. I have not had any surgeries as I would like to try to recover as naturally as possible. My mri…

No abnormalities of the cervical spinal cord. Reversal of the normal lordictic curvature centered at c5 . Slight narrowing of c5-6 disc space and mild narrowing of c6-7 disc space is noted with disc desiccations.

C2-3 no central canal stenosis or neural foraminal narrowing defined
C3-4 no central canal stenosis or neural foraminal narrowing defined
C4-5 slight central canal stenosis and neural foraminal narrowing related to disco- osteophytic protrusion and ligamentous and osseous hypertrophy.
C5-6 moderate central canal stenosis asymmetric to the right, mild to moderate right neural foraminal narrowing and mild left neural foraminal narrowing related to disco- osteophytic protrusion and ligamentous and osseous hypertrophy.
C6-7 mild central canal stenosis and neural foraminal narrowing related to disco- osteophytic protrusion and ligamentous and osseous hypertrophy.
C1-t1 no central canal stenosis or neural foraminal narrowing are defined.
Impression: multiple levels of central canal stenosis and neural foraminal narrowing most prominent at c6-7.
Mild degenerative changes from c5-7 more prominent at c6-7
Reversal of normal lordotic curvature centered at c5 and can be associated with muscle spasms. No abnormalities of the cervical spinal cord or compression fracture or bone marrow replacement.

My pain hops all over but mostly in my forearm, and wrist. index finger is totally numb. I do over the door traction, and some exercises with resistance bands. I also try to go to the gym 3 days a week to walk or bicycle. I feel like I am doing everything right. But pain is back and I don’t understand why. What is the prognosis of this type of thing and is reoccurring pain normal? Also my mri say asymmetric to the right but pain is on my left. I am not sure how to manage the pain. I don’t tolerate pain meds well. i use tens and OTC and cry a lot. I’m 37 and used to be active.