Dear Ask The Doctor: Here is my MRI Report. Want to know how severe my problem is. And also want to know the do's and don'ts till i go to neurosurgeon next week. Final Report: 06-25-2010 03:55:00 PM, received from MEDITECH Report Dictated By: Lumbar Spine MRI without contrast: History: Pain. Lumbar spine MRI was performed utilizing multiplanar multi sequence imaging without contrast. There is no compression fracture, subluxation. Conus medullaris demonstrated at T12-L1. At L-1-L-2 demonstrate no discrimination. Mild facet, degenerative hypertrophy. At L2-L3 no disc herniation. Right greater than left mild foraminal and far lateral disc bulge. Mild facet, ligament degenerative hypertrophy. At L3-L4 demonstrate no disc herniation. There is mild concentric disc bulge indenting anterior dural sac. Left greater than right mild facet. Mild central spinal stenosis. At L4-L5 demonstrate moderate posterior concentric disc bulge with left foraminal and far lateral asymmetric bulge. The facet, ligament degenerative hypertrophy. Mild -- moderate central spinal stenosis. Moderate left greater than right foramina narrowing. There is no disc herniation. At L5-S1 there is broad-based moderate posterior spondylotic disc protrusion, with superimposed small left paracentral disc herniation and annular tear. The disc abuts the exiting nerve roots. There is mild -- moderate central spinal stenosis. Mild -- Moderate foramina narrowing. Impression 1. L5-S1 broad based posterior disc protrusion with superimposed small left paracentral disc herniation and annular tear. Disc abuts the exiting nerve roots. 2. Multilevel mild spondylotic disc bulge resulting in spectrum of central spinal stenosis and foramina narrowing.
Dear Patient: All the MRI findings that you described above may correspond to a nerve compression that can produce an inflammatory process affecting nerve roots (neuritis) in the lumbar region (stenosis, degenerative hypertrophy of facets and disc herniations and bulging) In the younger patients, as yourself, lumbar radiculopathy may be a result of a disc herniation or an acute injury causing impingement of an exiting nerve. In the older patient, lumbar radiculopathy is often a result of spinal canal narrowing from bone (osteophyte) formation, decreased disc height and degenerative changes due to aging process. The treatment strategy would be as follows: try to keep a proper posture, avoiding repetitive cervical and lumbosacral stress (example weight lifting), adhering to a healthy lifestyle and proper nutrition, physical activity, losing excess of weight, smoking cessation, seeking medical advice in a timely manner when indicated. During the pain crisis a physical therapy program should be followed and aimed to reduce pain and inflammation. Basically the conservative treatment of the Lumbar Facet Arthropathy is Physical Therapy aimed to recondition and stabilize the lumbar spine by re-education , teaching you a daily stretching routine for the lumbar area, strengthening of abdominal muscles, and other important general recommendations as follows: sleeping with a pillow between the knees lying on the side, avoid activities that place additional strain on the lumbar spine (example: weight lifting). All of the above, with the objective to keep you as far as possible from episodes of acute low back pain, and also to preserve your quality of life.For patients that show poor response to these measures the surgical option may be considered.