MRI results, need some input

[Swaminator]

Fellas,
I had an MRI yesterday and they emailed the report to me. But I dont see a doc for 3 more weeks so I wont know what it says until he translates it to me. Here is the synopsis...can any of you decipher it?



FINDINGS: There is a straight lumbar spine compatible with spasm. The conus medullaris appears normal. Signal generated from the bone marrow of the osseous structure is normal.

L1-L2: The disc shows normal signal intensity without evidence of posterior disc bulge, disc herniation, or spinal stenosis.

L2-L3: There is mild thecal sac indentation related to a 3 mm broad-based disc bulge. Disc dehydration is noted.

L3-L4: There is a 3 mm broad-based disc bulge with mild thecal sac indentation with slightly more bulging to the right than to the left.

L4-L5: There is mild thecal sac indentation related to a 3.5 mm disc protrusion. Disc dehydration is noted.

L5-S1: There is a right lateral disc protrusion measuring 3 mm enlarging the exiting right L5 nerve root. Degenerative disc disease is noted. There is thecal sac indentation.

IMPRESSION: 1. Multilevel discogenic disease.
2. 3 mm right lateral disc protrusion at L5-S1 protruding into the right neural foramen laterally obtunding the epineural fat.
3. 3.5 mm disc protrusion at L4-L5 with mild thecal sac indentation.
4. 3 mm disc protrusion at L3-L4 with mild thecal sac indentation

[Sammich]

It ain't good, but it doesn't sound like anything that will need surgery or the like. You should, however, start altering the way you train to take shear stress off of your spine.

[Swaminator]

Nice. I certainly dont want surgery. I have already altered my workouts. Long gone are those DEVIL t-bar rows and bent rows. Unfortunately I think my deadlift days could be gone too. I switched from squats to front squats (*note: extremely light weight for now...like 135 for 10x10). Loving the chest supported rows. This entire thing has been a complete paradigm shift for me. I used to care about moving big weights in compound movements. Now I find myself in the 12-20 rep range using more machines and isolation movements. Feel like a wussy in the gym, but at least I can walk.

[big ross]

Thanks for this post, I have to wait two weeks for the results in my knee but now I'm just going to pick it up and see what I can make out of it.

[j_neatherlin]

Fellas,
I had an MRI yesterday and they emailed the report to me. But I dont see a doc for 3 more weeks so I wont know what it says until he translates it to me. Here is the synopsis...can any of you decipher it?



FINDINGS: There is a straight lumbar spine compatible with spasm. The conus medullaris appears normal. Signal generated from the bone marrow of the osseous structure is normal.

there should be a lordotic curvature in the lumbar spine. yours is more straight than it should be. the conus medullaris is the termination of the spinal cord, before it turns into basically a bundle of nerves that continue to travel down into the lumbar spine and exit outwards towards the body.

L1-L2: The disc shows normal signal intensity without evidence of posterior disc bulge, disc herniation, or spinal stenosis.

obviously anything noted "normal" is good. stenosis is essentially the narrowing of a hole or opening. you don't want stenosis

L2-L3: There is mild thecal sac indentation related to a 3 mm broad-based disc bulge. Disc dehydration is noted.

the thecal sac is a covering around the spinal cord. indentation of the thecal sac means that the 3mm broad based disc bulge is pressing on the thecal sac and causing it to push in towards the spinal cord. the discs in between the vertebrae are like cushions...dehydration of the disc means that it's flattening out due to loss of fluid, typically related to degeneration of the disc.

L3-L4: There is a 3 mm broad-based disc bulge with mild thecal sac indentation with slightly more bulging to the right than to the left.

again, the broad based disc bulge is putting pressure on the thecal sac, cauing it to dent it, this time more towards the right. by broad based, it means that there isn't a focal area of hernation, but rather a more general bulging outwards. kind of like on a beer belly...it's going to be a broad based bulge of his belly, not a focal protrusion outwards like someone with a visible hernia.

L4-L5: There is mild thecal sac indentation related to a 3.5 mm disc protrusion. Disc dehydration is noted.

same as described previously

L5-S1: There is a right lateral disc protrusion measuring 3 mm enlarging the exiting right L5 nerve root. Degenerative disc disease is noted. There is thecal sac indentation.

this is most likely your problem. you have a disc protrusion to the right that is putting pressure on the L5 nerve root. essentially like someone stepping on the nerve root, probably causing radicular symptoms into the right lower extremity (this is an assumption on my part, most people don't go and have an MRI performed if they aren't in pain or have some kind of symptom).

IMPRESSION: 1. Multilevel discogenic disease.
2. 3 mm right lateral disc protrusion at L5-S1 protruding into the right neural foramen laterally obtunding the epineural fat.
3. 3.5 mm disc protrusion at L4-L5 with mild thecal sac indentation.
4. 3 mm disc protrusion at L3-L4 with mild thecal sac indentation

this is the interpretation of the radiologist. keep in mind that MRI studies are performed in a non-weight bearing position. when you stand up and become weight bearing, there is more compression of the spine and discs, because of the loading due to your bodyweight. it is possible that these disc protrusion and bulges get worse when weight bearing and become larger, causing more pressure on the neural structures in your spine.

[Swaminator]

thanks J Neath. Obviously you have some type of formal knowledge of MRI's and spinal health. Funny thing is after years of powerlifting I was fairly certain I had some disc issues. But generally speaking I felt very good. Recently as a result of Tbar rows and sitting on the throne at work (no joke...taking a steamer) I wrenched my low back into my right leg. I am guessing (as you also figured) its that nerve impingement thing. Now I feel like a cat on a hot tin roof, pussy footing around trying not to pop my back out of place.

Question for you...if you know. What do you think the doc will recommend? Going to a back specialist in a few weeks and I am curious if he is merely going to tell me to rest/ice it. Secondly, are these conditions ^^^ curable on their own or am I stuck with just pain management?

[j_neatherlin]

It is not uncommon that you aggravated your disc condition while on the commode. It's what is referred to as the Valsalva Maneuver or Dejerine's Sign. You are increasing intra abdominal pressure, which puts additional pressure onto the disc.

It's hard to say what the doctor will recommend...it's really an individual opinion that is based on that particular physician. If he is a more conservative surgeon, I would think he would recommend physical therapy along with maybe some injections. I don't think a 3mm disc protrusion is all that severe, so I would think he probably wont recommend surgery, at least not as an initial treatment option.

As far as whether or not this can resolve on it's own, that is also hard to say. It is theorized that many people are walking around with disc herniations and have no idea that they have any kind of disc problem, b/c they are not symptomatic. At the same time, many people are able to become asymptomatic after being diagnosed with a disc herniation, but the herniation is still there...just not actively symptomatic. What I can tell you is that whether you are symptomatic or not, you DO have a disc problem and you have to be careful, because it doesn't take much (as you already know) to make it symptomatic.

What wasn't mentioned in the MRI report was whether or not you have any kind of annular tear. An annular tear would indicate more of an acute injury. There are essentially two categories of disc herniations (I use the term herniation, but it also applies to bulges and protrusions, extrusions, etc)...acute and degenerative. An acute disc herniation is due to an injury that caused a tear in the annular fibers of the disc, allowing the nucleus of the disc to seep out into the outer ring of the disc, causing it to bulge or protrude outward. A degenerative disc herniation is a condition that is secondary to degeneration of the disc...in this case, the annular fibers weaken and the nucleus of the disc is allowed to seep into the outer layers.

The anatomy of a disc can be thought of as being like a jelly donut. There is an outer, tougher material that we refer to as the annulus fibrosus. Think of this as like a chain link fence that strongly holds together the shape of the disc. The middle of the jelly donut is the nucleus pulposus. If the annular fibers are torn or weakened, the jelly can begin to seep out.

One of the most successful non-surgical treatments that I am aware of is called VAX-D. It is a vertebral disc decompression therapy. The only thing that sucks about it, is it is not covered by insurance, so the cost is 100% out of pocket, but it is highly effective. I have seen people go through several different types of decompression therapy, but the VAX-D is far and away the most successful one that I've seen. Most of the other ones suck, in my opinion. I have actually seen pre and post MRI studies where disc herniations have resolved significantly...I even had a radiologist tell me that if he wasn't told otherwise, he would have thought that the patient had surgery...it was that dramatic.

[mister69]

Vax-d I'll have to read about it.
Good stuff

[ROB550]

I went thru VAXD 10 yrs ago....took about 6 months to get normal but had about 8 good years.

Now, no leg issues but my lower back always hurts-LOL
After vaxd i invested in an inversion table-do it about 3-4 times aweek-should get on it more, also my chiropractor has a similier Decompression unit Like a VAXD but not exactly the same, I get pulled on it about every 6 months 3 days in a week Mon-wed-Fri I feel great after that.

Little history on the VAXD I lost my legs went numb, my L4-L5 disc space-angle was at 4 degrees(normal disc space 10-15 degrees) at that time and facat joint opeings where nerves come out almost could not see them on MRI
After 6 weeks of VAXD (Being pulled 5 days a week-sat/sunday off) the spacing opened to 10 degrees but the facat joint openings were at least doubled in size which was good due to smashing my nerves.

Good luck

[mister69]

Well its good you got better!
Sent ya pm.

[Swaminator]

It is not uncommon that you aggravated your disc condition while on the commode. It's what is referred to as the Valsalva Maneuver or Dejerine's Sign. You are increasing intra abdominal pressure, which puts additional pressure onto the disc.

It's hard to say what the doctor will recommend...it's really an individual opinion that is based on that particular physician. If he is a more conservative surgeon, I would think he would recommend physical therapy along with maybe some injections. I don't think a 3mm disc protrusion is all that severe, so I would think he probably wont recommend surgery, at least not as an initial treatment option.

As far as whether or not this can resolve on it's own, that is also hard to say. It is theorized that many people are walking around with disc herniations and have no idea that they have any kind of disc problem, b/c they are not symptomatic. At the same time, many people are able to become asymptomatic after being diagnosed with a disc herniation, but the herniation is still there...just not actively symptomatic. What I can tell you is that whether you are symptomatic or not, you DO have a disc problem and you have to be careful, because it doesn't take much (as you already know) to make it symptomatic.

What wasn't mentioned in the MRI report was whether or not you have any kind of annular tear. An annular tear would indicate more of an acute injury. There are essentially two categories of disc herniations (I use the term herniation, but it also applies to bulges and protrusions, extrusions, etc)...acute and degenerative. An acute disc herniation is due to an injury that caused a tear in the annular fibers of the disc, allowing the nucleus of the disc to seep out into the outer ring of the disc, causing it to bulge or protrude outward. A degenerative disc herniation is a condition that is secondary to degeneration of the disc...in this case, the annular fibers weaken and the nucleus of the disc is allowed to seep into the outer layers.

The anatomy of a disc can be thought of as being like a jelly donut. There is an outer, tougher material that we refer to as the annulus fibrosus. Think of this as like a chain link fence that strongly holds together the shape of the disc. The middle of the jelly donut is the nucleus pulposus. If the annular fibers are torn or weakened, the jelly can begin to seep out.

One of the most successful non-surgical treatments that I am aware of is called VAX-D. It is a vertebral disc decompression therapy. The only thing that sucks about it, is it is not covered by insurance, so the cost is 100% out of pocket, but it is highly effective. I have seen people go through several different types of decompression therapy, but the VAX-D is far and away the most successful one that I've seen. Most of the other ones suck, in my opinion. I have actually seen pre and post MRI studies where disc herniations have resolved significantly...I even had a radiologist tell me that if he wasn't told otherwise, he would have thought that the patient had surgery...it was that dramatic.

Thank you for this valuable information. I borrowed a compression table from a buddy and I have been icing regularly. Its getting better (well, not as much pain)...but I would like to be able to squat and deadlift again someday. But, it might not ever happen. Not worth the back pain.