Question
I'm a 50 year old woman who is having migraines 5 days out of the week. I had an MRI on 06/05/2013 and one on 7/7/2014, Findings: 6 non rib-bearing lumbar type vertebral bodies are suggested on the coronal sequence, the most inferior of which is designated L5 to maintain consistency with previous study. There is levoconvex curvature of the lumbar spine centered at L3. There is approx. 1.5mm retrolisthesis of L2 on L3. Schmorl's nodes are seen at multiple levels. Vertebral body heights are otherwise maintined. A hemangioma is present within the T11 vertebral body. Bone marrow signal is otherwise within normal limits. There is diffuse DDD. The conus medullaris terminates normally at level L2. On sagittal images provided, the thecal sac anf neural foramina appear normal from the levels of T10-T11 through L1-2. On axial images L2-3: there is a circumferential disc bulge, eccentric towards the left lateral recess/left neural foramen, with subsequent mild conturing of the thecal sac. There is facet degenerative change with bilateral facet joint effusions. There is mild left neuroforaminal narrowing. L3-4: Small circumferential disc bulge with annular tear that mildly contours the thecal sac. Facet degenerative hypertrophy and ligamentum flavum thickening. Small left facet joint effusion. Thecal sac narrowed to 10mm in midline AP diameter. There is mild left neuroforaminal narrowing. L4-5: Facet degenerative change with ligmentum flavum thickening and bilateral facet joint effusions. No significant neural foraminal or thecal sac narrowing. L5-S1: Facet degenerative change with ligamentum flavum thickening no significant thecal sac or neural foraminal narrowing. Impression:  Multilevel DDD and spondylotic change with approximately 1.5mm retrolisthesis of L2-3. Mild neuroforaminal narrowing at L2-3 and L3-4. Narrowing of the thecal sac to 10mm in midline AP diameter at L3-4.
I cannot sleep laying down and can only sit up un bed to sleep for a maximum of 4 hours. My migraines are brutal. I can only relieve them with an injection of Demerol and Phenergan. I'm asking your opinion of what you would do based on this evidence. Thanks Amy Casper

Answer
Hi Amy,

Sorry to hear about your symptoms and the impact it has on your life.

The MRI findings are numerous, however, they must be correlated to specific symptoms in order to provide clinical reasoning for treatments. I know how incapacitating migraines can be. I'm not sure if this is why you must sleep sitting, or if it is because of your back. If symptoms and examination findings correlate with the discs or facets, it is possible that epidural injections or injections directed at the facet joints or discs might help. Mostly, you have described migraine symptoms. If your symptoms are multifactorial, relating to a multitude of the MRI findings, it may be possible that decompression surgery would help. These decisions should be made by a spinal surgeon and possibly an evaluation by a neurologists.

So, it is not simple to just have the MRI report and come up with the best way to approach it. Because there are many findings on the MRI, it needs to be specifically correlated with your history, orthopedic and neurologic findings, and possibly further radiological investigations if indicated.

It is often seen with findings on MRI of the lumbar spine, similar conditions in the cervical spine. Though you have not mentioned any neck pain, these type of findings are sometimes seen with headaches; although severe migraines may have other causes.

It may be helpful to see a good chiropractor to get his/her opinion.

I wish I could be more helpful, but I wish you all the best and hope you feel better.

Kind Regards,

Dr. Steve