QuestionHi, I would greatly appreciate an interpretation of these two MRI reports in "layman's terms". I have had chronic back/neck pain for many years - even prior to the date of these reports (01/24/04), and have received chiropractic care on two separate occasions. I would have to assume that surely my condition(s) have worsened in the past (almost) six years since then.
Insurance company won't approve a new MRI and the neurologist will not see me until I have a recent one. I guess I'd just like to know what spine problems I am dealing with, and the possible causes, and what the likely prognosis will be. Thanks so much for your time and expertise.
__________________________________________________________________
Patient gender: Female
Date of Birth: 05 04 1972
Date of MRI: 01 24 2004
__________________________________________________________________
Examination: MRI lumbar spine wo contrast
Clinical Indication: Neck and lower back pain.
A nonccontrast MRI examination of the lumbar spine was obtained.
The lumbar vertebral bodies are normal in height, signal, and alignment. There is mild loss of disc signal at L4-5. The conus terminates at the mid-T12 vertebral body level and is unremarkable. There are superior endplate Schmorl's nodes of T12 through L2. The axial images demonstrate the following:
At L2-3 there is a mild diffuse disc bulge leading to minimal central canal narrowing and no significant neural foraminal narrowing.
At L3-4 there is no significant disc bulge or protrusion.
At L4-5 there is a posterior annular tear. There is a mild diffuse disc bulge and ligamentous flavum hypertrophy leading to mild central canal narrowing and no significant neural foraminal narrowing.
At L5-S1 there is no significant abnormality.
Impression: Disc bulges at L2-3 and L4-5. No evidence of disc protrusion.
__________________________________________________________________
Patient gender: Female
Date of Birth: 05 04 1972
Date of MRI: 01 24 2004
__________________________________________________________________
Examination: MRI cervical spine wo contrast
Clinical Indication: Neck Pain
A noncontrast MRI examination of the cervical spine was obtained.
There are no prior MRI examinations of the cervical spine for comparison.
The cervical vertebral bodies are normal in height, signal and alignment. The intervertebral disc height is preserved. The visualized prevertebral soft tissues and posterior fossa structures are within normal limits. The cervical spinal cord is normal in signal and caliber. On the sagittal images there is no abnormality at C2-3. The axial images demonstrate the following:
At C3-4 there is a small right paracentral disc protrusion which indents the ventral thecal sac but does not touch the spinal cord. There is no significant central or neural foraminal narrowing.
At C4-5 there is a mild bilateral uncovertebral hypertrophy without significant central or neural foraminal narrowing.
At C5-6 there is a small central disc protrusion which indents the ventral thecal sac but does not touch the spinal cord. There is no significant central canal narrowing. There is no significant neural foraminal narrowing.
C5-7 and C7-T1 are unremarkable.
Impression: Small disc protrusion at the C3-4 and C5-6 as described above.
AnswerDear Karen,
Neither the lumbar or cervical MRI are really that bad from what is described because the nerve roots that exit the spine are not being impinged or encroached in any way. However, 1. You have degenerative changes to the joints and disc bulges in the neck, 2. The disk bulges in the neck to touch the outer covering of the spinal cord (thecal sac) which can create inflammation or irritation of the neck, 3. You have degeneration of the disks in the low back as well as bulging in two areas and a tearing of the outer portion of the disc at the lumbar level of L4-L5. This can result in broad based low back pain...usually without any radiation of pain down the legs. Just as an aside [loss of signal intensity] usually means that the disk is losing it's water content=drying out and getting thinner=degeneration.
All of the findings you have can be present in a person who does not have pain, so they need to be clinically correlated with the types of pain you experience as well as the distribution of that pain. For instance, disc neck pain can refer to the neck, upper back and shoulder areas but in a broad diffuse pattern...conversely if the nerve root exiting the spine is irritated and inflamed, the pain will follow a predictable patter down the arm and possibly into the hand and fingers depending on which nerve root is affected. Moreover, the MRI only tells us a small portion of the story...what does the skeletal structure look like when under gravitational load...because laying on a table to get an MRI only shows gross pathology and does not show us anything about how the neck functions in a weight bearing gravitational environment. A standing x-ray projection would give us that information, but is not good for looking at the disks... everything has its place. Lastly, a functional orthopedic and neurological examination will give us even more information on the function of the neck... Obviously this applies to the low back as well.
Ok Karen, other things to consider are your daily movements, level of physical activity or inactivity, diet, work postures, etc... all of these lifestyle factors are extremely important to address, as they may be the exact cause of your pain and the pain may have nothing to due with the underlying spinal issue. Every bit of this information must be considered in context to your symptoms and dysfunction... not sure the doctors you have seen are doing this.
Final point...you want to see a neurologist, why? What are they going to do... if you have neck and back pain without radicular pain (into the arms and legs), numbness tingling, loss of sensation etc... the neurologist will do nothing more than prescribe pain meds. If the pain does radiate down the arms or legs, then they may perform an NCV (Nerve Conduction Velocity) which tells us how the nerves are firing impulses to the body. If the nerve firing has been disrupted, meds, injections, and neurosurgical referral all may occur. Now if you meant to say neurosurgeon, then the MRI is absolutely necessary for evaluation to determine if any of your current issues can be addressed with a surgical intervention. But I must tell you, I see many patients with worse spinal pathology than yours who do not need surgery or medication, and become pain free in about 6 weeks with chiropractic and spinal rehab...obvioulsy some do need surgical intervention and they are referred for consult, but most do not. The key is that it has to be applied according to the individuals presentation. Some chiropractors adjust everybody the same on every visit...some get better others don't. Some chiropractors do not incorporate rehab, and some chiropractors do not look at you purely from a structural perspective or a functional perspective when in reality you need both evaluated. My point here is that I have no information on how you were previously examined or treated and often that is the key to effective management, pain reduction, and increased bodily function. My partners and I often see patients in our office that did not get better from previous chiropractic care because it was applied non-specifically or inadequately...it's not that the previous doctors are dumb or lazy, they just had a different approach that didn't work in that case, and this can be true of any doctor in any discipline.
Try to find a doctor who will look at this from all angles and is willing to work with others as you may need a combination of chiropractic, medicine and surgery for full recovery, but the first step is to find someone who will first evaluate the case without bias and identify what the problem is specifically. Is the problem from within the anatomy of the spine or from your environment causing stress on the tissues of the spine?...there is a difference. Hope this helps and good luck.
Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net
