Question
QUESTION: i recently had an mri, because of lower back pain, tingling/numbness down right leg since oct, been going to the chiropractor and now going to PT, these are my mri results...my dr said its degenerative arthritis, but why did it start acting up 7 mos ago and why wont it go away?
mri results:

Findings:
There appears to be transitional vertebral body, which is sacralized and is designated as S1 for this exam.  the axial images were obtained from T12-L1 through the mid body of S2.  Study is performed as an otherwise routine lumbar spine on a 1.5 Tesla magnet.

There is some decreased T2 signal (mild) in the discs of the lumbar spine.  normal marrow signal.  No abnormalities of edema and paravertebral soft tissues are within normal limits.  There is normal alignment with no spondylolisthesis identified.

The imaged cord is normal in signal intensity and configuration.  the tip of the conus is seen at the mid body of L2.  No significant stenosis in the upper lumbar spine.  Mild facet arthropathy at L3-L4.  There is no significant stenosis seen.  At L4-L5, there is mild bilateral facet arthropathy and there is moderate bilateral facet arthropathy at L5-S1.  There is some thickening of ligamentum flavum, which results in mild stenosis of the lateral recess in the right at this level.  No significant stenosis of S1-S2.  No significant foraminal stenosis throughout the exam.  No abnormal disc protrusions.

Impression:
Transition of vertebral body designated as S1 for this exam.

There is facet arthropathy in the lower lumbar spine, which is greatest at L5-S1 on the right where it causes mild stenosis of the lateral recess.

i have no idea what any of this means nor do i know what i should do to relieve my pain...my dr was pretty vague (he is my family dr, i have not been to a spine specialist or surgeon, not sure if i even need to at this point)

any information you could provide would be greatly appreciated.

thank you so much!

kristi

ANSWER: Kristi;

Please pardon my late answer...I've been doing a lot of stuff lately!

So thank you for the entire detail of your MRI.. it makes it much easier to help you out.   First off, the numbness you feel in your leg is almost certainly due to the closure of the opening of the hole from which it exits the spine.  You are a bit different than the "normal person" in that you have a strangely shaped sacrum, the bottom bone of your spine.  

This may have led to some strange biomechanics of your low back, and may have contributed to the arthritis of your low back.

Stenosis is the choking of the opening for the nerve.  There are two ways of dealing with the problem:  One, conservatively, which means chiropractic care, PT care, and home exercises, and then there is the surgical route, which is essentially a roto rooter surgery to increase the size of the opening for the nerve.   Surgeons don't like to do this surgery until you experience "motor" problems: weakness, paralysis.  If you find your big toe dragging, or you trip more frequently, that's a bigger problem.  Numbness means that the nerve is not firing the way it should.

I'd love to spend more time talking to you about this, but I think if it were me I would look for a good DC and give their care a trial.  Would you like for me to find someone near you?  I'd be doing an Internet search, but should give you a good candidate or two to choose from.

---------- FOLLOW-UP ----------

QUESTION: Hi

Thank you for getting back to me, first off, what is a DC?

Second, why have I never had problems w/ this until this past Oct if my sacrum has been this way always?

The pain is just to the point where I cant do anything w/o ending up on the couch for a few days after I attempt to exercise or even just vaccum my house, so I need to talk to my dr about pain management or should I be referred to a spine dr, I just dont know and am very frustrated.

Thank you

Kristi

Answer
Sorry, DC stands for doctor of chiropractic... this is right up their alley.

The damage to discs is cumulative in its nature, and is the  reason most people never feel anything until middle age, typically.

My professional opinion is that you need to do SOMETHING.   I think a pain doc is a good start to break the cycle of pain, and you need something to keep it away.  I would recommend the idea of going from the least to most invasive methods, as well... do exercises and adjustments first, then look at shots and finally surgery.

I wish you the best in this!

Dr. Peter Carr
Seattle, WA