Question
Recently I had an MRI of the spine...indications as follows:
IMPRESSION:
1.  Disc buldge and degenerative changes, most pronounced at L5-S1. There is mild central canal narrowing and mild narrowing of the neural foramina bilaterally.
2.  1.4 cm heterogeneously-enhancing intradural oval mass inferior to the conus medullaris, which may represent an ependymoma or meningioma.

I have diffused osteoarthris, which i take percocet every four hours two tables...without this i cannot walk.. the pain now is acting as if it is going up the spine and I have a hard time breathing.. Plus now I am experiencing bowel problems.. constipated and a thickening in my bowel region..the pain wakes me up during the night even with the percocet.  Memory loss and headaches...

could you please give me your medical thought on what the mri means.. I went to a neurologist who could not even open up the cd disc to read the mri told me i had to lose 100 pounds and i weight 198....plus he said ohh just come back in three months.. it is progressively getting so bad.. i have pain in the legs always and before.. but no sciatic nerve pain or numbness.. just weakness in bilateral lower legs and ankles.. thanks so much.....

Answer
Dear Pamela,

Sorry to hear about your experience with the Neurologist, but it doesn't surprise me...I hear stories like that weekly.

MRI:  
1.  The lowest disk in your spine has bulged backwards into the spinal cord and the nerve roots that exit on the right and the left side of the vertebra.  Unfortunately, the report does not distinguish whether the bulge is the source of the encroachment or the degenerative changes (arthritic changes) are responsible for the problem.

2.You have a tumor in your spinal canal of 1.4cm in size...the location is lower than the L2/L3 vertebral level...that is where the conus medularis is located in the spinal canal, it is the termination of the spinal cord where it turns into a tail like whip of spinal nerves called the cauda equina. The tumor has identified as derived from neurological tissue...the meninges are three layers of tissue that surround the spinal cord and keep the cerebral spinal fluid in place. A meningioma is a slow growing tumor that arise from a tissue called mesenchyme, and are more prevalent in females, and can be cancerous. The layers are called the dura, arachnoid, and pia matter. Ependymal cells line the compartments of CSF in the brain and spinal cord and are responsible for the CSF production.  These tumors are benign and slow growing, and are the most common tumors found in the spinal cord.  They are also most commonly found in the low back.

So, now what...the increased symptoms you are experiencing is due to the pressure being exerted on the spinal cord in my opinion.  There is a syndrome called cauda equina syndrome in which the hallmark is the loss of bowel and bladder function or significant irritation due to compression of the cauda equina nerve plexus...this is serious and should be followed by with by a neurosurgeon, not a neurologist.  Additionally, pain that wakes you up at night is always regarded as severe, and is a primary red flag fro cancerous conditions.  the headaches are Likely due to the increased pressure in the CSF fluid reservoirs...commonly produces headaches.

Bottom line, you need to find a good neurosurgeon, and get a consult immediately.  This needs to be followed-up with now while the tumor is small, and before it progresses.  If you require surgery, the good thing is that they can additionally clean up the disk bulge (diskectomy), and remove the arthritic formations at the same time.

Concerning the weight issue, I would agree that you need to lose weight, but 40-50 pounds would be sufficient to reduce gravitational load on the lower disks...obviously it will do nothing for The tumor.  Moreover, improving vertebral movement will reduce the progression of arthritis, and help disk health, but the tumor needs to be the primary focus at this point.  Make the appointment.

Best of luck to you Pamela, and feel free to follow-up with me if you need to.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net