Question
HI, I just had an MRI done and I don't understand the report at all. I had xrays reveal a compression fracture on L5 and have had  severe pain since Dec 28th, 2008 in lower back and both legs. Sharp pains, and numbness in feet and tingles.

There is interspace narrowing at L3-4 and mildy at L5-S1. No evidence of spondylolisthesis is identified. The conus medullaris ends at about L-1. Diminished T2 signal is identified in the L3-4,L4-5 and L5-S1 intervertbral discs suggesting dis deciccation.

At L1-2 no abnormality is identified

At L2-3 there is a mildly diminished overall AP dimension of the spinal canal but no focal abnormalities are identified at this level. No disc protrusion or facet hypertophy is identified.

At L3-4 there is moderately large central focal disc protrusion causing effacement and attenuation of the ventral thecal sac bilateral formainal narrowing and nerve root distoration

At L4-5 there is a somewhat smaller but central focal disc protrusion causing lesser thecal sac distortion and foraminal narrowing at this level, compared to L3-4 mild facet hypertrophy is appreciated.

At L5- S1 there is mildly broad based but central focal disc bulging/protrusion at this level with mild bilateral foraminal narrowing at only mild thecal sac effacement centrally.

Answer
Dear Joshua,

I have copied some key phrases you have written below and every statement is followed by a brief explanation.

There is interspace narrowing at L3-4 and mildy at L5-S1:  This basically means that the discs located between the spinal levels of the 3rd lumbar vertebra and the 4th lumbar vertebra has become thinned out or has the appearance of initial degeneration.

The conus medullaris ends at about L-1:  this is where the end of the spinal cord is located which is a bit higher than normal (it usually terminates at L2).  The continuation of the spinal cord downward has a different appearance and therefore the name of the structure changes to the Filum Terminale and Cauda Equina.  This is just an incidental finding rather than a problem.

Diminished T2 signal is identified in the L3-4,L4-5 and L5-S1 intervertbral discs suggesting disc desiccation:  again initial degeneration of the disc material...dessication implies that the disc has lost some water content and is drying out.

At L2-3 there is a mildly diminished overall AP dimension of the spinal canal but no focal abnormalities are identified at this level:  the spinal canal is narrowed at this level, but does not seem to have any consequences. A-P means the anterior to posterior measurement (front to back). This is often called spinal stenosis, but in your case it is not affecting the spinal cord or associated nerves exiting the spinal cord at this level.

At L3-4 there is moderately large central focal disc protrusion causing effacement and attenuation of the ventral thecal sac bilateral formainal narrowing and nerve root distoration:  Okay...you have a disc bulge that is pressing on the front side (ventral) of the covering of the spinal cord at this level.  The bulge is straight back from the normal disk location rather than off to one side, and this is problematic because it is affecting the exiting nerve roots on both sides of the spine.  Foraminal narrowing is the name given when the holes that exit the spine are partially blocked which placed compression or irritation on the nerve roots that go through them. Foramen=hole. This can easily cause localized back pain as well as pain going down to the lower legs.

At L4-5 there is a somewhat smaller but central focal disc protrusion causing lesser thecal sac distortion and foraminal narrowing at this level, compared to L3-4 mild facet hypertrophy is appreciated:  Same as above, only not as bad at this level.

At L5- S1 there is mildly broad based but central focal disc bulging/protrusion at this level with mild bilateral foraminal narrowing at only mild thecal sac effacement centrally.  Again same as above statement.

Bottom line here is that you have generalized disc degeneration with three bulging discs that are located at the last three segments of the spine in the low back.  The nerve roots that are affected go into the lower portions of the leg below the knee.  The L4 nerve root supplies sensation to the inside portion of the lower leg.  The L5 nerve root supplies sensation to the upper and outside portion of the lower leg and some of the top of the foot.  The S1 nerve root supplies information to the outer and lower portion of the lower leg and into the outside of the heel and foot.  The pain distribution areas are called Dermatomes.  So, if you are having pain, it could be over the entire lower leg.  other things to loo for:  lass of strength in standing up on your toes or your heels...this tests the S1 and L5 nerve root for strength.  If you have loss of strength, then this is more significant.

Joshua, I Hope this helps your understanding of the problem.  I know that some of these terms may be confusing.  To help, I have a glossary section on my website with more detailed explanations of the terminology such as foramen, dessication, spinal stenosis, dermatome, etc...  Please feel free to write back if you need any further clarification.

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