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What Does The Spine MRI Result Indicate?
Question: In 2013 I had a spinal fusion on L4-L5. Since then I have had severe lower back pain sometimes crippling, I can't do normal everyday activities. I recently had an MRI and this is the results.
L1-L2 Small posterior disc ostephyte complex without central canal stenosis or neural foraminal narrowing.
L2-L3 2mm retrolisthesis of L2 on L3, with small posterior disc bulge. No central canal stenosis or neural foraminal narrowing. Mild bilateral facet arthosis and small bilateral facet joint effusions.
L3-L4 Small posterior disc bulge and mild bilateral facet and ligamentous hypertrophy.
L4-L5 No recurrent or residual central canal stenosis or neural foraminal narrowing after discectomy and posterior fusion.
L5-S1 Small posterior disc bulge extending toward the neural foramina. No central canal stenosis. Mild right neural foraminal narrowing.
My doctor says she can't tell a definitative reason for my back pain. My pain is around the L5-S1. I can't walk for more than 10 minutes at a time. I can't stand for more than 10 minutes. Household chores like sweeping and vacuuming brings pain that I can't do anything for a couple of days. So what does all this mean?
L1-L2 Small posterior disc ostephyte complex without central canal stenosis or neural foraminal narrowing.
L2-L3 2mm retrolisthesis of L2 on L3, with small posterior disc bulge. No central canal stenosis or neural foraminal narrowing. Mild bilateral facet arthosis and small bilateral facet joint effusions.
L3-L4 Small posterior disc bulge and mild bilateral facet and ligamentous hypertrophy.
L4-L5 No recurrent or residual central canal stenosis or neural foraminal narrowing after discectomy and posterior fusion.
L5-S1 Small posterior disc bulge extending toward the neural foramina. No central canal stenosis. Mild right neural foraminal narrowing.
My doctor says she can't tell a definitative reason for my back pain. My pain is around the L5-S1. I can't walk for more than 10 minutes at a time. I can't stand for more than 10 minutes. Household chores like sweeping and vacuuming brings pain that I can't do anything for a couple of days. So what does all this mean?
Brief Answer:
Diffuse degenerative changes of the spine.
Detailed Answer:
I read your question carefully and I am sorry about the pain you are in.
That report speaks of degenerative changes of the spine at multiple levels. Degenerative spine disease is generally a diffuse condition. The fusion while improving symptoms at that particular level doesn't address other vertebrae. Furthermore because mobility at L4-L5 is now lost after fusion that means that other adjacent levels have to endure more stress and load than before which could accelerate their degeneration.
So the doctor is right in saying there is not a single lesion which could be intervened say through surgery, it's a question of chronic pain due to diffuse changes of the spine and oversensitivity of pain pathways.
You seem to have received standard treatment with pain killers, injections and physical therapy. Physical therapy is very important and you should continue it.
Spinal decompression therapy through traction can also lead to improvement in many patients.
I don't know whether you have had treatment for chronic pain with antidepressants like amitriptyline which does provide benefit in a percentage of patients.
I remain at your disposal for further questions.
Diffuse degenerative changes of the spine.
Detailed Answer:
I read your question carefully and I am sorry about the pain you are in.
That report speaks of degenerative changes of the spine at multiple levels. Degenerative spine disease is generally a diffuse condition. The fusion while improving symptoms at that particular level doesn't address other vertebrae. Furthermore because mobility at L4-L5 is now lost after fusion that means that other adjacent levels have to endure more stress and load than before which could accelerate their degeneration.
So the doctor is right in saying there is not a single lesion which could be intervened say through surgery, it's a question of chronic pain due to diffuse changes of the spine and oversensitivity of pain pathways.
You seem to have received standard treatment with pain killers, injections and physical therapy. Physical therapy is very important and you should continue it.
Spinal decompression therapy through traction can also lead to improvement in many patients.
I don't know whether you have had treatment for chronic pain with antidepressants like amitriptyline which does provide benefit in a percentage of patients.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
So, basically its not fixable? Will all this get worse? My problem is that i can't hild down a job cause i can't lift thats just to painful and lays me up for days. I am limited on walking or standing even sitting . I wake up in pain every morning. I can't find a comfortable position ro lay in, is all this normal or part of the process.
Brief Answer:
Read below
Detailed Answer:
Of course pain is not a normal condition, but unfortunately chronic back pain is a very common problem in which treatment not always achieves complete relief all the time.
The only chance to stop it from getting worse or at least slow it down is through physical therapy, medication serves only to alleviate the symptoms, while physical therapy is the one measure which can alter the course.
As I said before I have had several patients who like you didn't respond to other measures, in which traction therapy has had great results and while there are no guarantees I would recommend you to try it.
I hope you will feel better soon.
Read below
Detailed Answer:
Of course pain is not a normal condition, but unfortunately chronic back pain is a very common problem in which treatment not always achieves complete relief all the time.
The only chance to stop it from getting worse or at least slow it down is through physical therapy, medication serves only to alleviate the symptoms, while physical therapy is the one measure which can alter the course.
As I said before I have had several patients who like you didn't respond to other measures, in which traction therapy has had great results and while there are no guarantees I would recommend you to try it.
I hope you will feel better soon.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
one more thing could define the big words like ostephyte complex,retrolisthesis, ligamentous hypertrophy
Brief Answer:
Read below.
Detailed Answer:
Of course I will try:
osteophytes are abnormal bony spurs which develop in degenerative joint disease, they can irritate the surrounding structures causing inflammation and pain, at time nerve compression as well.
retrolisthesis means that the body of one of your vertebrae is displaced backwards, in your case body of L2 displaced backwards in relation to the L3. When pronounced apart from pain, it can cause compression of spine or nerves and warrant surgery but not your case.
ligamentous hypertrophy: ligaments are fibrous tissue connecting bones and reinforcing joints. A hypertrophy means increase in volume, thickening of the ligaments due to the added strain endured over the years and these thickening structures in itself can cause inflammation and pain of the surrounding structures.
Basically they are all components of the same process which we call degenerative spine disease.
I hope to have been of help.
Read below.
Detailed Answer:
Of course I will try:
osteophytes are abnormal bony spurs which develop in degenerative joint disease, they can irritate the surrounding structures causing inflammation and pain, at time nerve compression as well.
retrolisthesis means that the body of one of your vertebrae is displaced backwards, in your case body of L2 displaced backwards in relation to the L3. When pronounced apart from pain, it can cause compression of spine or nerves and warrant surgery but not your case.
ligamentous hypertrophy: ligaments are fibrous tissue connecting bones and reinforcing joints. A hypertrophy means increase in volume, thickening of the ligaments due to the added strain endured over the years and these thickening structures in itself can cause inflammation and pain of the surrounding structures.
Basically they are all components of the same process which we call degenerative spine disease.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
would an epidural injection help?
Brief Answer:
Yes
Detailed Answer:
I didn't mention epidural injections because I thought you had already tried it (I thought that was what you meant by injections in the medications tried field).
Yes epidural injections do provide substantial relief and I think you should try them considering the amount of pain you seem to be in. The short term effects are very good.
Keep in mind though that their effect doesn't last forever, it wears off during the passing weeks or months, but in the meantime, apart from alleviating the symptoms, it allows you to continue with exercises for the spine which might otherwise be limited by the pain
Yes
Detailed Answer:
I didn't mention epidural injections because I thought you had already tried it (I thought that was what you meant by injections in the medications tried field).
Yes epidural injections do provide substantial relief and I think you should try them considering the amount of pain you seem to be in. The short term effects are very good.
Keep in mind though that their effect doesn't last forever, it wears off during the passing weeks or months, but in the meantime, apart from alleviating the symptoms, it allows you to continue with exercises for the spine which might otherwise be limited by the pain
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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