What Does This MRI Report Indicate?

Posted on Mon, 28 Dec 2015

Question: I Have been having Lower back pain which goes to Legs & buttocks. The lower back is mainly on right hand side but it goes to left side as well. I am currently taking vitamin supplements as Calcium, Magnesium, D3, C & B Complex.
The pain sometimes is too much that I have to lie down to relive it. I am not carrying any wait more than 3-4 killos if I have to.
The pain started approx. 4 weeks ago but it is still there it is not going at all.

I had an MRI of the Lumbar spine which I have attached with this query.

Please suggest what will be the next step towards my treatment. Doctors here in Australia have suggested painkillers such as Ibuprofen which I have been taking but soon as I go off them the pain comes back. I am tired of it now.
Kindly suggest what to do next, MRI is attached.

Answered by Dr. Ajay Panwar (2 hours later)

Brief Answer:
MRI is not visible here.

Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.

I have gone through the MRI films you have sent. MRI shows disc bulges at L1-L2,L4-L5 and L5-S1 levels.Though,these do not appear to cause significant foraminal stenosis but there appears to be slight compression on right exiting nerve root at L5-S1 level. Apparently, pain is classically radicular in origin.So,it will be taken that radiculopathy secondary to the disc changes is the cause of the pain.

Treatment plan -
1)Physiotherapy and posture training-Regular spinal exercises and effective posture training is the core component of the treatment.I suggest you to refer to an expert physiotherapist for having a proper training on exercises and posture.You need to be regular on this component on the management plan.
2)Medicines-
Antineuralgic medicines like Pregabalin,Gabapentin,Amitriptyline or Duloxetine will help ease off the pain from nerve compression.

Additionally,calcium/vitamin D and methylcobalamin supplementation should be taken.

Hope that I have answered your query.If you have some further questions,I shall be glad to have you in follow-up.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajay Panwar (12 minutes later)

Hi Doctor,

Thanks on replying so quick. Just a quick question how long will I have to go for Physiotherapy and does heat or Ice pack help in pain reduction?

Will Physiotherapy alone with the medications will treat my condition and would there be a pain always in future just a bit worried as I am planning to have second baby by end of next year??

Thanks
Hi Doctor,

I am planning to got to a Physiotherapist tomorrow but could you please help me in replying to the above question

Thanks

Answered by Dr. Ajay Panwar (2 hours later)

Brief Answer:
Exercises should be a part of regular daily routine.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

You should adopt spinal exercises as a part of your routine life,now onwards.Its better if you continue them for ever,unless you are told not to do them by a doctor.These exercises will strengthen your back muscles and other supportive structures,thus providing stability to your spine and discs,and hence preventing further damage.

Heat therapy and Ice packs indeed, are effective techniques to reduce pain.
Physiotherapy along with medicines,gradually will reduce your symptoms,to a significant extent.
There should be no problem,for you to have a baby.

Hope that I have answered your query.If you still have further queries,I shall be glad to have you in follow-up,else please close the thread,rate it and write a review.

I shall be glad to track your future clinical progress.So,please get back to me if you have any query in future,as well.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajay Panwar (6 hours later)

Hi doctor

I have one more question to ask if thiocolchicoside can be taken regularly with ibuprofen for pain reduction, would that be helpful?

Thanks

Answered by Dr. Ajay Panwar (5 hours later)

Brief Answer:
It can be taken regularly for a few days,and then on sos basis.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

Yes, Thiocolchicoside can be taken regularly with ibuprofen for a few days,and then on sos basis(at the time of pain).It will help to ease off the muscle spasm and pain.

Hope that I have answered your query.If you have some further questions,I shall be glad to have you in follow-up else please close the thread,rate it and write a review.

If that's for the day from your side,please get back to me in case,you have any query in future as well.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajay Panwar (24 minutes later)

Hi doctor

Thanks. I do take Sertraline from past couple of years for depression and anxiety. Does taking this and thiocolchicoside and ibuprofen causes adverse reaction since I have read that Zoloft and ibuprofen when taken together can let internal bleeding

Thanks

Answered by Dr. Ajay Panwar (5 minutes later)

Brief Answer:
You should avoid ibuprofen with sertraline.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

You should avoid taking sertraline with ibuprofen as they may rarely cause upper gastrointestinal bleeding when taken together.They may also result in abdominal pain,if taken together.

Instead of Ibuprofen/Thiocolchicoside, regular antineuralgic medicines(pregabalin,gabapentin,amitriptyline or duloxetine) along with opioid medications(like Tramadol,Tapentadol) on sos basis can be taken.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajay Panwar (1 hour later)

Hi doctor,

Just a quick one can Thiocolchicoside with panadol be taken with Sertraline instead of ibuprofen.

The only thing I am concerned is I might not be able to get anti neuralgic medications without a neurologist prescription in Australia. My appointment with him is not until end of January.

Waiting on your reply

Thanks

Answered by Dr. Ajay Panwar (17 hours later)

Brief Answer:
Yes.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

Its a 'Yes' for this one. Thiocolchicoside with panadol be taken with Sertraline.
No serious interaction.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajay Panwar (47 minutes later)

Hi Doctor,

Thanks for replying. I have found out today from my MRI written report from the doctor here is that I have bulges just at L1 and no where else and no nerve compression. I have attached my One page report for you to review. Is the report showing accurately since you had suggested I had bulges at Multilevel with nerve compression at S1 .

Kindly suggest

Thanks

Answered by Dr. Ajay Panwar (59 minutes later)

Brief Answer:
Impression is quite similar.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

I have gone through the MRI report.There can be some interobserver variation.However,overall impression is pretty much,the same.

Even I mentioned that radicular compression at S1 is slight.Probably, the reporting radiologist did not consider it significant enough to mention.

Further,I mentioned that there are disc bulges at L1-L2,L4-L5 and L5-S1 levels but none of them is causing significant foraminal stenosis or cord compression.Again,the reporting radiologist,probably did not want to over-report the findings at all.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajay Panwar (13 hours later)

Hi Doctor,

I am a bit confused with these medical terms. Does I have bulges at just L1 or at multilevel with nerve compression at S1 even though the radiologist did not mention in the MRI report.

I just wanted to know as a precautionary measure and to tell the physiotherapist about my circumstances which I am going to next week.

Kindly Suggest

Thanks
XXXX

Answered by Dr. Ajay Panwar (1 hour later)

Brief Answer:
Symptoms are radicular in origin.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

I can sense your confusion,no wonder.

Ok. I shall try to make it easy.Your disc bulges are of very mild degree which your radiologist did not consider enough to mention.

However, symptoms are typical of as seen in 'nerve radicular compression secondary to spine or disc changes. We have to treat the symptoms and not the MRI report-So,you should start doing spinal exercises as suggested by physiotherapist on a regular basis and medicines should also be started for now, as the pain is severe.

If it's still not clear, I shall be glad to further clarify it.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Ajay Panwar (22 hours later)

Hi Doctor,

I have started on Pregabalin day before yesterday 75 mg twice daily. How long should I take it? The only thing is that it makes me very drowsy and soon as the drowsiness is gone I can sense the pain.

Please suggest

Thanking You

Answered by Dr. Ajay Panwar (36 minutes later)

Brief Answer:
It should be once a day in the beginning.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

In our OPD's,we usually start it on OD(schedule) and then observe the response for a couple of weeks.If response is inadequate,then we make it BD(twice a day).This gradual escalation prevents excessive sedation.

Its too early for you to decide on the pain relief.Since,its just 2 days old,you can switch to pregabalin-SR(sustained release) and take it once a day.

Simultaneously,Duloxetine(Symbal) can be started.PLEASE TAKE ALL MEDICINES UNDER THE GUIDANCE OF A PHYSICIAN.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajay Panwar (9 minutes later)

Thanks Doctor

Will take it once daily near to the bed time and see how I go.

Thanks Again

Answered by Dr. Ajay Panwar (16 minutes later)

Brief Answer:
Feel free to ask,in case of any confusion.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

Of course.Bedtime is the ideal slot of the day to start with,as the induced sedation will help in overnight sleep.

Please be back,in case of any query.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar