Brief Answer:
Lets break it down

Detailed Answer:
Hey XXXXXXX welcome back! I’ll be happy to go over this scan with you. How is your neck doing? What’s going on with the C6-C7 thing from our earlier discussion?

Anyways,I think in this case it would be a good idea to define some terms first before we dive into the scan results. Just keep these terms in mind as we go through the scan line by line as we did last time.

Spondylosis: This is a fancy pants word for Arthritis of the Spine. Arthritis is basically inflammation of the bone. So when we say that there is spondylosis at any region T11-T12 or C6-C7.. what we are saying is that the radiologist has seen that the bones that form that joint are inflamed. Now, there are lots of causes of inflammation. From obesity to injury to certain medications, to infections to just natural aging which makes the bones softer and weaker and more likely to rub against each other causing friction and inflammation.

Arthropathy: This word means “Joint disease”. Plain and simple.

Listhesis: simply means displacement. One bone is sliding forward or backward on top of the bone below it. It can happen due to injuries or weakness of the ligaments that keep the spinal column stable.

Foraminal Stenosis: So, we know that the spinal COLUMN contains the spinal CORD right? Sort of like the Cord is wearing a suit of bony armor around it to protect it. Now the thing is, NERVES have too exit the spinal COLUMN at every segment of the spine so that they can travel to the periphery of the body. They exit the spinal COLUMN through tiny chinks in the armor.. tiny holes. These holes are called Foramina (spinal foramina to be exact). Foramina is plural of the word Foramen.

Thecal sac: The theca sac is the bag of fluids that your spinal CORD floats in on the inside of the spinal COLUMN. When the bones press against the cord, they first pinch the theca sac. This is an early sign of degenerative bone disease in the spinal column.

Now, lets get to that report. By the look of it. This is a MRI of the lumbar spine without contrast. as you say it was done over a year ago.


Report: “T11-T12 Anterior spondylosis. Minimal disc displacement, not compressive. Mild facet arthropathy is not noted.”

Me: T11-T12: here the bones are inflamed at bit near the front of the spinal column in at this level. Facet arthropathy is more of the same… The radiologist sees that the parts of the vertebrae that connect with each other.. the ‘facets’ are diseased.. most likely inflamed. T11-T12 is the joint that is at about the level where the torso and chest meet the lover back. Think of it as the area in between the lowest parts of the shoulder blade, maybe a bit lower than that. Overall, i don’t think any nerve based pain would be caused by what is seen here, on the other hand, all that inflammation can contribute to back pain.


Report T12-L1 Anterior spondylosis. No evidence of compressive disc disease.

Me T12-L1: We move one joint lower and see even more inflammation… could be contributing to back pain in your lower back if you have any


Report L1-L2 Anterior spondylosis. Decrease in height. Broad base protruding disc mildly effacing the thecal sac. No neurocompressive finding are noted.


Me L1-L2: Now we are in the lower back, to give you an idea.. watch any actor in a commercial complaining of back pain.. they will arch their back and put their hand on their lower back and then the screen will zoom in and show some cutesy red graphics denoting pain. Thats this area.

Here we are seeing more inflammation.. which could cause back pain. We also see the beginning stages of disc degeneration. The same process that is going on in your neck at C6-C7 if i remember correctly. But it’s very mild, at least from the way the radiologist has descried it.


Report L2-L3 shallow disc displacement more prominent rightward, mildly flattening the thecal sac. Mild facet arthropathy is noted. No neurocompressive finding are apparent.

Me L2-L3: So, some mild degenerative disc disease is apparent, nothing pressing against any nerves though. The disc is pressing against the theca sac a bit. That COULD cause some pain, but the inflammation of the facets is more likely to cause pain in my opinion.

Report L3-L4 Broad based shallow bulging disc. Facet arthropathy with findings resulting in mild biforaminal stenosis. The bulging disc minimally flattens the thecal sac.

Me L3-L4: More inflammatory processes going on here.. By now I would be convinced that this inflammation is probably causing you pain. The biforaminal stenosis is noteworthy. That means that the naked nerves that escape the spinal cord and travel to the periphery of the body might be getting irritated a bit. L3-L4 sends nerves to the mid thigh and wraps around the knee joint. So if there is any significant nerve compression here, you should be feeling electric shock like pain in the midthigh, maybe the knee and the side of the legs. Do you have any of those symptoms? If so.. than this finding at this level becomes important to deal with in your treatment.

Report L4-L5 Scant anterolisthesis of L4 relative to L5. Broad based protruding disc. Facet athropathy. The findings result in biforaminal stenosis that appears moderate to servere on the left with abutment and likely impingement of the left L4 nerve root. Mild to moderate right foraminal stenosis is noted with abutment of the L4 nerve root. The protruding disc mildly effaces the ventral thecal sac. Mild ligamentum flavum hypertrophy is noted.

Me: More of the same at this lower level, inflammation is the worst aspect here


Report L5-S1 Shallow protruding disc abutting but not compressing the thecal sac. Mild facet arthropathy is noted. Mild narrowing of the right foramen is present.

Me: More facet (joint connecting two vertebrae together) inflammation


Report: The distal cord and conus appear unremarkable.

Me: That's just peachy….


Let me round this up and make a comment on this scan… inflammation EVERYWHERE!

Ok, now that we see it.. the question is.. whats causing it and what do we do about it.

The inflammation could be caused by so many different factors that I can’t reasonable describe all of them to you in 1 message. Would take a textbook really. So i’m going to focus in on the most PROBABLE Cause.

As we age, the ligaments and tendons.. the elastic soft stretchy tissues that hold bones and joints together get lax.. they start stretching. It happens for everyone but its even worse in people who are overweight and those who smoke as well.

When those ligaments stretch… the bones inside those joints (like the bones at the L3-L4 level or T11-T12) will start rubbing together. That rubbing causes inflammation and back pain that would stick to the back alone and not radiate down into the legs.

Now, how do we deal with this? Unfortunately.. I am a hammer and all I see is a room full of nails when it comes to this stuff. I believe that surgically placing screws and rods in the lower back will hold those joints together long term and with the best results possible. If you have osteoporosis then they wouldn’t do their job well at all though.

But there are other options that you may want to try first.. One that I have seen a lot of success with is what we called “Facet Injections”. What is done here is that a pain specialist injects a steroid medication mixed with an anaesthetic to ‘cool off’ those inflamed joints. Now I don’t do those injections myself.. so i can’t really comment on the details of the procedure. But if it works once, then it normally lasts several months. Then it can be done again. I know that getting injections into your back 3 or 4 times a year doesn’t sound fun. But it is a sight better than surgery.

So that's what I can add here for now. Let me know what your thinking and I will try and clarify things further when you want it.

Vin

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Brief Answer:
Surgery seems like a good option in my mind

Detailed Answer:
Hey there, thanks for hanging on for an answer. Have been a bit slammed at the hospital, so couldn't get online.

So the facet injections didn't work. OK, that sucks, but I'm glad you at least attempted it.

I'm sorry i lost track of the nerve issues in your leg, Thanks for reminding me.

Lets concentrate on the latest scan results you have sent me and then try and round it all up together and make a plan.

Scan result "Long- and short axis fat- and water-weight images were performed, 1.5T High Field Oval."

This just tell us what kind of scan was done, when an MRI is done, they use different algorithms to create the images. One type of imaging makes the water in your tissues look dark and the more solid stuff look bright, sort of like an xray, the other fat imaging inverts the image. Those fat images are useful for looking at soft tissues more than bones etc. 1.5T means 1.5 tesla coils were present in the MRI machine 1.5 tesla is an incredibly powerful magnetic field. Several thousand times the strength of the local electromagnetic field that the Earth gives off in the local area. A powerful tesla coil makes for a good image.

Scan Result "Predominantly fibrous marrow is identified with a hemangioma or fat island in the L4 vertebral body. All visualized discs desiccated."

So inside the L4 vertebra, some age related changes have been going on. The bone marrow that is supposed to be supporting the vertebrae is drying up and converting to fat. Its age related. Not too much we can do about that other than making sure your diet and exercise regime is healthy. The other thing they mention is that all the discs they saw on the scan are drying up, and doing that 'pancaking' thing we talked about earlier.

So, from everything ive seen of your medical history, it looks like you have two trouble spots in the spine. One at C6-C7 as we discussed earlier, and now nerve compression at L3-L4, contributing to the numbness in your legs and quite probably the back pain.

When it comes to the lower back, again, surgery is my solution. I have to stress, i'm talking a bit too comfortably here, i have NOT examined you and confirmed these findings for myself, so me going on about surgery is just a theoretical armchair type thing. That having been said, I keep looking back at the fact that you are middle aged and that these things only get worse with time. Fixation and disc resection in the lumbar spine should stabilize the bones and reduce inflammation and reduce the pressure on the L4 nerve root.

Make sense? I hope i'm helping.

Vin

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Brief Answer:
Always happy to help.

Detailed Answer:
By all means, I will help you whenever you want. Feel free to follow-up, and thank you for coming to the site.

Vin

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