anyone here who can translate results of MRI spine into one sentence?

[Grasswire2]

This discussion thread was locked as off-topic by JudyM (a host of the General Discussion forum).

It's my adult son. Done today, long holiday weekend. The question is: does this look like surgical intervention, or not? A yes or no would be sufficient.

Impression:

1. L5S1 large right paracentral disc protrusion, which impinges the traversing right S1 root in the lateral aspect of the central canal.

2. L4-5 moderate spondylosis with mild disc bulge and prminent posterior annular defect. L1-2 mild spondylosis with small posterior annular defect. There is no high grade cental canal stenosis or cauda equine compromise.

3. L4-5 mild/moderate bilateral foraminal stenosis.

Very busy father of four children. Any suggestion appreciated. I am certified in medical terminology, but not in consequences of diagnoses.

Thanks.

[elleng]

1. I have no idea. Post in Health.

[cos dem]

2. Not a doctor, but recent spinal issues myself.

This is good: no high grade cental canal stenosis or cauda equine compromise.

This is probably the major issue: large right paracentral disc protrusion, which impinges the traversing right S1 root in the lateral aspect of the central canal

Surgery/not surgery is not a simple question of MRI results. A lot will depend on how regular treatments go. My guess is that this is not severe enough to merit surgery in the short term. I consulted 2 surgeons, and both recommended against diving in with knives. But you'll want to have your own consultations.

Core strength is important. I started swimming to improve core strength, and it has helped a lot. PT can help too. A lot of people are impatient with PT, but I had a really good therapist, she was intolerant of causing me pain. PT is not supposed to be painful. It wasn't even that strenuous. It was more about learning to engage core muscles better.

I hope your son gets relief. Back pain is no fun.

[LeftInTX]

3. 1. Herniated disc at L5-S1..If sciatica is present in the R leg, this is the explanation

2. and 3. can be considered, "expected degeneration, based on age". Since it is your son, if he is under 40 this may be more than expected. If your son is 60, this would be "normal".

Was he in an accident within the past year or did he have an event which led up to the herniated disc?

How long has he had symptoms of a herniated disc?

As to whether surgery is needed, it depends on his symptoms and progress.

Has he been to physical therapy? etc etc etc

Yes, his disc could make him a surgical candidate, but I would urge caution before jumping in.
They basically say, "Don't rush into surgery unless you have incontinence, or severe progressive numbness"

I agree with Post #2.
Sometimes people have really bad pain.
They get an MRI and then are looking at surgery.
Surgery really should be last resort, with a few exceptions. (The exception is incontinence)
Pain is not an exception.

[Grasswire2]

4. Thank you so much.

Thank you so much. Very helpful, considering a long weekend now with no information.

He's 46. Extremely active, strong, and hard-working at a physical job building sets for a theater and dance troupe. Plus has two boys ages 1 and 3 that require carrying and a two story house that means carrying up and down stairs.

He has had the sx for about four months. Unbearable, exquisite pain. I am also worried about the necessary pain control, long-term, but that's another worry.

I know that he feels that surgery will end the pain. So I appreciate very much your caution.

He lives on the other side of metro area, so I don't see him every week.

I do not know positively about sciatica -- but when we spent July 4th together for several days he did have to lay on his stomach on the floor and have his partner either stretch his leg or his back, from time to time. I wasn't paying a lot of attention.

I do not know the answer about PT but I will gently ask.

I can only be supportive, but it is very good to be more informed, and I thank you very much.

[usajumpedtheshark]

5. I had a very similar L5/S1 condition and had surgery after a half a year of constant pain

It was such a relief to wake up after the surgery and find my sciatica gone. However, as the surgeon will explain, surgery is not risk free. Unfortunately, two days after surgery I devloped a bleed which led to a condition called cauda equina syndrome. So he will need to weigh the benefits vs risks.

[Grasswire2]

6. thank you

The trick is that the desire to be pain-free complicates the decision making. I hear you. I hope his doctor is carefully explaining.

[LeftInTX]

7. Yikes. Did it get better?

[llmart]

9. I had a very similar condition also when I was about 50.

I was prescribed a six-day regimen of steroids and began physical therapy three times a week for three months. The steri-pak (not sure if that's the exact term) relieved the sciatica almost immediately after two days. The physical therapy was gradual and yes, strengthening your core is important. I continued all the PT for months at home because I never wanted to go through that again. I'm now 73 and have not had any other episodes since I was 50. I'm also much more careful about what I do and how much I do. I tend to be a very physical person.

[moonscape]

8. Through my own spine issues and debilitating referred

pain, I’ve learned some to me counter-intuitive things:

1. An MRI is not as diagnostic as to primary source of pain as I had believed. I have several issues and had 3 docs (spine surgeon/specialist at teaching hosp, physiatrist also at teaching hosp who managed care for 2 major sports teams, and another physiatrist) all disagree on primary issue and recommended course.

2. P/T can be brilliant. Okay, my bias gave it some credit but not as much as it deserves. The right therapist matters. I had one for 2 go-rounds before switching and it’s night and day!

3. Surgery fixed my shoulder 2x, my bad leg, my friends hips and knees, but the spine can be tricky. I wanted surgery so to be done with the pain, but now find I’m fighting to overcome this without surgery. It takes work, body movement/awareness work, etc but is worth it. The spine is not a quck-fix deal.

4. Core, core, core.

[Grasswire2]

10. thank you

I know that my son is desperate for pain relief and thinks surgery will be the relief. I hope his doctor is fully advising him of the possible downside.

[DenaliDemocrat]

11. So, there are novel disc treatments out there

Spinal fusion is obviously the last course of treatment and it works. The prognosis is excellent if his pain is primarily leg pain. It’s shitty if it’s back pain. I had a fusion because my l4 was literally sliding over my l5 causing horrible leg pain.

Best advice I can give DO NOT LET AN ORTHO TOUCH YOUR SPINE! Get a neurosurgeon!

[Meowmee]

12. links etc.

1 sounds like he has a slipped or herniate disc. 2 sounds like a bulging or torn disc maybe and 3 I found a link for:

https://www.bonati.com/conditions/foraminal-stenosis/bilateral-foraminal-stenosis/

https://www.spine-health.com/glossary/bilateral-foraminal-stenosis

I am sure I have had some similar things like this written in numerous spine mri but I can't remember what they all said now.


This can all be treated with PT which uses, ice/heat, tens, ultrasound, massage, exercise and other anti-inflammatory methods. Injections of steroids and steroids can be used as well as pain killers orally and or injected. tricyclic anti d can help chronic pain and if he can tolerate them anti-inflammatories can help. You have to try a different pk to see what works.

Has he tried otc lidocaine patches? They helped me tremendously when I had severe pain for months with covid pneumonia and also helped me before that for chronic neck/back pain from 3 different injuries. Any worse pain and I put one on an leave it for as long as needed, sometimes all day/night and more. They are amazing and there is lotion but the patches are better. Just the pure lidocaine patches.

The pt is work but it can help so much and every doc I saw always said never do spinal surgery unless it is a true emergency with no other alternative. Once they get the inflammation down he can exercise and that helps strengthen everything- the disc can be absorbed a bit again lessening the pressure and pain etc.

He will need to stop carrying anyone or doing anything stressful for a while too. You need to do ice and heat etc. every day and all the exercises they tell you to do religiously. You can purchase a portable tens unit, that helped my pain a lot as well. I had neck and back injuries, also knee and other parts and had pt on and off for all. They all passed through an acute phase and went to chronic unfortunately but it is usually much more manageable now. The worst was an initial bad accident that caused nerve damage.

[JudyM]

13. Wrong form

The forum hosts received an alert on this post because it’s not about politics or current events, so we need to lock it. You can repost it in the Health group, though.