Help with MRI and X-Ray Dictation reports??

[jena1225]

Posted also on Spiney Forum, but it is not quite as actice :)

Ok, the MRI report: (only pointing out the "positive" findings to keep it short)

"At L5-S1 there is a minimal degenerative midline annulus bulge that does not significantly encroach on the secal sac or lateral recesses. There is also some posterior ligament hypertrophy at this area but no evidence for any central canal stenosis"

Now, I am assuming the last part rules out Spinal Stenosis even though whenever I google "Hypertrophy", that is about all that comes up.

Does the first part indicate the Annular Tear or the DDD or arthritus? Because in her notes, the OS says SHE see's it, but I don't see it on the findings...

The In-house X-ray dictation from OS seems to indicate a lot of my pain is coming from my spasms:

Physical Exam - really can'ttell what all this means (5/5, 20/20, etc...)

Lateral Bending: 20/20 with significant
Paralumbar spasm: Present
Deep Tendon Reflexes: 3+knee and ankle jerks bilaterally
Plantar Responses: Flexor
Dorsalis Pedis Pulses: 2+ bilaterally
Motor Stength: 5/5 in all major lower extremity muscle groups
Femoral Nerve Stretch?: Negative on affected side

I don't think this looks all that bad... My MS spasms have gotten much worse over the last several weeks, and do feel that these are my biggest "consistant" pain problems, although however I move my back badly hurts on both sides now.

I know since my traction episode my right side of lumbar has same pain as left, but I hesitate to ask for more x-rays since surgery is not recommended and PT is hurting me. Like, what good would it do?

Any feedback would be appreciated :)

[Kira]

"At L5-S1 there is a minimal degenerative midline annulus bulge that does not significantly encroach on the secal sac or lateral recesses. There is also some posterior ligament hypertrophy at this area but no evidence for any central canal stenosis"


"minimal degenerative midline annulus bulge": there is a minimal bulge in the middle of the disc (annulus is part of the disc)

"does not significantly encroach on the secal sac or lateral recesses": I think they meant thecal sac, not secal sac... the notes get dictated and transcribed, and the transcriber probably heard/typed it wrong. Anyway, this means that the "minimal bulge" does not really push on the sac containing the big nerves coming off the base of your spinal cord or on the spaces off to the sides

"some posterior ligament hypertrophy at this area but no evidence for any central canal stenosis": the ligament running down along the front surface of the discs is thickened/bigger than normal, but the spinal canal itself, where the nerves are, is not narrowed

Lateral Bending: 20/20 with significant
Paralumbar spasm: Present
Deep Tendon Reflexes: 3+knee and ankle jerks bilaterally
Plantar Responses: Flexor
Dorsalis Pedis Pulses: 2+ bilaterally
Motor Stength: 5/5 in all major lower extremity muscle groups
Femoral Nerve Stretch?: Negative on affected side


"lateral bending: 20/20 with significant paralumbar spasm present": you can bend side to side fully, but he sees that the muscles running vertically up and down your back are spasmed

"deep tendon reflexes: 3+ knee and ankle jerks bilaterally": within normal range or maybe a bit fast

"plantar responses: flexor": no abnormal Babinski sign seen on either foot (a good thing)

"dorsalis pedis pulses: 2+ bilaterally": you have normal pulses in your feet

"motor stength: 5/5 in all major lower extremity muscle groups": you have full strength in all of the muscle groups in your legs

"femoral nerve stretch?: Negative on affected side": exam didn't show a problem with your femoral nerve on the side that is bothering you

So... to sum up... it says you have a minimal bulge in the disc that doesn't appear to be significantly compressing things (at least on the imaging)... the ligament by the bulging disc is a bit thickened but the canal where the big nerves are is not narrowed... physical exam note says normal range of motion, reflexes, blood flow, and femoral nerve stretch, but spasms in the muscles next to your spinal column in your lower back.

Disclaimer: I'm just translating... this isn't medical advice b/c I haven't seen the films, examined you, met you in person, etc, etc... yadda yadda disclaimer disclaimer... and so on...

[Kira]

Now, I am assuming the last part rules out Spinal Stenosis even though whenever I google "Hypertrophy", that is about all that comes up.


It seems to rule out Spinal Stenosis... that is what they mean by the no central canal stenosis... though I am not sure if a different method of imaging would show it? (sorry don't know enough about that)...

Does the first part indicate the Annular Tear or the DDD or arthritus? Because in her notes, the OS says SHE see's it, but I don't see it on the findings...


I'm not sure. They say that the annulus is where it is bulging... could be b/c of a tear... but they also call it degenerative... which would be the DDD...

[jena1225]

Thanks Kira :) The only problems I have with their findings is that I have always had a positive Babinski for the past 14 years! And that if all of this is so minimal according to their findings, why would my back feel ike it is going to break no matter which way I move or bend it?

Also, my legs turn to jello a lot, especially when I bend backwards to stretch my back.

I know I have a lot of spasms/spasticity and that cause most of my constant/continuous/ pain, but I cannot see that being the cause of that particular lumbar pain...

This is another reason I do not want to pursue any further tests: they make it seem like "all is pretty good" aarrgghh.

I am just thankful my PCP has been very understanding in treating my pain. She is familiar with MS pain, thank God.

[Kira]

I have a Babinski on my left foot sometimes and a normal response on my left foot other times. I have no idea why. The right foot is always normal. I do have Hoffman's sign all the time (doesn't go away) in both hands, and also hyperreflexia, spasticity/high tone in my legs and in my forearms...

Sigh... it is never easy, never straightforward...

[jena1225]

I have the positive babinski on both side now from the brain lesions. I am pretty sure I had it at OS too because I have had it for the past 14 years :rolleyes: I mean, what "else" did they miss?

[jena1225]

I have the positive babinski on both side now from the brain lesions. I am pretty sure I had it at OS too because I have had it for the past 14 years :rolleyes: I mean, what "else" did they miss? Oh, and I think they even said my reflexes were normal! That is a hoot because you can barely tap my knee without me kicking you in the face! I am noy kidding, and my Nuero always smiles and puts his hand to protect himself because he knows, lol

Kira, I know, never easy and never straight forward :rolleyes: