Lumbar spine MRI
Please help me understand my results. Will surgery help? I have been doing PT, laser therapy, acupuncture, ultrasound... and have been on Celebrex and Ultram for 6 months. I am currently waiting to see a neurosurgeon.
There is a gentle lordosis; no significant abnormalities on alignment. No significant bone marrow signal abnormalities. There is a focal hypointense T1 hyperintense T2 signal area underneath the superior endplate of L3 query small Schmorl hernia. The spinal canal and neural foramina are within normal limits at T11-T12, T12-L1, L1-L2, L2-L3, L3-L4.
L4-L5: There is a global bulge disc with central annular tear without evidence of herniation of nucleus pulpous. There is hypertrophy of ligament flava. There is a mild stenosis left lateralized, due to the above described bulge disc which appears to be in contact with the L5 nerve root however no clear evidence of compression, mild posterior displacement cannot be excluded. There is a mild OA of the facet joints. The neural foramina are within normal limits.
L5-S1: The spinal canal and neural foramina are within normal limits; mild irregular aspect of the facet joints may represent early OA.
The conus medullaris is located at T12-L1 within normal limits. No significant abnormalities on the included distal spinal cord.
Impression: L4-L5 discopathy as described causing mild spinal stenosis. Questionable posterior displacement of the L5 nerve root.
The Schmorl's node is an incidental finding. They are commonly seen in the thoracic and lumbar regions.
At L4-5, the disc bulges but is not torn and there is no herniation. The bulge narrows the area where the nerve root travels through. The radiologist could not tell if the L5 nerve root was being compressed. The bulge might might push the nerve over a little. The ligamentum flava is a ligament within the spinal column, which is a little bigger than normal. You have some early degenerative changes in the facet joints, which are in the posterior elements of the vertebra. The neural foramina are the holes through which the nerve roots exit the spine.
So, if you are having symptoms of the left L5 nerve root being irritated, then surgery may help. But, if not, then surgery probably won't.
This is why it is important to discuss the study with your surgeon. All studies have to be correlated with the patient's symptoms.
Although Gaelic is much more qualified then I am, I do not see any thing remarkable in the report. Much of what is listed is age related wear and tear.
What I really wanted to comment on was your "Will surgery help" question. Please be very careful when considering any spine related surgery. Do loads of research and ask loads of questions prior to committing to surgery. Many disc related injuries can be helped by non-surgical techniques like decompression, aqua or hands on therapy. This is just my 2 cents, but I would opt for any alternative solution before going the surgery route. Sometimes surgery is promoted by a doctor as a quick fix to relieve pain. I took this route 15 years ago by having two discectomy surgeries on my L-4 & 5 discs. I did not research alternatives and wound up losing a 5 million $ a year business. I'm not saying this will happen to you, or that you shouldn't have surgery, just that imho you should research all your options b/4 surgery.