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MRI Results not understood (Page 1)

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I had a back injury 14 years ago which started to cause me problems around 10 years ago. Over the last 10 years it has gradually got worse. Major pain in my lower back with on occassion my back 'going' and leaving myself unable to move. For the last 6 years I have been having lumbar epidurals which usually help, in some degree. Since January this year my back problem has been getting more and more painful. I recently had a MRI scan and I am unable to understand it. It states:

Sagittal.

*Some loss of lumbar lordosis.
*Very dehydrated disc disc at L4/5.
*Endplate irregularities at L1-3.
*Disc bulges at serveral places in lumbar spine especailly L1/2,L4/5 and L5/S1
*Annular tear at L4/5 disc bulge with unexpected high signal behind the bulging disc material.

Axial.

*Small central / right sided disc bulge L2/3 with a small sequestrated segment of disc material extending up behind the L1 vertebra.
*Canal a little tight at L3/4 but no disc protusion.
*Moderate sized central disc protusion at L4/5 and mild spinal stenosis giving generally narrow canal which is aggravated by the central disc. Annular tear noted at this level.

Symptoms I am suffering from are pain in lower back, groin, hips and legs, Weakness, pins and needles, in legs also heaviness and at times problems with walking. Sleeping problems mainly due to pain. Pain is helped by lying down but have a huge amount of pain if I sit without any back support when legs are out front such as sitting on the floor.
I have now had to take time off work with the possibility of having to give up work. I can not play with my children and am getting depressed from the whole situation. My GP is very helpful with such things as pain killers but am finding no help from the hospital who are refering me to pshyio. Which I know exercise will help but exercise causes more pain and I am scared of what the future holds and if I will have to deal with this pain for the rest of my life. I would be grateful if anyone could help me understand the MRI results better so that I have a better understanding of what is going on.

With thanks.,
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replied October 6th, 2009
Experienced User
Very in-depth MRI findings. Your MRI results are telling you that you are beating up your back. Say you hit your finger with a hammer. The MRI would show bruising to the bone, maybe even a break along with inflamed tendons.
What is important is not so much what the MRI shows but has caused all that damage. An MRI will not really tell you what is going on in terms of treatment unless of course you are looking for treatments of surgical procedures like injections.
Your symptoms are only chronic if you have a chronic dysfunction. So the problem is not chronic back pain but a chronic dysfunction in your body which is causing back pain.
I can guess at postural. muscular issues but it would be better to be evaluated by someone who can look at your posture:

"*Some loss of lumbar lordosis. "
Means distortion in the discs and /or weak lumbar multifidus muscles.

"*Very dehydrated disc disc at L4/5. "
Tight psoas muscles, among others, and lack of motion squeezing the fluid out of the disc.

"*Small central / right sided disc bulge L2/3 with a small sequestrated segment of disc material extending up behind the L1 vertebra. "
Do you have breathing issues? Damage in this area can be related to diaphragm not working correctly.

"have a huge amount of pain if I sit without any back support when legs are out front such as sitting on the floor. "
Tight hamstrings, weak lumbar multifidus, disc distortion with bulging to the rear.

"heaviness and at times problems with walking"
Sounds like nerve compression damage so the nerves are not conducting / activating the muscles. Nerves control the muscles.

These symptoms can be successfully treated at least to some extent with postural corrections and muscle balancing. Your body is screaming at you that it is hurt and needs to be fixed. If you choose to ignore the problem with injections / surgery it could lead to more pain.
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replied October 8th, 2009
Thank you for your comment, I am very grateful for it. I am, generally, very careful with my posture ever since my teens as this is when i first injured me back (crushed vertabrae and small fracture which was stable. But I will look into what you have said. Many thanks.
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replied October 9th, 2009
Experienced User
I also broke my back. Actually it was the car that hit me. Not only did this ruin my day, but even though I apparently "recovered", that is disc and bone damage, in 6 months my body and muscles took a "set" and never went back to normal. After 20+ years I started getting terrible pain, because, for example, my right psoas locked up while my left psoas went limp. While I looked fine, the postural deviation were very subtle, it wasn't until a skilled osteopath started finding all this core distortion that I started to realize what was going on.

As for correct posture, I would suggest Esther Gokhale's book "8 Steps to a Pain-Free Back". I did not think she was correct but since I followed my, my doc's, my P/T's ideas and still in pain I tried Esther's. Much, much better.
For example, did you know that 75% of the spine bending is at L5/S1. When standing there is a sharp bend at L5/S1 and the rest of the back L4-L3-L1 etc is virtually straight. Many of those lumbar supports cause swayback with a big sweeping inward arch throughout the lower back. Bad, bad, bad.
You can get a chapter from her book for free at her website, egwellness and it will show you good posture. Just look on her homepage for:

Claim your FREE chapter from...
8 Steps to a Pain-Free Back
on the single most important abdominal exercise you can do, and sign up for our monthly newsletter, Positive Stance.

What got me better was Esther's explanation of correct posture and then I went to egoscue dot com for e-cises to fix my posture / muscle tension problems. You get a menu of 10-15 e-cises to fix your posture.
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replied October 12th, 2009
Extremely eHealthy
hi renz...you are chatting with a fellow whos back is worse than yours so we are in the same boat and i feel your pain. you have watched this problem increase with time and now the time has come to have your back evaluated by an ortho or neuro surgeon. some of your issues will not go away with the conservative treatment you have received. i would get 2 opinions and please feel free to check back here at ehealth for any advice before proceeding to next step i your treatment...dont get discouraged...better days are ahead....pete
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replied October 12th, 2009
Extremely eHealthy
Hi Renz,

Pete is 100% correct. Any attempt at self treatment for your spine pain is a very risky thing to do.

You really don't know what is or isn't going on. Any wrong exercises could very well make your spine worse, cause further injury and make the potential for more serious treatment needed.

You do need to be evaluated and diagnosed by a spine specialist. Either an orthopedic surgeon that specializes in spines or a neurosurgeon that specializes in spines only.

That is the only way you will be able to find out exactly what is going on. The longer you wait the worse the problem will get and the "fix" can be much worse than doing something about it now.

Good luck and please let us know how you are doing and what you find out from a spine specialist.

Fran
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replied October 13th, 2009
Thank you for your comments, I am very grateful. I have an appointment with a neurosurgeon at the end of the month, so hopeful something will come from that. At present to try and deal with things, my nerve pain medication has been increased and I am already on alot of pain management tablets. I have been told by a doctor (not a specialist)that the surgoens will be reluctant to conduct surgery as there are multiple levels of damage an one surgery is not going to solve all the problems, but that something may need to be done to the part that is causing the main problem i.e legs.
The main thing that bothers me and causes me the most difficulties, along with the pain, is that I have two young children aged 5 and 10 and I can not play with them and do the things I want to do with them and I am finding this very depressing. Bless them, as the do say they understand and they try to look after me but that is not their responsibility and I worry that I am taking their childhood away. They do still do things with their step dad but I want to interact as well.
I think with these kinds of problems such as back pain/damage or any other pain issue, all the attention is placed on the physical, which is right of course, but there are many levels to this such as emotional, practical etc.... These kinds of things, I know, can't be solved on a web site and in time I am sure things will work out in the way it is meant to be!
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replied October 13th, 2009
Extremely eHealthy
hi renz...i guess bad backs are like alarm clocks in that they get you up early...me too 6 am rise and shine....i know how you feel about playing with kids. however if you are there just paying attention they will remember. they will learn a considerable amount playing with kids their own age. that feeling of comfort that they get knowing your just there for them will carry them on. so just relax and take in their enthusiasm as they enjoy their lives under your loving eyes....pete
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replied October 14th, 2009
Experienced User
Keep us posted on what the neurosurgeon finds. You are correct in that emotions, stress, etc. can make back pain worse. That is the mind-body connection.

I guess the big question in my mind is what are YOU willing to do to heal? Sounds like you are just (sorry to say this) ignoring the problem and covering it up with pain pills. If this is the case it is no wonder you have only gotten worse over the last 10 years since your accident. Pills do not heal an injury. Injections do not heal an injury either. They just cover up the problem.

For example there are 3 simple positions that you can lie in when your back hurts really bad. They are pretty much guaranteed to work. Meditating while putting your body in the healing position can be a better way to deal with the injury than pills / injections. Especially if that route is not working for you anymore.

Actually, by playing with your kids, you have the perfect excuse to help your back at the same time. When was the last time you:
1) Got down on the ground on all fours. Let your stomach muscles relax and your lower back arch.
2) Crawled on your hands and knees.
3) Lie on your stomach and prop yourself up on your elbows.
4) Swung from a jungle gym.
5) Gone in the pool. Either swimming or just gentle movements.

Kids are active. They can give you lots of excuses to do things that adults aren't supposed to do but would be helpful in giving you some relief. The sitting with legs in front is bad but kneeling or lying on your stomach can help your back while getting you down at the 5 year old's level. You have some muscle tension and imbalance issues but don't worry about that stuff right now. Just get moving. It may make your back hurt but I don't think you will actually hurt your back or injure it more. You are more likely to injure it by doing nothing.
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replied October 15th, 2009
Thank you for the comments. I don't feel that I am ignoring the problem with the pills. I agree, if you are able, then there can be other ways to deal with pain, to a certain extent. But I take the pills to enable me to carry on doing the limited amount of things I still do with the children. I do not lay in much, as anyone with young children will know, that is impossible! I do as much as I am able and more sometimes but suffer for it! I thank you Awaq for the exercises you have written about but I am unable to get on all fours,(doing so makes my back spam and lock in place, with me not able to move) nor am I able to arch my back in the ways you described. I do go swimming and I walk in the water because of the resistance but going swimming relys on friends taking me as I can not drive at the moment due to the weakness in my legs and it would be unsafe for me to even thinking of doing so. And swinging from something is completely out of the question!
Over the last ten years my back has gonen worse but thats not to say I have not carried on with life! Up until June this year I have worked and studied and gained lots experience. I have continued through out to do the exercses given to me, and been as active as I could (up until this year).
I know that your comments Awaq were not meant as a personal attack but I am sorry to say that it has come across that way. Perhaps it is me being sensitive, I dont know, but I feelI need to defend myself!

Anyway I will keep undating once I have seen the doctor. Thanks again for all your comments.
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replied October 15th, 2009
Experienced User
Hi Renz77. Sorry no offense intended.
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replied October 17th, 2009
No problem, Probably me reading too much into things and being touchie about the whole matter because it is so frustrating! Thank you for your interest and comments.
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replied October 17th, 2009
Extremely eHealthy
hi renz...i believe your first ? to dr. should be will i develop permanent nerve damage if i do not have surgery?
i do hope the dr can establish a good plan for you....pete
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replied October 18th, 2009
Extremely eHealthy
Renz,

Pete has pointed out some good questions to ask your surgeon.

Unfortunately, the doctor may not be able to answer it for you because there really isn't an answer.

If nerves are compressed for too long, they will suffer permanent nerve damage, but no one can really be 100% sure how long it will take for the nerves to become permanently damaged. It can be a very individual thing.

Another very important point to understand is that the longer you are in pain, not moving correctly and not using some of your muscles, tendons, and ligaments, they can atrophy on you, especially the muscles.

That old adage "what you don't use, you lose" becomes a serious problem with spine issues.

Those muscles that don't get used to atrophy and if they atrophy long enough, and again it can be difficult to know how long is too long, then it becomes very difficult to strengthen those muscles again and get them working properly. Not only that, but they can and do develop permanent weakness and permanent pain.

Many times physical therapy can strengthen those muscles, tendons, and ligaments so that they can be used properly again, but only time will tell.

Sometimes, as in my case with my first spine surgery, that weakness and atrophy developed in less than 5 months and it took quite a while to get the strength back in my fight leg and thigh.
I did get just about all of it back, but after a long day up and down and on my feet, the leg does feel week.
Also It is thinner than my left leg and will always be that way.

Also another thing to watch for is developing of serious problems as a result of nerve compression of the L5/L5/S1 nerves.

They go directly to controlling the bowel and bladder. If you ever get any symptoms of loss of bowel and/or bladder control or the beginning of either of those, please seek immediate ASAP treatment at either the ER of your spine surgeons office.

This would be what is called cauda equina syndrome and is an emergency situation. You have very little time to have surgery to remove the compression of those nerves before the damage to them results in permanent loss of bowel and bladder function.
Usually 24 hours, no more than 48 before that happens.

Again, not everyone will suffer from this and it can take years and years to develop or happen very quickly as it did with me, within 5 months. But it is a serious problem and fortunately for me, I had surgery less than 8 hours after the symptoms began and I have full bowel and bladder function.

Surgery should always be the last treatment for spine problems, but at the same time, should not be considered as never ever having it done.

Surgery in the hands of a skilled surgeon and for the correct reasons is the best option for many, many people.

Reading posts that one should never ever have surgery is not the way to go, nor should those posts be seen as the only result that one has from spine surgery.

Most spine surgeries are very successful in both the doctors and the patients eyes.

What one must remember is that most people who post on health forums with spine issues are either looking for information because they have a spine problem or they have had poor results from either conservative treatments or surgery.

Those that have had good results, like myself, don't usually stick around and post on spine sites. They are far to busy returning to their life and just don't bother to come back and post any more.

That is one of the reasons I continue to stick around. I want others to see that spine surgery can be extremely successful and life does return.

Fran
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replied October 18th, 2009
Thank you for you comments, I am very grateful, and thank you Pete, for the questions to ask. I will ask them! Fran I am aware of cauda equina syndrome and understand of the 'red flag' symptoms. I do try and keep as active as I can be but obviously at times it's difficult.

One thing I must add is that I am in the UK, and the health system does work differently. I don't know if this is a good or bad thing, but at a guess, a bad one (from pervious experience)! My GP says that I need surgery (not something I really want, but who does?), as the problems I am getting is seriously affecting my day to day life. An example being that to take the children to school is 'normally' a 5-10 minute walk, as it is in the same street. At present it is taking me roughly 20 - 30 minutes! But the doctors at the hospital often have very different views....sadly!

You are completely right Fran, people never hear the success stories, and I thank you for sharing you positivity. It shows that serivous problems effecting the spine is not always the end of the journey!

I see the surgeon in just under two weeks and I will make a post after this. For now I will just keep moving as much as possible and just wish this all works out good in the end!
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replied October 18th, 2009
Extremely eHealthy
hi renz...i commend you on your continued efforts to walk the kids to school...that is exacly what fran recommended you need to do to keep some strength in your legs....pete
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replied October 27th, 2009
I have another question / matter which I would be so grateful if someone could comment on.

I have noticed over the last couple of days that I am having bladder leakage, mostly in the mornings. Could this be related to my back problms or is it just normal, such as loose pelvic muscles? I know the red flag syptoms which people with back problems need to be aware of but as this is not 'full blown' (as such) I am unsure if I needed to mention this to my doctor when I see them later on in the week.

I send thanks in anticipation of any replys.
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replied October 27th, 2009
Extremely eHealthy
hi renz
my experience was that leakage was early warning of CES. yes tell your dr. i hope its not CES...pete
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replied October 27th, 2009
Extremely eHealthy
Renz, please tell your doctor ASAP about the bladder leakage.

Cauda equina syndrome does not have to be full loss of bladder and or bowel control.

Sometimes it's starts with just leakage of urine and does not progress further for ome time, other times it is just sudden loss of control.

Best to tell the doctor ASAP and be safe.

Fran
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replied October 28th, 2009
Thank you, I will inform my doc asap.
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