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Q: Help With Mri Results of Lower Back And F/u Opinion
asked by: subliminll on August 18th, 2007
New User
First I’ve had lower back pain off and on for the past 5 years. A couple weeks ago I awoke at 4am with severe pain in my lower back, radiating down my left buttock, left leg and foot. I went to the E.R and was given an X-Ray. The E.R doc said I had a bulging disk in my lower back. The doc said “Everyone has a bulging disk, just right now, yours is really bulged”. I was given a shot of tordol(sp), a couple valium right there. I was also given a perscription for oxycodone w/apap 5/325 and Diazepam 10mg and told to follow up with the military hospital. Since this day, the littler toes on my left foot are numb, I have a burning sensation on the left side of my foot and back of my ankle. My left leg feels “lighter” than my right leg and just doesn’t seem to respond as fast .

The military Physicians Assistant(PA) scheduled a lower back T/L MRI for me at our local civilian hospital. 5 days later the MRI was done. The radiologist report states:

Findings: Composite images show some straightening of the usual lordosis. There is an anomalous L5-S1 level with sacralization of the L5 vertebra. This correlates with the plain-film acquisition of 7/22/07 showing the small vistigal T12 ribs.

Vertebral body heights, appearance, and signal are preserved, allowing for multiple Schmorl’s node deformities seen on the superior and inferior T12 endplate and the inferior L2 endplate. These generally are of no clinical significance.

Vertebral body height, appearance, and signal are preserved with no marrow edema, hemorrhage, and/or edema.

Conus is seen at about the T12-L1 level and shows no mass effect and/or abnormal signal in this uncontrasted study.

Disk spaces demonstrate the L1-L2 level and above to be essentially of normal height, appearance, and signal without herniation apparent.

The L2-L3 level is of normal height, appearance, and signal.

The L3-L4 level demonstrates normal height and signal without herniation of the disk evident.

The L4-L5 level shows diminished height and signal. There is a broad-based annular bulge into the left anterolateral canal and neural foramen consistent with L4 nerve root entrapment. A small fragment extends inferiorly into the left lateral recess, entrapping the thecal sac and L5 nerve root.

The L5-S1 level shows essentially no disk material to be present.

Conclusion: L4-L5 disk herniation to the left of midline with a fragment extending into the left lateral recess.

After my MRI results came back, I was referred to a military Orthopedic Surgeon to discuss my options. Instead of the surgeon, I met with a Physicians Assistant that didn’t even read my medical records and I had to practically force him to look at the MRI results the civilian hospital had put on a Computer Disk. While speaking with the PA I was asked how long until I was to retire from the Armed Services and questions that I didn’t think had any bearing on my current situation. The PA mentioned that radiologists don’t really know what they are looking at which left me wondering why they even look at them to begin with. He then left the room to review my MRI images, then came back 15 minutes later . He said that the reason I have numb toes and the other symptoms was the disk material was pushing against my nerve and “irritating it”, not really compressing it. A friend of mine told me that the longer a nerve is pinched there was a less chance of me getting feeling back. I asked the PA if this was true and he stated that the numbness and pain would never go away, and I’d hopefully just “get used to it” and even if they did operate on me, it wouldn’t stop the numbness and burning sensations in my foot and leg. We would have to take a “ wait and see” approach and was told to come back in 6 weeks. I was prescribed motrin, steriod injections in my lower back and physical therapy. No prolonged standing, sitting, running for 2 weeks.

My gut feeling is, I should get a second opinion. I just wanted to throw this out there and see what any of you have to say. I apologize for the long post, I am in pain, feeling hopeless at the moment and would like to see what others might have to say.

Thank you for your assistance.
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yogahoneybunny
replied on August 21st, 2007
Supporter
If nothing else, a second opinion from a caring doctor may actually provide you with some compassion! Yes...I say go for it! Better to explore all options and make an educated decision.
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sillyakchick
replied on August 30th, 2007
Extremely eHealthy
Get a second opinion. If there is a free fragment in there, it really needs to be removed. the fact that you have numbness and burning in your left foot and you have nerve root entrapment is a really significant finding. i am sorry about the shoddy treatment you received. I don't necessarily think surgery is the best thing for most people, but I think in your case, you need to get that fragment out of there stat. It is not only causing your pain, it could do some long-term damage. you could try the steroid injections, but the fragment is what worries me. Best of luck. Sad
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subliminll
replied on August 30th, 2007
New User
Thanks for the info! I did set up an appointment for a second opinion and was told it would be a "Real Doctor". I ended up seeing another PA that said he felt comfortable with the earlier recommendation. He mentioned that the numbness and pain in my foot may go away with physical therapy. (Not sure i believe this but i guess i want to).

I had my first round of Physical Therapy yesterday and while my back was starting to feel better (before physical therapy), It isn't now. The pain / burning in my left foot seems to be mainly along the side and bottom left side. The left 2 toes are still numb and left leg still seems weaker than the other. This was noticed by the Physical Therapist.

I called a couple spinal doctors in town for a consult / second opinion, and they seem to have a 3 month waiting list to see patients.

I appreciate the feedback and will keep you updated as I find anything out.
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sillyakchick
replied on August 31st, 2007
Extremely eHealthy
OH that is really a long time to wait. Did you tell them you had a fragment? That may get their ears pricked up a little bit.

We can seee you next Tuesday if you would like to drive about 1600 miles.
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rollar64
replied on September 4th, 2007
Experienced User
Hi Subliminal sacralization is described as A developmental abnormality in which the first sacral vertebra becomes fused with the fifth lumbar vertebra this can be a serious condition you need to have an honest talk with a medical professional who knows something about this. You seem to be getting the usual routine which is to tell the patient as little as possible. Good luck.
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subliminll
replied on September 4th, 2007
New User
Thank you again for your responses. I have a follow-up appointment with the PA in a couple weeks and will deffinately ask about these things.
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