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DEPARTMENT OF IMAGING SERVICES
Pt Type: REG CLI Pt Location: IMCANC
Attending:
Referring:
06/24/21 Time: 1351 Primary Care: MD Requisition No:—— Account Number Proceduæs: REPORT NO:
ÄI/MR Spine Lumbar Wo IV
MR Spine Lumbar Wo IV
CLINICAL INDICATION: Backache
TECHNIQUE: Multi sequential MR images of the lumbar spine were obtained multiple planes without intravenous contrast.
COMPARISON: None.
FINDINGS:
For purposes of this dictation, it is assumed thåt there are 5 non-rib-bearing, lumbar-type vertebrae, and the most caudal fully segmented lumbar vertebra is labeled L5.
No acute fracture or subluxation.
There is minimal levoscoliotic curvature centered at 1-44-5 with a rotatory component.
Vertebral bodies are normal in height.
Mild marrow signal changes noted at L5-S1 and to a lesser extent at L2-L3..
There is multilevel loss of disc height and desiccation, most pronounced at L5-S1.
The conus medullaris terminates at a normal level. The nerve roots of the cauda equina appear normal. No epidural fluid collections.
The included paraspinal soft tissues are normal.
The included retroperitoneal structures are normal.
Evaluation of the individual levels demonstrates:
T12-L1: No significant disc abnormality. No significant spinal canal or neural foraminal narrowing.
L1-2: No significant disc abnormality. No significant spinal canal or neural foraminai narrowing.
12-3: There is a small disc bulge with bilateral facet arthropathy and ligamentum thickening causing mild spinal canal narrowing and bilateral subarticular effacement. There is also mild left and minimal right neural foraminat narrowing.
L3-4: There is a disc bulge with bilateral facet arthropathy and ligamentum thickening causing mild spinal canal narrowing and bilateral subarticular effacement. There is also mild bilateral neural foraminal narrowing.
L4-5: There is a disc bulge with bilateral facet arthropathy and ligamentum thickening causing moderate spinal canal narrowing with bilateral subarticular effacement and effacement of the thecal sac. There is also mild left and moderate right neural foraminal narrowing.
1.5-SI: There is a disc bulge with mild bilateral facet arthropathy causing moderate right and moderate to severe left neural foraminal narrowing. No significant spinal canal narrowing. An annular fissure is also noted.
IMPRESSION:
Multilevel degenerative changes of the lumbar spine, as described detail above. These findings are most pronounced at L4-L5, where there is moderate spinal canal narrowing, moderate left and mild right neural foraminal narrowing.
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@dougie12 Your report describes thickening of the ligament on the back of the spinal canal which makes the spinal canal smaller, and narrowing of the foramen at multiple levels which are the spaces between vertebrae where the nerve roots exit the spine to send specific nerves all over the body. The minimal levoscoliotic curvature centered at L 4-5 with a rotatory component means that there is a slight scoliosis curvature to the left with rotation of the vertebrae. Loss of disc height at L5 - S1 is where the lumbar spine joins to the pelvis (sacrum) and according to spine deformity surgeons, that level is the most difficult to surgically fuse because it is bearing most of the body weight. Facet arthropathy refers to arthritic changes (wear and tear) in the facet joints. These are on the sides of the vertebrae and allow the spine to twist as these joints slide. The discs themselves act like shock absorbers, but don't have movement of joints.
You must be having symptoms. What I suggest is to write a detailed description of your symptoms and how it has changed over time. Include what makes it worse or better if you are in different body positions such as twisting, bending, standing, sitting, lying down, etc. If you want to contact a specialist for a consultation, that would be what they would ask for, and I'm sure they would get new MR imaging.
Do you have a specialist in mind? You had mentioned Mayo in your post. If you wanted to request an appointment at Mayo, the first thing to do is to make sure they take your insurance. I don't think they will grant an appointment if you don't have insurance coverage that they accept because spine surgery is very expensive.
You can find insurance information and a contact for the billing office at this link. https://www.mayoclinic.org/billing-insurance
If you want to request an appointment at any Mayo campus, you may get started with this link, and someone from Mayo will contact you. http://mayocl.in/1mtmR63
A lot of spine changes occur with aging with discs losing moisture and some disc height. If there has been an injury to the wall of the disc, when a disc dries, it can open a crack, and the jelly like nucleus inside can spill out. When that happens, it causes inflammation and will lead to extra bone forming spurs which can compress nerves or the spinal cord. I had a compressed spinal cord in my neck from a whiplash injury 20 years earlier, and that lead to surgery and a fusion of my C5 - C6 vertebrae. Discs can bulge for a long time before a rupture may happen.
Before any surgery, it is advised to get several opinions. Spine surgery with fusions leaves a patient with limited mobility. Lumbar spine surgery is major surgery that requires a long and likely painful recovery to a new normal that won't be the same as before a spine injury. What is your next step? Do you have a specialist in mind?