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Confusion about MRI results for L5-s1
Please help with mri results. Also can this cause extreme pain in foot.
S1 segment is partially lumbarized with 5 additional nonrib-bearing lumbar type vertebral segments. Last rib-bearing segment labeled as T12. Conus medullaris terminates at L1 with no abnormal intramedullary signal alteration. Moderate endplate degenerative marrow space findings at L5-S1. No discitis osteomyelitis lumbar spine. Common bile duct measures approximately 0.7 cm. This desiccation at L3-L4 through L5-S1.
At T12-L1, no disc bulge, spinal canal stenosis, or neural foraminal stenosis.
At L1-L2, no disc bulge, spinal canal stenosis, or neural foraminal stenosis.
At L2-L3, no disc bulge, spinal canal stenosis, or neural foraminal stenosis.
At L3-L4, no neural foraminal stenosis or spinal canal stenosis. Posterior disc bulge (2 mm AP).
At L4-L5, mild disc height loss. No neural foraminal stenosis. No spinal canal stenosis. Posterior disc bulge (3 mm AP). Mild bilateral facet arthropathy.
At L5-S1, moderate disc height loss. Mild left neural foraminal stenosis. Moderate right neural foraminal stenosis. No significant spinal canal stenosis. Mild/moderate bilateral facet arthropathy. Broad-based posterior disc osteophyte complex (4 mm AP) with finding extending into the bilateral neural foramen.
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Any help would be greatly appreciated-
@lessie Hello and welcome to Mayo Connect, a patient support group where we share our health journeys and talk about what helps each of us.
We are not medical personnel, and the groups is not monitored by doctors, so we can't interpret your images. I can say your reports look a lot better than mine, and that my orthopedist said after the latest image that there likely isn't any surgery in my near future.
Can you tell us what symptoms led to the imaging? And what measures (like exercise, stretching and PT) you have been doing since the image last October?
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1 Reaction@lessie - just wanted you to know I moved your post to this discussion where members were chatting about something similar to what you mentioned:
- Confusion about MRI results for L5-s1 https://connect.mayoclinic.org/discussion/l5-s1/
As @sueinmn mentioned, we are not medical professionals, but fellow travelers seeking to help others going through medical situations and provide support. With the MRI results you were provided, was there an accompanying recommendation for treatment? If so, what was it?
@lisalucier
Thank you, Lisa. My symptoms are mostly right sided. My foot and toes are mostly numb on the top. I get stabbing pain in my right buttock and occasionally in the left side as well. Pain shoots down my outer leg to my foot, and recently to my pinky toe. I've had L4-5 hemi-laminectomy (2023) and fusion of L4-5 in 2024. My right leg always aches. And I've been getting charley horse cramps in my feet and ankles, sometimes up my calf since November. I've also had pins and needles primarily down from my back down my right side. My left foot has recently started to ache and occasionally I get the pins and needles down that leg as well. But, it is mostly the right side that is bothering me, even though that latest MRI indicates that it's the left side that's mostly involved. And my balance is also difficult, but I'm in PT for that.
My activity consists of walking 3 times a week, chair yoga 2 times a week, mat stretches 3-4 times a week. I'm doing the exercises I was taught by my PT after my second surgery. I was in PT for a year.
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1 Reactionlessie, your L5-S1 disc has expanded it's bulge. Now it is making contact with the S1 nerve root. The expansion has reduce the space between the joint (facet) facet where the nerves exit the spinal canal enough to cause arthropathy (joint disease which in your case is reduced space and maybe some inflammation probably pain) https://www.totalorthosportsmed.com/what-are-the-symptoms-of-l5-s1-nerve-damage/
You might consider minimally invasive microdiscectomy and/or facet radiofrequency.
I hope you aren't in pain.
@gently
Today is a "good" day. I'm not in any unbearable pain. My foot is tingling (mild pens and needles), but no Charley horses and no zinging sharp pain. But I've been resting for 3 days. Sprained my ankle while getting out of bed at 3 am Sunday night to walk off the Charlie horse.
I'm seeing the neurosurgeon on Monday. He did my last two surgeries and is very conservative. I trust him.
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2 Reactionslessie, one thing after another. Be careful.
I'm glad you have a trustworthy neurosurgeon.
If he is conservative he probably doesn't like the micro surgeries which often are just a delay tactic. I'll be curious about what he thinks of your shallow subarticular protrusion.
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1 Reaction@lessie Please let us know what your neurosurgeon says. I have similar symptoms (right side calf / foot / toes numbness). Thank you
@gently
When I said he's conservative about treatment I meant that he does not jump to surgery and if he does recommend surgery, he does just what he feels is necessary. Therefore, since the levels above and below L4-5 were fine when he did the fusion of L4-5, he chose not to fuse either of those levels. Another surgeon who I went to wanted to do 3-4 levels of fusion all at once. So, the disadvantage of doing just one level is that there's more chances that I'll need to have another surgery. So, I am second-guessing myself and my decision to go with my current neurosurgeon. If he recommends surgery this time, I will seek a second opinion from a spine surgeon at Mass General Hospital.
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1 Reaction@ccchang
I saw the neurosurgeon yesterday. He was concerned about L3-4, which is the level above the fusion that I had 2 years ago. He said the MRI looked unusual and that he has seen only 6-7 cases where the nerves are unevenly blocked. He is recommending a laminectomy and the tough part (for him) is convincing my insurance that I need it. Why? Because the radiologist said the following:
L3-L4: Disc bulge and ligamentum flavum thickening causing lateral
recess and mild spinal canal stenosis. Moderate facet arthropathy with
mild left neural foraminal narrowing.
The report says that the spinal canal stenosis is mild when in fact it is moderate to severe and warrants surgery. My surgeon is pretty certain that they will be able to deal with my insurance (Medicare).
As far as the symptoms go, this will help with the sharp, shooting pain in my buttocks that then travels down my legs and into my feet. It should help with the pins and needles sensation as well. It may or may not help with the charley horse cramps in my feet and calves.
We will be traveling in September so we are scheduling surgery in mid October. In the meantime, he has referred me to the pain clinic for an injection, perhaps 2 if there's time before I leave. That should help at least a little bit.