Modic End Plate Changes of Spine With Classification
Q: Dear doctor, since 3 years I have been suffering from backache. On 24th February 2011, I took an MRI scan of lumbar spine. Its result is shown below:
At L1-L2, L2-L3 and L3-L4 no disc desiccation seen. Discs show no significant bulge/herniation. No evidence of significant primary canal / foraminal stenosis seen.
At L4-L5 disc desiccation seen with reduced disc height. Para-discal bone marrow appears hypointense on T1W , hyperintense on T2W images – suggestive of modic type I changes. Posterior disc protrusion causing significant spinal canal and bilateral foraminal stenosis with compression of the exiting nerve roots.
At L5-S1 no disc desiccation seen. Posterior annular disc bulge causing bilateral foraminal stenosis and mild spinal canal stenosis.
Vertebral alignment appears normal. No evidence of spondylolisthesis seen.
Vertebral bodies, pedicles, laminae, spinous processes and facetal articulation appear normal. Normal marrow signal intensity preserved.
Mid sagittal spinal canal measurement .
L1-L2–17 mm L2–14 mm
L2-L3–16 mm L3–14 mm
L3-L4–15 mm L4–13 mm
L4-L5–11 mm L5–13 mm
L5-S1–11 mm
Sir in this case, I am eagerly waiting your precious suggestions. Kindly inform me if surgery is its only remedy? We have so many doubts whether the operation would be success or not. Can you suggest any good doctor in Kerala?
-By Padma
Reply:
It is evident from your MRI that you are having a lot of back pain.
What Are Modic Changes?
Let us first know what these modic changes are. These are vertebral endplate and subchondral bone marrow changes due to the degeneration of discs. These are observed on MRI as signal intensity changes in vertebral body near the end plates of the affected discs.
With increasing age and repeated stress, wear and tear occurs in our back. This includes:
- Wearing out of the cushions provided between two vertebrae
- Shortening of the height between two vertebrae
- Minor fractures in the bony areas (like trabeculae) of the vertebrae
- Presence of signs of inflammations in the area, that is swelling etc.
- Later on, fat tissue may get deposited
- Inflammation finally leads to bone scarring
Pathologically, these changes are called modic changes and are grouped into 3 types.
i) Modic type 1 changes show signs of active inflammation. These signs are pain, presence of minor fractures and other breakages near the endplate area, accumulation of inflammatory fluid in the region leading to swelling. This stage is very painful and the pain usually correlates with the amount of inflammation.
ii) Modic type 2 is when the marrow gets substituted by yellow fat.
iii) Modic type 3 is the stage where all inflammation is finally replaced by bone scarring.
Since your MRI is showing modic type 1 changes, you have active inflammation in your back adjacent to end plates, which is giving you the pain.
Management of Backpain in Lumbar Vertebral Area
It won’t be proper to rush for surgery. Strong anti-inflammatory medication needs to be tried first.
It is something like you have many blisters there. Give yourself adequate rest. Don’t strain that part in any way. Avoid all movements that give you pain. You may also read here about the management of backache.
We are unable to suggest you a doctor at your place. However, it is advisable that you visit an orthopedician, preferably in a big hospital or institutional setup, not a solo clinic.
Hospitals are adequately equipped to meet emergencies. Also, there are people from other fields too, like neurology etc., who may be consulted during your treatment.
Your doctor may start with anti-inflammatory drugs first. This includes NSAIDs and corticosteroids.
He may consider giving you intradiscal injections of corticosteroids. 3 to 4 such injection are usually enough to take care of such inflammations.
Muscles relaxants are also given. SerratioPeptidase is a potent anti-inflammatory enzyme helpful in such conditions.
Surgery in this area is difficult and is suggested only when there is substantial herniation of the intervertebral disc tissue.
Take Care,
Buddy M.D.
HELLO, DO MODIC 1 CHANGES, WHICH ARE VERY PAINFUL, NATURALLY PROGRESS TO THE LESS PAINFUL MODIC II AND III TYPE? WHAT IS THE TEST FOR MODIC I CHANGES? CAN ANTIBIOTICS CURE THIS? THANKS, JOHN
If no corrective measures are adopted at modic stage 1, it would naturally progress to stage 2.
Corrective measures include rest of those parts, showing inflammatory changes, and anti- inflammatory medications.
Antibiotics are not given. Patient requires anti-inflammatory drugs, even steroids. They should be given in time to arrest the progress of stage 1 to stage 2.
Regarding modic 2–are the use of antibiotics a reasonable treatment? They are being used in England and Denmark. My MRI shows severe modic 1 and 2.
You may try a course of antibiotics for your problem. Many clinical trials included antibiotics in their regimen and have proved their efficacy, though the role of antibiotics in backaches is still debatable.
Modic 1 and, to some extent, Modic 2 type of changes are basically conditions characterized by inflammatory changes between the vertebrae.
There is plenty of inflammatory fluid and tissue debris between the vertebrae. This material may work as a culture material for the growth of bacteria.
A few anaerobic bacteria have been seen to grow in this here.
Though the mainstay treatment for backaches is anti-inflammatory medications, a course of antibiotics may be tried under the supervision of a doctor.
Sir,
I had a long time back pain problem. Recently I took a MRI and reports findings are as bellow:
Vertebra : Marginal osteophytes are seen at L1-L5 vertebral bodies. Type 2 end plate
changes are seen at L1 & L2 bodies. Alignment is normal. Marrow signal intensity is normal.
Disc : Dehydration of L1-L2, L2-L3 & L3-L4 discs are noted with reduced disc height between L1- L2.
No canal stenosis or foraminal narrowing is seen.
Visualized cord and conus appear normal.
Para vertebral soft tissue appear normal.
Impression : mild degenerative changes in lumber spine.
Please help me giving suggestions. Thanks.
Mild degenerative changes can be seen in your vertebral column. These suggest some wear and tear of the disc cushions and the vertebrae in the back.
For now, you need to take rest till the pain subsides. You may be given pain killers for this.
Once you are alright, avoid all activities that may lead to further wear and tear. Avoid excess weight lifting, wrong postures while sitting or working.
Physiotherapy is suggested for strengthening the muscles of the back area, so that the burnt of all day work falls on the muscles and not on the vertebrae.
Hello, I have been dealing with back/right leg pain that I first noticed in 2002 but which didn’t really alter my activity level until 2008. Since then, I took driving jobs that took the pain away since standing for more than 45 minutes was out of the question, but sitting all day was okay. I can’t say it didn’t hurt, I could feel it, and some days were worse than others, but it wasn’t ever so painful that I couldn’t work through it. My doctor kept telling me that surgery should be my last option, and that I should continue to manage the pain by adapting what I do as long as it works. Well, this past April I left the driving job for a desk job that didn’t work out, but over the summer my back got worse to where now I can’t sit at the desk for 45 minutes without painkillers, and not much longer with them.
I finally got an MRI two weeks ago, which I have included verbatim below. I am anxious because my appointment with the specialist is not until 12/5 and I haven’t really talked to anyone else who seems to really know much about the terms on here. My physical therapist, really nice, admitted she had no idea what Modic Type I changes were, so I pretty much stopped asking questions and she didn’t really offer to interpret anything else in the report.
My G.P. would only say that it was “Significant.” And that was it, plus plenty of percocet.
From what I’m reading, the Modic Type I changes seem to be quite serious, and the rest of it does seem pretty “significant” but I don’t know by how much and I’m too anxious to wait until 12/5 to find out.
Anyone out there who would please be kind enough to briefly interpret what this report says I WOULD BE FOREVER GRATEFUL. THANK YOU.
FINDINGS:
There is convex right lumbar scoliosis centered at the L3 vertebral level. There is a trace anterolisthesis of L3 on L4. Modic Type I endplate change is seen at L4/L5. The tip of the conus medularris terminates at the L1 vertebral body level. Limited assessment of the paraspinal soft tissues is normal in appearance.
At the L5/S1 level, there is a disc bulge and degenerative facet disease with a small superimposed right paracentral protrusion impinging the right S1 nerve root as it enters the lateral recess within the mildly narrowed spinal canal. There is moderate bilateral neural foraminal narrowing.
At the L4/L5 level, there is a disc bulge and degenerative facet disease with moderate spinal canal narrowing and moderate/severe right and moderate left neural foraminal narrowing.
At the L3/L4 level, there is a disc bulge and degenerative facet disease with moderate/severe spinal canal narrowing. There is a small right neural foraminal annular fissure with mild/moderate bilateral neural foraminal narrowing.
At the L2/L3 level, there is a disc bulge and degenerative facet disease with moderate spinal canal narrowing and mild left and moderate right neural foraminal narrowing.
At the L1/L2 level, there is a small disc bulge with mild spinal canal narrowing. The neural foramina are patent.
IMPRESSION:
1. Convex right lumbar scoliosis with advanced superimposed degenerative disc and facet disease. Current findings include L3/L4 moderate/severe spinal canal narrowing as well as L2/L3 and L4L5 moderate spinal canal narrowing.
2. Multilevel neural foraminal narrowing including L4/L5 moderate/severe right neural foraminal narrowing. Additional findings include a L5/S1 small superimposed right paracentral protrusion abutting the right S1 nerve root as it enters the lateral recess within the mildly narrowed spinal canal. Additional levels of degenerative disease discussed above.
END OF REPORT
You have degenerative changes in your lower back. As you age up, the vertebra and the cushions between them start getting eroded by continuous friction between them. This degeneration is more if you are calcium deficient or adopt wrong postures in day to day activities.
All foci of degeneration show some inflammation signs, that is pain and swelling. Your report shows that your back has inflammatory signs (This is modic type 1 changes).
Due to swelling in between the affected vertebrae, the nerves coming out from between them is getting pressed and that’s giving you the pain.
To alleviate pain, anti inflammatory medicines may be given. In severe cases, they may be even injected at the sites of severe inflammation.
Apart from this, traction may be used in the affected limb. This would provide you relief for a long time.
Once the pain is gone and you are alright, you need physiotherapy. Exercise under a physiotherapist to strengthen your back muscles. If back muscles are strong enough to handle all brunts of your daily work, they’ll not let the load come on the vertebral bones. This would prevent further degeneration.
Findings:
There are 5 lumbar type vertebral segments. Ileal lumbar ligaments
are evident at the L5 level.
There is grade 1 retrolisthesis of L4 on L5 with grade 1
anterolisthesis of L5 on S1. No MR findings to suggest pars defects.
No acute-appearing vertebral body height loss. Degenerative endplate
changes are evident about the L3-4 level (Modic type I) and L4-5
level (Modic type II). Bone marrow signal is otherwise unremarkable.
L3: Mild bulging of the disc annulus and mild facet and ligamentum
flavum hypertrophy impress upon the thecal sac without significant
thecal sac or neural foraminal narrowing.
L3-L4: An inferiorly directed right central extrusion extends
approximately 0.8 mm inferiorly within the ventral epidural space. A
smaller right subarticular and foraminal extrusion is nearly
contiguous with the right central extrusion. These findings coupled
with moderate facet and ligamentum flavum hypertrophy result in
moderate narrowing of the thecal sac with a paucity of CSF signal.
There is contact and suspected mass effect upon the descending right
L4 nerve roots. There is moderate to severe narrowing of the right
neural foramen.
L4-L5: Loss of intervertebral disc space, a small diffuse disc
osteophyte complex and moderate to advanced facet and ligamentum
flavum hypertrophy contacting the descending L5 nerve roots. There is
moderate narrowing of the neural foramina bilaterally with contact of
the exiting nerve roots.
L5-S1: Grade 1 anterolisthesis, uncovering of the intervertebral disc
and an associated annular fissure and moderate facet and ligamentum
flavum hypertrophy do not result in significant thecal sac or neural
foraminal narrowing.
The included intra-abdominal contents are unremarkable on the
included sequences. Fatty atrophy within the posterior paraspinal
musculature is more prominent distally.
Let us know the treatment you are taking.
I’m 34 years old and having been dealing with lower back pain for 7 years. Just had my latest MRI which doesn’t show any disc buldge this time but not sure what other stuff means. The pain is worse and am wondering how much longer injections and meds will work. Here are my results.
-2: Normal; no disc herniation or bulge. No central canal stenosis or neuroforaminal narrowing. L2-3: Mild disc space narrowing and desiccation. No disc herniation or bulge. No central canal stenosis or neuroforaminal narrowing. L3-4: Moderate disc space narrowing and desiccation. Modic 2 endplate signal changes. No disc herniation or bulges. No central canal stenosis or neuroforaminal narrowing. L4-5: Mild disc space narrowing and desiccation. Small Schmorls node. Small asymmetric left lateral disc osteophyte complex narrows the lateral recess and abuts the traversing nerve root on that side. There is no significant central canal stenosis. Mild left neural foraminal narrowing is present. L5-S1: Normal; no disc herniation or bulge. No central canal stenosis
1. Multilevel spondylosis. 2. Mild left-sided neural foraminal narrowing at L4-5 with narrowing of the lateral recess on the same side.
Till you have pain, injections and medications are essential to keep you moving. Once relived, you may start with some physiotherapy under a trained instruction. Patients in conditions similar to you have benefited with such sessions.
Weight reduction, if overweight, helps a great deal.
I torqued my groin area several years back do to a knee problem that caused me to loose the function of my leg temporarily. I had muniscus surgery that relieved some knee pain. I continued with alot of groin pain, thigh pain and knee and shin pain. about a year ago I started experiecing severe leg pain and started loosing my ability to stand or sit for any length of time. I could walk ok for a period of time but after I stopped the leg thigh and shin pain continued to get worse. and had muscle knots and spasms. that is my history. I had an mri because the pain was getting so great I could not sleep for more than several hours, even with pain meds. The mri results were degenerative endplate edema with no large disk herniation or severe root comp. From what I read it does not seem this can cause this much trouble but am confused as to what the future holds and what can I do. I am 67 years old.
At what spot does the pain start, is it your back, groin or thigh area? Does it radiate downwards?
When do you feet the pain most, during standing, walking or lying down?
Can you share the MRI report here.
SIr,
Good day to you,
I am sunil from Kerala, India. I work as a loading man in a logistics company, since from the last 3 months I severely suffering due to back pain and I consult one doctor(ortho) he gave some pain relief medicines and antibiotics. Result was null and doctor refer to take MRI and refer surgery
please goes through the findings and give me your valuable suggestions
MRI lumbo -sacral spine Report
1.Numbering of vertebrae done by counting from C2 downwards
2.Exaggerated lumbar lordosis is noted.
3.The conus medullaris is at T12-L1 level
4.The lumbar vertebral bodies show normal stature, and marrow signal characteristics. Modic type 2 changes noted at multiple levels. Mild retrolisthesis of L4 and L5 noted.
5.Bilateral SI joints are normal
6.At D12-L1, L1-L2 and L3-L4: The disc heigh and hydration are well maintained. The disc contour is normal. There is no significant spinal canal/neural foraminal stenosis. The facet joints are unremarkable
7.At L3-L4: The disc heigh is maintained with loss of hydration. Broad based posterior disc bulge seen causing bilateral severe neural foramen stenosis.
8.At L4-L5 and L5-S1 : The disc height is reduced with loss of hydration .Broad based posterior disc bulge seen causing bilateral complete neural foramen stenosis .End plate of L5 and S1 are irregular.
9.Spinal canal diameter at disc level:
L1-L2 : 15.3 mm
L2-L3 : 13.1 mm
L3-L4 : 14 mm
L4-L5 : 12.9 mm
L5-S1 : 13 mm
Please goes through the findings and give me your valuable suggestions and treatment level
faithfully
sunil
Overall picture shows wear and tear in your back. However, damages are reversible. For now, you’ll need to take pills to minimize pain and swelling in the affected region. Minor surgeries to relieve pressure over nerves may be suggested (depending upon your symptoms).
Once the acute episode goes away, physiotherapy is suggested. This would go a long way in strengthening the musculature of your back, so that your vertebrae don’t have to bear the strain of your work. Instead, you strong muscles bear it.
RETIRED LAWYER ,75, WHO IS ACTIVE PLAYING TENNIS, ROAD BIKING AND WEIGHT TRAINING WITH MACHINES IN HEALTH CLUB. PAIN DOWN BACK OF BOTH LEGS, PARTICULARLY UPON ARISING FROM SLEEP. USING ALLEVE @420MG BID. COURSE OF STEROIDS BY PILLS FOR FIVE DAYS HELPED BUT PAIN RETURNED. A BOT OVERWEIGHT AT 5’10 AND 205 LBS. MRI SAYS L-5-S1 SEVERE DEGENERATIVE DISC/ENDPLATE DISEASE WITH MODERATE TO SEVERE MARROW EDEMA. RETROLISTHESIS AND 6MM PROTRUDING DISC OSTEOPHYTE COMPLEX SUBLIGAMENTOUS EXTENSION/EXTRUSION. MILD THECAL SAC STENOSIS. BILATERAL FACET ARTHOPATHY MODERATE BILATERAL STENOSIS
ALSO SACRAL MRI SAID MODERATE TO MARKED HYPERTROPHIC CHANGES INVOLVING S1 JOINT. HESITANT TO SEE A SURGEON SINCE SURGEONS SEE THINS AS A ‘CASE’ AND SEE SURGICAL SOLUTIONS TO MOST PROBLEMS THAT COME THEIR WAY. THAT IS HUMAN NATURE: WE SOLVE THE WAY WE WERE TRAINED TO SOLVE. I LIVE IN AN AREA OF RETIREES AND LOTS OF MEDICAL CARE BUT I PREFER LARGE TRAINING HOSPITALS SUCH AS UCLA OR SCRIPTS AND NOT LOCAL SURGEONS. OF COURSE I WOULD LIKE NON-SURGICAL CONSERVATIVE TREATMENT FIRST. IS THIS TREATABLE WITH CORTICOSTEROID INJECTIONS AT S1 ON EACH SIDE? BY THE WAY I HAVE A FLAT DISC AT L4-L5. VERY ATHLETIC AND NEVER HAD ANY BACK PROBLEMS UNTIL A FEW MONTHS AGO. 75 YEARS OF GOOD BACK IS NOW COMING FULL CIRCLE WITH AGING ISSUES I SUSPECT.
Your nerves are getting compressed by degeneration changes in your lower back. That’s giving you the pain.
Surgical interventions, yes, would give relief.
However, steroid injections may also alleviate pain in many cases and help you pull on the same way for a couple of years. Also, physiotherapy under a trained instructor may help a great deal.
Recommended you avoid weight lifting and other gym exercises for some time.
Hello, I am 35 (f) and have been dealing with back problems for about 17 years now after an accident in which our car hit and bounced off 3 different trees. Both my thoracic and lumbar spine are affected. I have recieved steroid injections in my l5-s1 and sacroilliac joints since about 2013 (I have gotten multiple injections over this time period, usually in sets of three over a few months time. Lately however they are becoming less effective). My constant daily pain is around the T9-10 level, but my doctor says the MRI findings don’t correlate with the amount of pain I feel (it is constant, not always the same intensity, but it is always there. When I bend it feels like my back is pivoting at that spot rather than all my vertebrae moving together. Also, I remember not long after the accident, any time I tried to lay flat on my back, there was incredibly intense pain in this same spot.) I’m hoping you can look at my results and provide any advice. I sceduled an appointment with my pain mgmt Dr. but again, the injections don’t seem to be helping anymore and she has said the only injection she would do in the Thoracic area is trigger points, but those were unsuccessful in helping the pain as well.
Thoracic MRI results:
FINDINGS:
Alignment: Very mild thoracic levoscoliosis. No spondylolisthesis. The facets are well aligned.
Height: Vertebral body heights are maintained. No compressive deformity.
Marrow: Marrow signal pattern is unremarkable. No infiltrating lesion.
Cord: The thoracic spinal cord and conus medullaris are normal in contour and signal intensity.. Conus terminates at the L1-2 level.
Paraspinous soft tissues: No abnormality identified in the paraspinous soft tissues.
DISC SPACE NUMBERING SYSTEM: Note that numbering system used in this report utilizes the craniocervical junction as a reference for disc space numbering purposes.
SEGMENTAL FINDINGS:There is no spinal canal or neural foraminal stenosis at any level. At T7-8, T8-9, and T9-10 there are disc bulges which minimally effaces the ventral thecal sac without causing spinal canal narrowing. No significant thoracic facet degeneration.
IMPRESSION:
No evidence of fracture or traumatic malalignment. Minimal early degenerative changes in the lower thoracic spine without spinal canal or neural foraminal narrowing at any level.
Lumbar MRI results:
FINDINGS:
Alignment: Alignment of the vertebral segments is normal.
Height: The vertebral body heights are well preserved and no acute compression fractures are evident.
Marrow: Modic type I endplate degenerative changes are identified at the L4-L5 level. Type II Modic endplate degenerative changes are present at the L5-S1 level.
Conus: The conus medullaris appears normal.
Retroperitoneum: No retroperitoneal disease is seen.
T12-L1: Normal
L1-2: Normal
L2-3: Normal
L3-4: Normal
L4-5: Broad-based disc bulge, ligamentum flavum hypertrophy and mild posterior facet degenerative changes are present no significant central canal stenosis is identified. Minimal right foraminal narrowing is present
L5-S1: Mild disc height loss is identified. No central canal stenosis or foraminal narrowing identified
Sacroiliac joints:Visualized portions of the sacroiliac joints are unremarkable.
IMPRESSION:
1. Stable MRI of the lumbar spine
Thank you,
Jess
AS per your reports, spine looks fine and stable. Better to go for injections at trigger points only.
Perceived pain, however, cannot be ignored. You’ll need to avoid those activities which give you intense pain. Be slow and gentle while changing positions or rotating yourself. Any movement that elicits pain should be dose more gently.
Pain may be due to inflamed soft tissues around your vertebrae. Though the bony elements look fine, soft tissue out there may take time to heal.
QUOTING HERE THE findings of my MRI:
1. There is a normal lumbar lordosis with no fracture or spondylolisthesis. Conus is normal and ends at L1. Caudia equina is normal.
2. All the lumbar disc spaces have loss of height and signal on T2. There are associated Modic type II degenerative endplate changes and focal bony spur at L2-3 and L4-5. Mild degenerative endplate changes are noted L5-S1 and L3-4.
3. At L5-S1, there is moderate acquired stenosis from posterior ligamentous hypertrophy, bilateral facet arthritis and diffuse disc bulge. Neural foramen are narrowed bilaterally with compression of each L5 nerve root.
4. At L4-5, there is marked canal stenosis from facet arthritis, posterior ligamentous hypertrophy and diffuse disc bulge. Neural foramen are narrowed bilaterally and facet abut the right L4 nerve root. There is focal compression of the left L4 nerve root.
5. AT L3-4, there is acquired canal stenosis with facet arthritis, posterior ligamentous hypertrophy and diffuse disc bulge. Neural foramen are narrowed bilaterally, left greater than right. There is loss of fat around the nerve roots.
6. At L2-3, there is a Schmorl’s node thru the inferior endplate of L2. There is diffuse disc bulge and mild facet arthritis with compression of the thecal sac. The neural foramen and cana are narrowed without nerve root compresion.
What is your diagnosis? and your recommended treatment(s)/
Thank you.
Your nerves are getting compressed at different locations, likely to be giving you pain. Treatment would aim at decompressing them. THis is sometimes achievable by physiotherapy and diathermy.
In some cases, steroid injections may be needed.
Long term physiotherapy and recommended exercises have a big role to play in most cases. It would not only alleviate symptoms, but also check progression of disease.
Your underlying disease, arthritis, needs to be attended by a doctor with medications.
I had an MRI today,could you please explain this to me so that I can understand? Thank you.Skip navigation to main content
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Susan
MRI LUMBAR SPINE WO CONTRAST – DetailsPrinter friendly page–New window will open
About this test
Details
Study Result
Impression
Mild spondylosis. No evidence of central canal or
foraminal stenosis. Trace Modic type I endplate changes at
endplates surrounding L2/L3 disc.
Narrative
CLINICAL DATA: Low back pain rated in 6 weeks of treatment.
Degenerative disc disease. Bilateral leg paresthesias. Back pain
for one year. Radiates down left leg.
COMPARISON: Plain film study dated 10/25/2021 of the lumbar
spine.
TECHNIQUE: Multiplanar, multisequence MR images of the lumbar
spine were obtained without contrast
FINDINGS:
Spine numbering: For purposes of this dictation it is assumed
that there are 5 nonrib-bearing, lumbar-type vertebra, and the
most caudal fully segmented lumbar vertebra is labeled L5.
Alignment: Normal
Vertebral bodies: Normal height.
Marrow signal: Dark on T1 and bright on T2 Modic type I signal
seen involving the posterior endplates surrounding the L2/L3
level.
Intervertebral discs: Mild generalized disc desiccation with
slight loss of disc space of L3-L4.
Conus medullaris: Terminates at a normal level.
Cauda equina: Normal.
Paraspinal soft tissues: Normal
Individual levels:
Level Specific Findings:
T12- L1: Normal.
L1-L2: Cervical frontal disc bulge without spinal canal or
foraminal narrowing.
L2-L3: Circumferential disc bulge without canal or neural
foraminal narrowing.
L3-L4: Circumferential disc bulge without significant canal or
foraminal narrowing.
L4-L5: Normal.
L5-S1: Normal
Basically, the vertebral discs in your lower back are showing degenerative changes. Changes are not very severe. However, some nerves appear to be pressing against the bony surfaces, as tissue cushions have eroded. Pressure over these nerves is giving you leg pains.
Your doctor may suggest physiotherapy to ease pressure symptoms. Intervention is essential to arrest progress. Also, cause of degenerative changes need to be investigated to arrest further degeneration.
Mild edematous endplate degenerative changes at L5-S1. Marrow signal is otherwise normal. Lumbar alignment normal. Paraspinal tissues within normal limits. Conus terminates at a normal level. Signal intensity in the cauda equina and cord are normal. L1/L2: Mild disc bulge. No spinal canal stenosis or neural foraminal stenosis. L2/L3: Ligamentum flavum hypertrophy and facet degeneration. No spinal canal stenosis or neural foraminal stenosis. L3/L4: Mild disc bulge and small central disc protrusion. Ligamentum flavum hypertrophy and facet degeneration. No spinal canal stenosis or neural foraminal stenosis. L3/L4: Disc bulge and endplate osteophytes. Ligamentum flavum hypertrophy and facet degeneration. No spinal canal stenosis. Mild bilateral neural foraminal stenosis. L4/L5: Disc bulge and endplate osteophytes. Ligamentum flavum hypertrophy and facet degeneration. Mild spinal canal stenosis. Moderate bilateral neural foraminal stenosis. L5/S1: Disc bulge and endplate osteophytes. The previously demonstrated disc extrusion has improved, now there is just a small central/right subarticular disc protrusion which can contacts the transiting right S1 nerve root. Possible partially conjoined right S1 and S2 nerve roots. Moderate bilateral neural foraminal stenosis due to endplate and facet osteophytes.
I had a partial discectomy ( due to a CSF leak). The above is from last MRI. A spinal fusion, discectomy is being suggested. What is your advice. 51 yr old male. Constant back pain. Bending, standing long periods, sitting long periods send first burning numbness, then pins and needles from elbow to underside of left hand. Jolts and numbness down lower back to buttocks to foot.
Have both kinds of shots, Pregabalin, and Cyclobenzaprine are the meds. Gained weight (291) walk with a cane ( short distances) and crutches for long.
Thanks for any advice.
This requires an expert advice after thorough physical examination. See a neurosurgeon with all your previous and present reports. He’ll correlate your MRI findings clinically and then decide further treatment.