OpenHealth Q&A

Interpreting MRI Results: Lower Back Pain and Limb Discomfort in Relation to Dupixent Usage

I’m inquiring on behalf of my husband, a 40-year-old male, measuring 6 feet tall and weighing 195 pounds, who is currently being treated with Dupixent for lichen planus affecting his lower limbs. He primarily suffers from lower back discomfort and reports that, when at rest, he experiences a sensation of heat and discomfort in his knees and feet. Unfortunately, his primary care physician has not provided a clear diagnosis and has merely suggested physical therapy. **MRI Examination of the Lumbar Spine (No Contrast)** **Date of Procedure:** June 4, 2025, 3:14 PM **Reason for MRI:** 40-year-old male presenting with low back pain alongside bilateral discomfort in the knees and feet. He reports no history of trauma, surgery, or prior health complications, and no indication of cancer. His low back pain has persisted despite over six weeks of ongoing treatment. **Comparative Studies:** There are no previous images available for reference. **Technique:** The MRI was performed using standard multiplanar imaging techniques without the use of contrast agents. **Findings:** The conus medullaris ends at the upper-middle level of the L1 vertebra. At T12-L1, a slight posterior annular bulge is observed. The L1-2 intervertebral space shows a mild posterior and left posterolateral bulge. At L2-3 and L3-4, a minor diffuse posterior disc bulge is noted with minimal retrolisthesis present. The L4-5 space has a mild posterior disc bulge, also with minimal retrolisthesis. The L5-S1 segment reveals a mild posterior-central annular/disc bulge. There are indications of potential irregularities and a discontinuity within the marrow at the expected areas of the pars at L5 bilaterally. Additionally, there is mild to moderate hypertrophy of the lumbar facet joints. The combination of lateral spondylotic changes and facet entrapment manifests as varying degrees of neural foraminal narrowing, including minimal to moderate changes at multiple levels (T12-L1, L1-2, L2-3, and more). There is also evidence of mild degenerated disc changes in the lumbar region. **Conclusions:** 1. Mild lumbar spondylosis is present without any focal disc herniation or central canal stenosis detected. 2. There are indications of irregularity and marrow discontinuity at the pars regions at the L5 level, implying potential pars defects, for which further assessment through a CT scan might be warranted to evaluate the integrity of the posterior elements. 3. Mild to moderate hypertrophy of the lumbar facets is contributing to the previously mentioned neural foraminal narrowing. 4. There are mild degenerative disc changes noted within the lumbar spine.

Answers (1)

6/17/2025, 10:01:44 AM

OpenHealth AI

Your husband's MRI results suggest some mild lumbar spondylosis and degenerative disc changes, which can often contribute to lower back pain and discomfort in the limbs. Additionally, the findings indicate some irregularities at the L5 level that may require further investigation. Although Duplex usage for lichen planus is not directly linked to these lumbar problems, it’s understandable to concern given the complexity of multiple symptoms.

Key Points:

1. Mild lumbar spondylosis and degenerative changes suggest aging and wear on the spine, which is common but can contribute to pain and discomfort.
2. Neural foraminal narrowing is observed, which can compress nerves and may explain the limb discomfort.
3. Recommendations for further investigation, like a CT scan, were made due to potential irregularities at the L5 level.

Actionable Next Steps:

1. Physical Therapy: Since your husband's doctor has already suggested physical therapy, encourage him to start this as it can help in strengthening the muscles supporting the spine and alleviating pain.

2. Pain Management: Consider non-prescription pain relief like acetaminophen or ibuprofen, as long as he has no contraindications. This can help manage discomfort during his therapy.

3. Activity Modification: Encourage your husband to avoid strenuous activities or heavy lifting that may aggravate his back pain. Integrating gentle stretching and low-impact exercises, as advised by a physical therapist, may be beneficial.

4. Follow-Up for Further Imaging: Discuss the need for a CT scan with his doctor to further evaluate the irregularity at L5. This is important to rule out any serious issues related to the pars defects.

5. Monitor Symptoms: Keep track of any changes in his symptoms, especially with the onset or increase of discomfort in his knees and feet. This information can be very useful for future consultations.

Encourage him to be proactive about seeking clarity from his doctor regarding the MRI findings, especially if symptoms persist or worsen. Understanding the condition and the treatment plan is crucial for managing his health effectively. Let me know if you need further guidance or support!