OpenHealth Q&A

MRI Findings of the Lumbar Region

In 2012, I was involved in an accident that triggered debilitating pain in my lower back. Over the years, I have endured this discomfort, occasionally being confined to bed when the pain became severe. However, in March of this year, I began to experience symptoms reminiscent of sciatica, with persistent pain extending down my right leg. Given my experience as an overweight teenager, this pain felt different, prompting my primary care physician to refer me to physical therapy. Four weeks into treatment, I underwent an MRI, and I am hoping for some insights while I await my doctor’s feedback on the findings, which are somewhat complex for me to interpret. HISTORY: The report indicates chronic low back pain with right-sided sciatica. Symptoms have persisted since March 20, 2025, without any specific trauma or surgical history noted, although asthma and anemia were reported. TECHNIQUE: A 1.5 Tesla MRI scanner was employed to conduct multiple imaging sequences of the lumbar spine, specifically T1-weighted and T2-weighted scans. COMPARISON: This MRI is benchmarked against a previous study from July 8, 2020. FINDINGS: - The height and alignment of the vertebral bodies appear to be normal. - Normal bone marrow signals are noted. However, a small ovoid region at the posterior superior endplate of L2 shows mildly increased T1 and T2 signals, consistent with a small hemangioma, which diminishes in STIR imaging. - At the L5-S1 level, there is a mild reduction in disc height and signal consistent with disc desiccation and degenerative changes. - A rudimentary disk is identified at the S1-2 space. The conus medullaris ends at the T12-L1 junction. - Imaging at T12-L1 shows no notable herniation or spinal canal narrowing. - The L1-2 segment also shows no significant issues, with minimal bilateral facet disease and a small amount of fluid seen in the facets. - At L2-3, a minor disc bulge slightly narrows the inferior neural foramina, but there are no indications of nerve root compression. Fluid signal is noted in the facets. - The L3-4 level appears unremarkable with no significant changes, just some fluid within the right facet. - The L4-5 level displays a slight disc bulge that minimally narrows the inferior foramina. - Finally, at L5-S1, a broad-based disc bulge with a focal right paracentral protrusion is present, measuring approximately 1.4 cm x 0.5 cm x 1.2 cm. This protrusion displaces and may compress the right S1 nerve root. There is also mild pressure on the left S1 nerve root and the extraforaminal L5 nerves. These findings suggest mild to moderate spinal canal stenosis, with the contents of the thecal sac being pushed posteriorly. The bilateral S2 nerve roots appear normal. Visualized sacroiliac joints are symmetrical, and there are no significant abnormalities such as retroperitoneal adenopathy or abdominal aortic aneurysm detected. The kidneys appear normal without hydronephrosis. IMPRESSION: The MRI demonstrates multilevel degenerative changes in the lumbar spine as described. There is a new focal right-sided disc protrusion impacting the right S1 nerve root, with minimal to moderate spinal canal stenosis. Additionally, there is potential subtle impingement on the left S1 nerve root and the bilateral L5 extraforaminal nerve roots. Note: The report was prioritized upon completion.

Answers (1)

6/25/2025, 12:31:25 PM

OpenHealth AI

It sounds like you’re dealing with a complex and challenging situation regarding your chronic lower back pain and recent sciatica symptoms. The MRI findings indicate a combination of degenerative changes in your lumbar spine and a protruding disc that may be affecting your nerve roots, which could be contributing to your pain.

Summary of Findings:

• Chronic low back pain with right-sided sciatica.
• Mild degenerative changes and disc bulging at multiple levels, particularly at L5-S1.
• A right-sided disc protrusion possibly compressing the right S1 nerve root, with some mild pressure on the left S1 nerve root and L5 nerves.
• No significant issues in vertebral alignment or serious narrowing of the spinal canal, but there are some degenerative changes, including disc desiccation and mild facet joint disease.

Explanation:

1. Degenerative Changes: As we age or due to injury, our spinal discs and joints may undergo wear and tear, leading to changes in their structure and composition (like disc bulging and desiccation). This can irritate nearby nerves, causing pain that radiates down the leg (sciatica).

2. Disc Protrusion: The protrusion at L5-S1 may cause inflammation or direct pressure on the nerve roots, which could explain the pain extending down your leg.

3. Symptoms and Management: Given the current findings, symptoms like sharp pain, numbness, or tingling in the leg can occur. It’s crucial to manage these symptoms effectively while waiting for your doctor's recommendations.

Next Steps:

1. Continue Physical Therapy: Keep attending physical therapy sessions as these can help strengthen your back muscles, improve flexibility, and relieve pressure on nerve roots.

2. Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain and inflammation. Always follow the recommended dosage and check with your doctor if you have any underlying conditions or are on other medications.

3. Activity Modifications: Avoid activities that exacerbate your pain, such as heavy lifting or prolonged sitting without breaks. Incorporate gentle stretching and low-impact activities, like walking or swimming, as advised by your physical therapist.

4. Posture Awareness: Pay attention to your posture, especially when sitting for long periods. Use ergonomic chairs and take regular breaks to stretch.

5. Ice and Heat Therapy: Applying ice in the first few days of pain flare-ups can reduce inflammation, while heat therapy (like warm compresses) can help relax tight muscles.

6. Symptom Monitoring: Keep a journal of your symptoms, noting when pain occurs, its intensity, and any activities that trigger it. This can be helpful for your doctor in planning your treatment.

Reassurance:

It’s understandable to feel concerned about your MRI results and ongoing symptoms, but with proper management and ongoing support from your healthcare team, many people with similar findings can find relief and improve their quality of life. Focus on your therapy, pain management, and maintain open communication with your provider regarding any new or worsening symptoms.

Feel free to reach out if you have more questions or need further clarification on any of these points!