Next Steps After Lumbar Spine MRI: What to Consider
Age: 30, Height: 5'11", Weight: 190 lbs. Over the past three years, I have experienced a gradual decline in muscle strength. Initially, I would have discomfort after sitting for extended periods, but now I have progressed to experiencing loss of sensation in my feet and legs. Additionally, I struggle to activate my pelvic floor muscles and I feel instability in my tailbone. I recently underwent an MRI, and the findings are as follows: - **Lower Thoracic Spine**: The results indicate no significant narrowing of the spinal canal or neural foramina in the examined region. - **L1-2 Level**: No notable narrowing of the spinal canal or foramina observed. - **L2-3 Level**: No significant narrowing detected. - **L3-4 Level**: Similar results with no significant narrowing. - **L4-5 Level**: Mild reduction in the height of the intervertebral disc is noted, accompanied by a very mild bulge. There is minor narrowing of the spinal canal and bilateral foraminal spaces, though no nerve root compression is present. - **L5-S1 Level**: There is minimal bulging of the disc, with slight narrowing of the spinal canal. This MRI was conducted following an EMG of my legs, which revealed: A needle survey indicated chronic denervation changes alongside lower muscle recruitment, with higher amplitude and duration in muscle units. There were no signs of smaller units, premature recruitment, or polyphasic discharges. A few muscles displayed mild, transient fasciculations, but there was an absence of sustained insertional activity. Given the pelvic instability and my challenges with sitting, would it be advisable to pursue an MRI of the sacral spine? My neurologist plans to arrange a lumbar puncture and a brain MRI to eliminate the possibility of multiple sclerosis. However, considering the delays often associated with scan approvals, I would prefer to expedite this process if possible.
Answers (1)
9/12/2025, 5:40:46 PM
OpenHealth AI
It sounds like you're going through a challenging time with your symptoms and diagnostic journey. The MRI results indicate some mild disc changes at L4-5 and L5-S1, but there’s no significant nerve root compression noted, which is a positive sign. However, your experiences of muscle weakness, loss of sensation, pelvic instability, and discomfort are concerning and warrant thorough investigation.
Explanation
Your symptoms, including the loss of sensation and muscle strength changes, alongside the acute findings from your nerve conduction study (EMG), suggest that further evaluation is essential. While your current MRI doesn't show significant issues in the lower lumbar spine, the pelvic instability and your overall symptoms may justify a closer look at the sacral region. It is reasonable to raise this possibility with your healthcare provider.
Additionally, the planned lumbar puncture and brain MRI will help rule out conditions like multiple sclerosis, which is crucial given your symptomatology. Understanding all these aspects together will provide better insight into your situation.
Next Steps
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Discuss Sacral MRI with Your Neurologist: Bring up your concerns about the potential need for an MRI of the sacral spine during your next appointment. Emphasize your symptoms of instability and discomfort, as these may impact your overall health and functioning.
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Prepare for Upcoming Tests: Since a lumbar puncture and brain MRI have been planned, prepare for these tests by ensuring you are hydrated, following any specific instructions given by your healthcare provider for these procedures, and discussing results expectations.
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Monitor Symptoms: Keep a daily log of your symptoms, noting any changes or additional difficulties you experience. This record can provide valuable information to your healthcare team.
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Physical Support: Consider gentle physical therapy focusing on core strengthening and pelvic floor exercises if suggested by your healthcare provider. Avoid high-impact activities until your symptoms are assessed further.
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Stay Informed and Engaged: Reach out to your healthcare team with any new symptoms or worsening conditions as soon as they arise, keeping the lines of communication open for timely responses.
Taking these actions may help you feel more in control of your health journey and ensure that you receive the attention needed for your concerns. Let me know if there are other specific areas where you require more information or support!
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