Expert: Dr. J. Shawn Leatherman - 5/15/2009

Question
Can someone please help interpret my MRI.  I am having alot of pain and need to know what and why.  The report says VertebralCerebral angiography
Herniated nucleus pulposus
Intervertebral disk
Spinal fusion
Thoracic spine x-ray
Vertebral column bodies are normal in height.  There is disc dessication at t10-11, t11-12, and t12-L1.  Alignment is anatomic.  The conus medullaris has a normal appearance and terminates at approxiamately t12-L1.  T10-11 There is a small right paracentral disc protrusion.  There is no cord compressionCompression of the median nerve
Cpr - adult
Cpr - child (1 to 8 years old)
Cpr - infant or canal stenosisAortic stenosis
Blocked tear duct
Carotid stenosis, x-ray of the left artery
Carotid stenosis, x-ray of the right artery
Hypertrophic cardiomyopathy
Mitral stenosis
Pulmonary valve stenosis
Pyloric stenosis
Renal artery stenosis
Spinal stenosis.  NeuralCluster headaches
Neuralgia
Trigeminal neuralgia foramina are patentPatent ductus arteriosus.  T11-12 There is a small to moderate centralCentral sleep apnea disc extrusion.  There is no cord compression or canal stenosis.  Neural foramina are patent.  T12-L1 There is a small left paracentral disc protrusion without significant central canal or foraminal stenosis.  L1-2 through L4-5 Unremarkable  L5-S1 There is a mild facet hypertrophy without significant central canal or foraminal stenosis.  Prevertebral/paraspinal soft tissues are unremarkable.  
Please, no one online will answer me.  I see the doctor on Monday to discuss treatment options.
Thank you

Answer
Dear Camie,

This is very jumbled and contains numerous amounts of information that should not be included on an MRI report.  Furthermore, it appears to just contain a list of conditions, x-ray findings and CPR classes which is very peculiar.  It seems as though you may have placed your entire health history (or someones) and diagnostic impressions in this list, which is quite extensive, and out of order too.  Maybe the reason why no-one will comment.

However, I will comment on the MRI findings of the back which are included.  The basic problem here is that you have degenerative conditions from your mid back region down to the sacrum (bottom of the spine).  This mostly consists of dessication (degenerative drying out of the disc), a few small disc bulges (this is usually classified as less than 3mm:  {see below}), and facet hypertrophy (degenerative arthritic changes to the joint spaces of the vertebra).  These things are common in back pain suffers but should not be considered normal.

{The proliferation of the numerous and varied utilization of disc terminology by radiologists eventually prompted the North American Spine Society (NASS) to establish a nomenclature development group or task force consisting of itself, the American Society of Spine Radiology (ASSR), and the American Society of Neuroradiology. The resulting document was endorsed by themas well as by the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS), as well as by the CPT (Current Procedural Terminology) and ICD(International Classifications of Disease) Coding Committee of the American Academy of Orthopaedic Surgeons (AAOS). This will serve as the new definitive terminology...

...Bulging of the disc indicates less than 3 mm of extension beyond the normal margin. There have been many terms used in the description of herniation. We have herniated nucleus pulposus (HNP), but it is discouraged now. Ruptured disc is also discouraged, as was disc prolapse. Then there is the term disc protrusion, which represents a herniation in which the distance of protrusion is less than the width of the base. And finally we have disc extrusion, in which the distance of protrusion exceeds the width of the base. In the final analysis, the terms of choice are bulge and herniation. And now you probably know more about this mysterious lexicon than most other physicians.}

Your report indicates that the spinal cord and spinal nerve roots have not been specifically compressed or inflamed, and this is a good sign. But...did you have a prior spinal fusion surgery...the list above is actually quite confusing. Nothing on your report indicates a need for surgery or any other invasive procedure, and I would recommend that you get a referral from your medical doctor to a good local chiropractic physician for continued care.  Even if you have had a prior fusion surgery, a chiropractor can help, I am seeing 4-5 post surgical fusion patients in my clinic right now, and have been able to reduce pain levels while increasing function.  There are multiple techniques that can be utilized.  I know this may be complicated, but I hope it helps Camie.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net