Expert: Robert Borucki - 10/27/2009

Question
I have been referred to a neurosurgeon due to continued nerve pain in right leg. Epidural injections have not helped.  Currently take Lyrica for nerve pain. I had lumbar fusion (L5-S1) in 2000.  My MRI states there is a 3 mm of disc bulging in L3-4.  The spinal canal is mildly narrowed by disc bulging and  ligamentum flavum hypertrophy.  There is bilateral facet arthropathy.  Both neural foramen appear patent.  At L1-2 there is 2 mm disc bulge - spinal canal and neural foramen are patent.  At L2-L3 2-3 mm disc bulge and spinal canal is mildly narrowed. Both neural foramen appear patent.  L5-S1 post-surgical change of 2-3 mm enhancing scar tissue anterior to the thecal sac.  It does mildly displace the right S1 root in the right lateral recess-both neural foramen appear patent.

Explain this MRI in lay terms please.

Answer
wow.... the hard part is the terms don't convert to easy language sometimes.  Before I try, let me say that back pain is very subjective and doesn't always follow MRI findings... ie some people have horrible pain and a normal MRI, most adults have disc bulges and don't have back pain.  

3mm disc bulge L3-4... that is nothing.  facet arthropathy means arthritis on the parts of the spine that connect... the facets... the little pieces near the back that are the joints in the back.  This often causes a lot of pain, sometimes they can inject the facets by themselves and help.  L1-L2 2 mm bulge... that again isn't significant... that isn't causing pain.  Post surgical changes--- the scarring can cause pain if it is trapping or pinching a nerve.  Especially with that Right S1 nerve root being pushed.  

I will imagine they said that surgery won't help with this MRI.... medical management... NSAID's, Lyrica, maybe Cymbalta, maybe some narcotics and then trials of oral steroids, epidural steroid injections, maybe facet injections.   

This is a very complicated hard subject that I tried to summarize.