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Radiology/My MRI scan in London: clarity.

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Sir, I have only just seen the questions to you and the answers you have given ie first time on this site. I do hope you can help me, I will be clear. Ive spent many hours researching this spine stuff and all the stuff conected with problems there.
My story so far; escalating pain, mainly in lower legs for the last 3 to 4 years. Pain turns to electric shock type feelings in legs..fizzy like theres a current running thru them. Got so bad I couldnt catch up with my 2 yr old boy. X ray done, reveals "moderate severe scoliosis". Also this is turning on its axis. Pain caries on , getting worse.MRI reveals multiple diffuse bulges lumbar spine, Central L3 L4 disc extrusion which extends inferiorly over 1.9cm.....
Buckling of lig. favrum ( I can feel this) at this level & marked  narrowing of spinal canal and (THIS IS MY WORRY) clumping of the cauda equina. I am fully aware of the inplications of CES. I have no saddle anesthesia. bladder or bowel problems. My pain symptoms ( the consultant wanted to know clearly if walking was hard because of pain or loss of control)
have in the last 4 weeks diminished. Do I have slow onset CES? My spine is a mess and stenosis is present  for me too, and yet  I have a kind of remission at the moment. The neurologist said if he went by my scan alone, he may want to take action, but looking at me the patient, with less symptoms, will see me 24thJan for follow up. In the meantime I am super aware of any changes, perinium etc that could mess me up. Sorry long letter. Hope you can help.
Thanks,MIke....send me a reply. I'll send you an MP3 of my music...All help apreciated.

Answer
Hello,

This is a bit complicated to figure out in this venue however I'll try to give you my two cents...
Your symptoms MUST be carefully examined because there are several things at play here.

1. You have a very large disc extrusion - which is displacing the nerve roots (cauda equina). It likely displaces many of them given the size.
2. "Clumping of nerve roots" needs to be clarified.  Are they truly clumped together because they stick to each other OR are they just bunched up together because they are being pushed together from a large extrusion.  I think it is likely the latter which is much much better for you because once the extrusion decreases in size, your symptoms are likely to improve.  The former one implies inflammation of the nerve roots, what is called arachnoditis - and that is not so good at all.  Again, I bet it is not arachnoditis but rather just displacement/bunching up; especially if you never had surgery on your spine or any kind of significant trauma to your body (like a car accident).
3. That size of an extrusion is usually treated with surgery but apparently you are doing better than expected and that is why your doctor didn't recommend it just yet....which is great by the way. Surgery on the spine should only be considered as a last extreme.  So I think you are on the right track.  You will likely undergo repeat MRI depending on your symptoms.  If you have weakness, not just pain, but weakness in your legs, decrease in size of your muscles in legs then you have to go see your doctor and likely undergo decomopression surgery to release the mass effect on the nerves.
4. I doubt you feel buckling of the lig. flavum - it has likely been there for ages probably related to your scoliosis etc...

Hope this helps.

Michael

Radiology

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Michael K.

Expertise

Almost any kind of questions regarding any types of radiology exams, procedures, meaning of radiology reports etc...

Experience

12 year experience in the field of radiology

Organizations
American Society of Neuroradiology, Senior Member Society of Pediatric Radiology, Active Member

Publications
Radiology Seminars in pediatric neurology American Journal of Roentgenology American Journal of Neuroradiology

Education/Credentials
Board Certified in Diagnostic Radiology Additional Certificate of Qualification in Neuroradiology

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