Radiology/Lumbar MRI scan
Please could you explain my lumbar MRI results. Especially the lesion - my GP at first thought was referring to my cervical spine then phoned me to say otherwise. I still don't know what this lesion is.
My MRI report recommends orthapedic referal but my GP has just sent me for physio. I don't really understand it so just wanted some piece of mind about the pain I'm having.
I was sent for an MRI because of bad lower back pain and pain and numbness down my legs. At the time of referral I had extremely bad pain in my hips and groin although that has eased somewhat now. I always get pain in my back and hips if I walk for more than 45 minutes. I am otherwise a very healthy 38 year old female.
Forward malalignment of the L4
Anterior and posterior lipping formation can be seen in the lumbar spine.
There is reduction in signal intensity in the lumbar invertebral discs at L3/4 and L4/5 levels, due to disc dehydration.
Mild OA changes at the apophyseal joints.
At L3/4 level, generalised disc bulge indenting the theca and narrows the lateral recesses, touching/abutting the L4 nerve roots.
There is an 1.4cm lesion with bright signal intensity on T1 and T2-weighted images at the right posterior facets which indenting the theca.
At L4/L5 level, generalised disc bulge abutting the right sided L4 root.
There is a tear at the left exit/exit foramen annulus.
At L5/S1 level there is minor canal stenosis and abutting of the S1 nerve roots.
Conclusion. Touching/abutting of the traversing L4 nerve roots
There is abutting of the right sided L4 nerve root at L4/L5 level
There is abutting of the S1 nerve roots and minor canal stenosis at L5/S1 level.
I am not sure from the description what that lesion is, except to say that if it is bright on T1, it is probably benign...but the description is confusing as if this is really a 1.4 CM lesion indenting the thecal sac then it should also displace some nerve roots...Can this be a synovial cyst from a facet joint? may be but these are usually dark on T1 and bright on T2. MRI signal is that of fat but again I am puzzled. Perhaps you can find it on the MRI and attach a picture of it here.
As for the rest of your spine, there are a lot of technical terms that summarize only MILD degenerative changes. Sometimes radiologists recommend referrals but inappropriately. Given the report, I am with your GP and physical therapy as the most appropriate next step. However, your GP or phys terapist needs to do a very careful assessment of your legs, hips, and spine to figure out if you have any specific radiculopathy that would correlate to any level described in your report where the disc may touch/abut the nerve root, and if so then you and your doctor may consider injection along the nerve root to see if your symptoms are really from the disc/nerve.
Unfortunately, most of what we see on MRI of the lumbar spine does not correlate well with symptoms. There are way too many structures that we see and degenerate with age but back pain is a very complex issue and is not easy to solve or correlate with MRI findings. On MRI we are looking for big disc herniations and stenosis of the canal that is significant which would then prompt a surgical evaluation. You don't have any of that. I would follow up on that lesion however. Perhaps there is a typographical error in the report like CM instead of MM or something else.
Hope this helps. Let me know if you have any other questions.