Holy crud, batman! Or, What the MRI of My Lumbar Spine Says.
Well, the MRI and X-rays taken a few weeks ago at the Neurospine Insitute of Hell (not going back there -- oh, happy day!) were read by my neurologist this morning, and he walked me through them, since he knew I'd looked at MRIs and loads of X-rays before (and my husband is the son of a teaching doctor at Temple, etc. etc.).
Short story is:
L1-2
L2-3
L3-4
L4-5
All have bulging discs, all bulging out to the left. L2-3 looks like it's the closest to prolapsing (bursting).
All have inflammation of the facets, some "hugely" inflamed (see under cut, below). May be impinging on the nerves (his words: "L4-5 are undoubtedly causing some nerve pain" but we need to have tests done, again see below cut).
L2-3
L3-4
L4-5
These also have stenosis, L4-5 being the worst offender. Also may be impinging on the nerves (see under cut for more, below).
The bulging disc at L1-2 is an old bulge, detected first about 5 years ago, and doesn't seem to have improved but neither has it gotten much worse (we think). All the others are new. The one at L2-3 is the worst, and is probably the sucker causing the most pain: it appears to be the closest to prolapse (burst) and may already be impinging on the nerves. It may never prolapse if we can stop it in time (which is the GOOD NEWS). The others may be impinging on the nerves too, but it's hard to say until more tests are done (see below).
The inflammation of the facets pretty much proceeds in order of "some inflammation" starting at L1-2 and proceeding to "hugely inflamed" (his words) by the time we get to L4-5. He's sure that at least some of this is causing nerve pain, maybe all the way down. Hard to tell until tests are done.
The stenosis is known from an MRI done 5 years ago, but only at L4-5. The stenosis at L2-3 & L3-4 are new. The one at L3-4 is moderate, while the one at L4-5 seems to have progressed since it was last imaged. If any nerve pain is being caused by stenosis, it will only be from the L4-5 area, most likely. Again, can't tell without tests anyway.
The X-rays apparently showed significant "arthritic degeneration" throughout the lumbar spine. I'd had a lot showing as of 5 years ago, and even 10 years ago when I had a full set done of the cervical and lumbar (because of growing back pain at that time). Because we were busy talking neurological issues and not arthritic, I let that go, but I'm going to have him send the set of X-rays by email to my rheumatologist and take it up with her, since it sounds like it's progressed quite a bit, and may be some of the cause of the pain I've been in during the last year and a half. I'd also like her to check the cervical, since I had some doozies of calcium spurs and arthritis as early as 15 years ago, when I started to have neck pain in my twenties.
The next steps will be:
I left the clinic with the front desk telling me that all of these appointments would have to be done "later" by the staff and they'd call me. That was at 10:30am this morning. They never called back. I'll check with them tomorrow, and hopefully they've started the process.
(The frustrating part is the system with Dartmouth Hitchcock is all computerized, so the notes from the doctor were literally on her screen while she told me with a straight face that she had to "wait for the doctor's notes." Oh, the notes he sent into the system while he was with me not five minutes ago? Those notes? The ones that I know are instantly available to everyone, including me? [I love that part of the system, frankly.] Maybe she wanted to take a coffee break, but I was too damn tired and in too much pain to argue with her. Tomorrow, I may not be so polite. Just set up the freakin' appointments. Sigh.)
The GOOD NEWS is THE PAIN IS NOT ALL IN MY FREAKIN' HEAD. It's in my back. Where we thought it was. :D
Other good news is that he considers the amount of painkillers I'm taking daily to not only be reasonable given the condition of my spine, but he thinks I should perhaps up it if I need to, within reason of course.
And my suspicion is that my sleep patterns will improve if I can get this pain under better control. May it be so.
Short story is:
L1-2
L2-3
L3-4
L4-5
All have bulging discs, all bulging out to the left. L2-3 looks like it's the closest to prolapsing (bursting).
All have inflammation of the facets, some "hugely" inflamed (see under cut, below). May be impinging on the nerves (his words: "L4-5 are undoubtedly causing some nerve pain" but we need to have tests done, again see below cut).
L2-3
L3-4
L4-5
These also have stenosis, L4-5 being the worst offender. Also may be impinging on the nerves (see under cut for more, below).
The bulging disc at L1-2 is an old bulge, detected first about 5 years ago, and doesn't seem to have improved but neither has it gotten much worse (we think). All the others are new. The one at L2-3 is the worst, and is probably the sucker causing the most pain: it appears to be the closest to prolapse (burst) and may already be impinging on the nerves. It may never prolapse if we can stop it in time (which is the GOOD NEWS). The others may be impinging on the nerves too, but it's hard to say until more tests are done (see below).
The inflammation of the facets pretty much proceeds in order of "some inflammation" starting at L1-2 and proceeding to "hugely inflamed" (his words) by the time we get to L4-5. He's sure that at least some of this is causing nerve pain, maybe all the way down. Hard to tell until tests are done.
The stenosis is known from an MRI done 5 years ago, but only at L4-5. The stenosis at L2-3 & L3-4 are new. The one at L3-4 is moderate, while the one at L4-5 seems to have progressed since it was last imaged. If any nerve pain is being caused by stenosis, it will only be from the L4-5 area, most likely. Again, can't tell without tests anyway.
The X-rays apparently showed significant "arthritic degeneration" throughout the lumbar spine. I'd had a lot showing as of 5 years ago, and even 10 years ago when I had a full set done of the cervical and lumbar (because of growing back pain at that time). Because we were busy talking neurological issues and not arthritic, I let that go, but I'm going to have him send the set of X-rays by email to my rheumatologist and take it up with her, since it sounds like it's progressed quite a bit, and may be some of the cause of the pain I've been in during the last year and a half. I'd also like her to check the cervical, since I had some doozies of calcium spurs and arthritis as early as 15 years ago, when I started to have neck pain in my twenties.
The next steps will be:
- Get a nerve induction test (my neuro can do that) to see if there is nerve impingement from disc bulging, facet inflammation, or stenosis. Results are usually ready in a day.
- See a spine surgeon all the way the heck up at Dartmouth Hitchcock in Hanover, NH, at the medical school & hospital. If there is no nerve impingement, we may skip this step for the moment.
- Get some gentle PT started at Dartmouth/CMC down here in Manchester to get the muscles to relax more on the left side and stop pulling my spine (and discs) the heck out of whack. As well as relieve some of the muscular pain that's built up over the last year and a half.
I left the clinic with the front desk telling me that all of these appointments would have to be done "later" by the staff and they'd call me. That was at 10:30am this morning. They never called back. I'll check with them tomorrow, and hopefully they've started the process.
(The frustrating part is the system with Dartmouth Hitchcock is all computerized, so the notes from the doctor were literally on her screen while she told me with a straight face that she had to "wait for the doctor's notes." Oh, the notes he sent into the system while he was with me not five minutes ago? Those notes? The ones that I know are instantly available to everyone, including me? [I love that part of the system, frankly.] Maybe she wanted to take a coffee break, but I was too damn tired and in too much pain to argue with her. Tomorrow, I may not be so polite. Just set up the freakin' appointments. Sigh.)
The GOOD NEWS is THE PAIN IS NOT ALL IN MY FREAKIN' HEAD. It's in my back. Where we thought it was. :D
Other good news is that he considers the amount of painkillers I'm taking daily to not only be reasonable given the condition of my spine, but he thinks I should perhaps up it if I need to, within reason of course.
And my suspicion is that my sleep patterns will improve if I can get this pain under better control. May it be so.