Wednesday, September 5, 2012

MRI results in - not good news; my spine is f'd up

Damn. I was really hoping it was simply a matter of only Humira side effects, but the MRI on Tuesday revealed a lot of crap that I don't fully understand yet, but what I do know is that it's not good news.

X-rays were not able to detect a lot of what is going on that was affecting the pain radiating from my lower spine, down to my hip and more prominently down my left leg. The MRI, however did all too well.


Indication: Low back pain with leg weakness.

Technique: Extradural protocol MRI sequences of the lumbar spine were obtained without gadolinium.

Findings: The conus terminates at approximately L1. Bone marrow signal is normal.

No evidence of compression fracture. Limited evaluation of the sacrum demonstrates no abnormalities.

Alignment of the lumbar spine is normal.

T12-L1:  Evaluated on sagittal images only.  No significant disk herniation, canal stenosis, or neuroforaminal narrowing.

L1-2:     Mild broad-based disc bulge. No canal or neuroforaminal stenosis.

L2-3:     Disc desiccation. Mild broad-based disc bulge with left far foraminal protrusion. No canal stenosis. Moderate left neural foraminal stenosis.

L3-4:     No significant disk herniation, spinal canal stenosis, or neuroforaminal narrowing.

L4-5:     Mild broad-based disc bulge. No canal or neuroforaminal stenosis..

L5-S1:   Broad-based disc bulge with superiorly directed extrusion. The extrusion measures up to 10 mm in AP dimension. The disc has a rim of different signal which may represent blood products associated with an acute herniation. Severe canal stenosis and severe left neural foraminal stenosis. Severe mass effect on the left exiting L5 and descending S1 nerve roots.

SI joints: Within normal limits.

Impression: 1. At L5-S1 there is a broad-based disc bulge with large superimposed disc extrusion causing severe canal stenosis and severe left neural foraminal stenosis. The disc has a rim of different signal which may represent blood products associated with an acute herniation.

2. At L2-L3, there is a on broad-based disc bulge with a left far foraminal protrusion causing moderate left neural foraminal and far foraminal stenosis.

I'm not certain about what it all means, but some cursory Googling explained some of it:


L2-3: Moderate left neural foraminal stenosis.
http://www.stenosis-foraminal.com/neural_foraminal_narrowing
The most common cause of neural foraminal stenosis is due to disc degeneration. Through the natural ageing process, our discs may become herniated or bulge resulting in a narrow foramen. As the foraminal continues to narrow, nerves are compressed and the outcome of this is pain, tingling, numbness and weakness in the muscles of the affected area.
Another cause of neuroforaminal stenosis may be due to rheumatoid arthritis or osteoarthritis.
Neural Foraminal Stenosis Treatment
Tradition or conservative forms of treatment may offer short term relief, however most patients find that altering their lifestyle to avoid certain activities or movement offer some pain relief.  In order to experience full relief, surgery is often recommended.  
There are now minimally invasive procedures with a very high success ratio that can be performed and patients experience a plenitude of benefits when comparing these newer procedures versus tradition or conventional surgery.
I have an appointment with a spinal surgeon on Tuesday to discuss the report and the options. I guess I should be scared; I'm more resigned to the fact that my body continues to fail me with new levels of pain and disability. I have to figure out how to cope and make things work. 

Right now I'm in a holding pattern with my rheumatoid arthritis; I'm no longer on Humira or Enbrel, so my joint pain is likely to return fairly soon. I may have to try another option, perhaps an infusion drug like Orencia or Remicade - another decision for another time, my rheumy wants to see what the spine surgeon has to offer. The main issue is handling the chronic pain that will increase while waiting to see what challenge lies ahead to address my deteriorating spine and keeping the RA under control. 

I have to adjust to the reality that all of these changes mean l will never be the person I was a year ago, 3 years ago -- a status of "normal" that I (and most people) take for granted until you lose it.
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