mri scans

by Brin
(England)

Dear Sarah,

I've had lower back pain for years and have recently begun to address the pain. Following an MRI scan last August I was told that I have diffuse disc bulges between L3/L4 and between L4/L5, and dehydration of the L4/L5 disc. I then underwent five physiotherapy session with no result whatsoever. Almost at the end of my tether I stumbled across your book 'The Back Sufferers Bible', which has given me a renewed sense of hope. However, I can't self diagnose which of the conditions in your book I have.

Thinking it might help, about a week ago I requested a copy of the MRI scans to look at myself, however I have no medical training...

Sorry to be a bother, but could I trouble you to take a look at the MRI scans and give your professional opinion please?

Further, to my untrained eye there appears to be a part of the L5 vertebrae missing (I got quite a shock when i saw this!), however the radiologist who examined the MRI scans made no mention of this. I wonder if perhaps this is the root cause of my pain... perhaps the radiologist missed this? Or is it benign?

Thank you so much for your help,
Brin

Comments for mri scans

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Feb 05, 2013
 thanks
by: Anonymous

Thank you
Feb 05, 2013
 further MRI comment
by: Sarah Key

Hi Brin,
The additional view of the L4-5 disc does show it slightly more dehydrated but this is well within acceptable clinical limits. The very slight bulge, though present, does not represent a remarkable finding, at this level or any of the other of your lumbar levels. Remember, there is an important saying in our profession: 'treat the patient, not the pictures'. Furthermore, with the advent of MRIs as an non-invasive form of scanning, large populations of pain-free people could be scanned with no risk to their health. The results of several studies basically turned the radiology world on its head. An early and important study in 1994 by Boos et al* concluded '76% of asymptomatic individuals had disc prolapse on MRI' and another by Jensen et al** "MRI bulges or protrusions in people with low back pain may frequently be coincidental'
and 'some disc prolapses are associated with back pain but the majority are not'.
Yes, L4-5 may be your problem level, and the muscles protecting and locking the spinal link will squeeze the disc at that level and tend to dry it out, make it bulge more - and eventually cause it to thin. Even so, you are in the early days of this, when I believe things are reversible. The pain you are feeling is like a 'flag' urging you to get something done.
* Boos et al 1995 The diagnostic accuracy of MRI, work perception and psychosocial factors in identifying symptomatic disc herniations Spine 20: 2613-25
**Jensen et al 1994 Magnetic resonance imaging of the lumbar spine in people without back pain N Engl J Med 331:69-73
The take home message here Brin is, yes, get some mobilisation of the bottom lumbar segments to make it easier for the decompression to work and do your own mobilising exercises (spinal rolling) and decompression to help release these lower segments. But also, don't get too caught up with the MRIs. In the scale of things, yours are pretty good. There are many cases of much more devastatingly bad MRI's than yours, yet the patient has and has had NO pain.
Feb 05, 2013
 thank you
by: Anonymous

Dear Sarah,

Thank you so much for your reply, your comments have really put my mind at ease (although the pain continues of course). I will reread the relevant sections of your book and begin working with a back block immediately.

Thanks again,
Brin
Feb 04, 2013
 What I think about your MRI scan
by: Sarah Key

The first thing to say Brin, is that your MRI scans aren’t bad at all! You can see that you have a slightly flat lumbar arch which means that your spine won’t bend on impact of heel strike to absorb shock as well as it might when walking. You can help this immediately by doing the passive extension over a BackBlock. But all in all, your scans are not bad.
The second thing to say is that your discs are not dehydrated either (though I can only see the first larger image clearly). A dry disc is a black disc and none of yours are black, by any stretch of the imagination. Furthermore, (the third thing to say) there is no disc thinning at all. Your discs are all normal height (I really must say, I can’t see where your radiology report is coming from!).
The irregularity of the vertebral endplate you see on the lower disc is significant, as it shows past damage to this part of the spine. The vertebral endplates are the weakest part of the spine and can be minutely damaged with vertical forces up through the back sustained by trauma such as falling on your bottom (you can go back and read about this in Chpt 2 of your book Back Sufferers’ Bible). This sort of incident can cause a slight perforation in the 1-3mm thick cartilage layer which can cause this sort of irregular appearance but more important, thereafter means the pressures in the disc reduces – which you will know from reading me – causes faster breakdown of the disc.
The good news though Brin, is that you do not appear to have started breakdown at all, yet! And you will avoid it, far into the future, if you get your ‘pressure change therapy’ going with a BackBlock to shunt extra quantities of nutritional fluids through your disc here to aid repair.
Importantly, you would seem to fall into the category of ‘simple back pain’ which as you prolly know, I have just written a whole website about www.simplebackpain.com. This diagnosis also corresponds to what I call a ‘stiff spinal segment’ in Chpt 2 of BSB.
You may need a bit of spinal mobilising to get things moving, but get going with the decompression and see how far you can take yourself.

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