T3_MRI_One-Year-Post

[ Gadolinium Enhanced IDD | Isolated S1 Root Inflammation ]

I suffered a terrible flare-up of sciatica from an attempt to box for about 20 minutes on 03/26/05. It took a few days to manifest, but OMG did that hurt and I was convinced I had re-herniated that disc... or something!

So, on 04-12-05 off I ran to my favorite MRI facility(Los Gatos MRI) where the radiologist immediately threw me into their new, state-of-the-art, 3 Tesla closed tube MRI. This is the only such MRI tube in Northern California and produces incredible images... you can now even see annular disc tears in the cervical discs!

Anyway, boy did we (Dr. Murray Solomon, MD Radiologist and I) get a surprise on these images:

First, lets look at how beautifully this 3T gadolinium enhanced MRI high-lights IDD (radial annular tears):

Note the T1 image on the non-gadolinium view shows absolutely no sign of pathology (black arrow); however, once the contrast is injected, WOW how that tear sticks out like a sore thumb (red arrow). The gadolinium (aka: contrast) collects within the tiny blood vessels inside of the granulation tissue (scar tissue) that sealed my L4 annular tear. This tear was barely visible on my T2 image as well.

The next images demonstrate a severely inflamed and swollen S1 nerve root WITHOUT any sign of compression from disc herniation or stenosis. Amazingly, not only is the left S1 nerve root swollen and enhanced (bright-white color that indicates fluid, swelling, and inflammation within the root-sleeve) at the anticipated L5 disc level, but this 'glowing white' nerve root can be follow all the way up to the L3 vertebral body level (It probably would have went all the way to the conus is the MRI images went that high)! Let's take a look:

Here is an over-head (axial) view of my L5 disc that underwent micro-discectomy surgery a little over one year ago.

There is no sign of recurrent disc herniation, although there is the usual and expected scar tissue that surrounds the nerve. (if you lost, you need to go to my MRI tutorial and get caught-up on the axial anatomy - here)

The amazing thing here (kind of hard to see) is the 'white dot' (red arrow) that is noted within the S1 root sleeve. This is a sign of swelling/inflammation/anger within my Right S1 nerve root (probably the sensory root) and is very rarely seen on MRI.

The biggest mystery is why in the hell did it get so inflamed from my little Boxing tournament? There is nothing 'pinching' it, i.e., no compressive herniation or stenosis is seen and we know I'm not unstable!

There is some scar tissue but certainly not a huge amount.

So, the above doesn't seem that surprising, you might say, but here's where things get interesting:

Did I really need to put a red arrow to show you this? It's pretty evident: This white 'dot' represents that same swollen/inflamed left S1 nerve root at different spinal levels throughout the lumbar spine. In fact every image in this series demonstrated this 'angry' root. I've never seen anything like it. Dr. Murray Solomon, Head radiologist of Los Gatos MRI, was even a little excited by this finding although he told me he does see it from time to time even on conventional 1.5 Tesla MRI.

Even more surprising is the fact that I have now (04-22-05) completely recovered from this flare-up of S1 sciatic (and it's accompanied neuroplastisic gremlins in my arms and right leg [extraterritorial pain gone amuck]) and am back to my normal 2-3 daily S1 root pain that I can live with. It only took about three to four weeks to bounce back! By the looks of that, you would think I was in for months of pain... but no?

The more I study and research, the more I realize that we don't know 'shit' about chronic persistent sciatica/radiculopathy.

MY CURRENT THEORY:

The above phenomenon certainly tells us one thing about my case: That small contained herniation that was only slightly contacting my left S1 root was NOT the cause of my pain syndrome and, as my surgeon [who did an incredible job on my surgery according to Dr. Solomon] said, "we were duped."

I believe that I am one of the unfortunates whose left S1 nerve root was damaged by some sort of massive inflammatory attack (probably macrophage in nature that produce cytokines [Tumor Necrosis Factor - alpha, and IL-1]) following a rupture of the final layers of the disc. After this rupture, biochemicals from the L5 disc leaked upon the adjacent S1 roots and 'somehow' set up this inflammation. This inflammatory attack destroyed the microcirculation within my left S1 root and has left it incapable of 'keeping up with' the oxygen demands of the muscles, proprioceptors, and skin of my left lower limb when I attempt to exercise; hence, resulting in that delayed terrible sciatica a day or two following the exercise.

In a couple of months, I'm going to be one of the very first to undergo some sort of f-MRI of the S1 nerve roots. It should be interesting...

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