Doug's MRI,EMG,CT, Myelo

Open MRI & EMG results 11-25-03 | MRI 02-09-04 | Contrast MRI 5-24-04 | 3T Contrast MRI 4-12-05

THE MRI: 01-08-03

I underwent an MRI study of the lumbar spine on 01/08/03 and was happy but puzzled to learn that the scan did not look that bad. Here's the impression from the radiologist:

At L5/S1 there is a small contained left paracentral herniation that abuts without appearing to deviate or compress the central left S1 root sleeve. No significant lateral recess or foraminal encroachment is identified on the either side of the current exam at the L5-S1 level.

At L4/5 a broad-based central annular tear and very small disc protrusion. There is no extrusion of disc material and no significant lateral recess or foraminal encroachment on either side at the L4/5 level.

In layman's terms this means I have a small slightly left sided disc herniation at L5/S1 that is touching the left S1 nerve root but not smashing it or even pushing it backwards. I also have an anular disc tear superimposed on a small protrusion that is not touching any neural structures.

I was quite happy that there was no real compression on my S1 nerve root and felt that I just needed a little more time. As you can see from my latest axial on the left, the herniation has contacted the left S1 root (white arrows) but no backwards deviation of the root is note. You can see some encroachment of the lateral recess and foramen but it's not severe. Note the HIZ lesion is again visualized. (green arrow)

Instead of getting better back and left leg continued to get worse! My usual treatment protocols were not working. I was being treated with Cox Flexion/Distraction method, which is a very specific form of manual traction that chiropractors often use to treat disc herniation. This treatment, along with 'Core spinal stabilization' exercise has always 'healed' me in the past but this time even the simplest form of exercise, would flare me up. I was not even tolerating the Cox Flexion/Distraction well either. I was forced to my recliner for most of the day with only short 1 to 2 hour up periods.

Because of worsening leg pain and burning I felt that despite my rather innocent looking MRI, I was in need of an EMG/NCV study.

THE EMG/NCV STUDY:

My worst fears were confirmed when I went for an EMG test on 02-07-03. The test was positive for the dreaded radiculopathy at both L4 and L5. S1 would have most likely been positive as well but he did not have time to finish the whole test.)

Here's the Impression from the report:

Abnormal exam. Electrodiagnostic study findings are consistent with the following:

1) Left L4 L5 Radiculopathy.

2) Right superficial peroneal mononeuropathy. (Not related to this injury)

3) There is no electrodiagnostic evidence of deep peroneal, tibial, sural, or saphenus neuropathy.

On 3-03 I had another MRI because of a severe negative reaction to my first TFESI which I talk about on another page.

CT Myelogram:

On 6-03 I was ready for surgery for I just was not getting better. I was convinced that I had more nerve root compression that the MRI showed. The gold standard for detecting root compression is the CT Myelogram.

The CT myelogram did confirm mild compression of the left S1 nerve root but again it was not felt it was severe enough for surgery. On the right we have my axial view through the L5 disc. #1 is the cauda equina (spinal cord) containing all the lumbar spinal nerve roots. It is slightly contacted by the disc herniation (yellow arrows). #2 is the left facet, which makes up the posterior border of the neuroforamen. #3 is the right S1 nerve root. Note that the left S1 root, which should be in the same position as #3 only to the left is gone or blotted out by the disc herniation which is depicted by the yellow arrows which extend from the back of the vertebral body which I've hi-lighted with a white line. The white arrow points to contrast material that had leaked out into the epidural space.

Flexion / Extension X-ray with Contrast:

I also had what we call a "poor mans myelogram" which is a standing lumbar flexion / extension series performed immediately after the myelogram and before the CT. This weight bearing exam sometimes will increase the size of a small disc herniation demonstrated on a supine MRI, because of the extra weight bearing axial loading. In my case it did not.

On the left, you can see my lateral extension view (Ext) and neutral view (Neut). Note the contrast material (#3 - white) posterior to the discs. Also note that there is NO 'fill defect' seen behind the problematic disc (L5) which indicates that there is no larger disc herniation at this level. There is a small fill defect noted at L3 disc (white arrow).

On 6-03 another MRI was performed after Dr. Solomon, who is the head radiologist of Los Gatos MRI was concerned that the herniation may have worsened after going over the CT results with me. There was no change since the 3-03 MRI. The CT magnified the herniation making it look bigger than it really was.

So, I've got a non-surgical disc herniation that just needs time to heal.

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