Doug's MRI, EMG recent

MRI - Open - 11-25-03

Things have been going down hill since I saw Dr. Seago last month. The flare-ups came from increased walking episodes including two 70 minute back to back walks on a Saturday and Sunday, which included some two small rolling hills. Now I'm not only getting lower limb pain but it seems like it now is in the L4, L5, and S1 dermatome.

A new MRI was shot at a friends new open MRI center in Los Gatos CA. It was free so I jumped at the chance. The lateral (sagittal images) images (not shown) again were non-impressive, but this T1-weighted Axial view of L5 seems to show a 4 mm focal left paracentral disc herniation that has encroached the left lateral recess and has contacted the left S1 root without much, if any, posterior deviation. It certainly seems more eccentric looking on this view that I've ever seen it before but again its tiny, 3 to 4 mm max.

I've labeled that structures for you all down below:

MRI Structure Identification:

Here's a little MRI reading lesion:

The view on the left is the same as above left, only I've numbered the important structures: This is a over head view (aka: Axial view) of a L5 lumbar disc. The disc herniation (#2) is quite visible as it protrudes posteriorly from the back of the disc by about 4 millimeters. Note the 'Mickey mouse' configuration of the important neural structure: #1 is the the thecal sac (which houses the lumbar nerve roots (not visible) which are collectively called the 'Cauda Equina'), which is Mickey's head. #3 and #4 are Mickey's ears, although as you can see, Mickey's right ear is touch by the disc herniation. Also, when you see a dark thecal sac and dark nerve roots, you know that the image is a 'T1-weighted' image - which are done under high power and always give the best clarity.

MRI Structures:	Labeled Numbers:
Thecal sac (contains nerve roots)	1
Small disc herniation (4 millimeters)	2
Right S1 Nerve root (on left side of film)	3
Left S1 Nerve root (being contacted by herniation	4
Left facet joint	5

EMG Results: 11-25-03

Right after my MRI scan, I hurried over to Ali Soozani's D.O., Ph. D. who performs all my clinics EMG/NCV scans. He does great work and keeps the procedures as pain free as possible. He uses #30 gage acupuncture needles which are more expensive but much easier on the patient.

The good news was the L4 and L5 radiculopathy has healed. The bad news is that the S1 radiculopathy still was present in my paraspinal muscles - although this is considered a 'soft finding' for my lower extremity muscles were are within normal limits.

Impression:

1. Abnormal exam. Electrodiagnostic study findings are suspicious for left S1 radiculopathy.

2. In comparison to the prior study dated 02/07/2003, there is resolution of the left L4-L5 radiculopathy.

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