Waiting on MRI results; questions on lumbar DDD

Good evening

Today I had an L-spine MRI because of constant pain in my lower back and down my legs, and some numbness and tingling in my feet. I have had the Rx for the MRI for 3 months but have been putting it off and now I'm regretting that.

Looking back on my last L-spine MRI in 2000, I am now really kicking myself because I didn't get a second ortho opinion and took the doctor at his word when he said this was normal degenerative disk disease for a 29 year old. Here's what the report summary says:

"At L4-5 and L5-S1 there is mild degenerative disk disease with decreased signal intensity in the disk on T-2 weighted images. A mild disk bulge is seen at L4-5 however there is no herniated disc or significant canal stenosis.

Impression: Minimal degenerative disc disease at L4-5 and L5-S1. No herniated disk or significant stenosis is seen."

(It was 7 months later that I ruptured the C5-6 disk in an auto accident and had ACDF. Healed, went on with my life)

So the Ortho said that 2000 L-spine MRI was normal for my age. Was it?

My next question is: My new doctor gets the report on Monday. I'm going to try to get him to refer me to a specialist since I read this guy's online reviews and have met with him twice and am not impressed. He is a DO who pushes prolotherapy, PLP and vitamin shots. That's no bueno, right? And if he refuses to refer me (as I have read he does that), I have to change my PCP, right?

If the MRI reads no change then I plan on ordering the HLA-B27 test for Ankylosing Spondylitis.

And regardless of either result, here I am in bed for the 4th day in a row, taking Vicodin when I can't stand the pain anymore. Big problem with this is, the super ironic and pathetic part: I am sole proprietor and employee of a business that I started 3 years ago. I work 50-70 hours per week, and this is my sole source of income. I have 70 clients who rely on me and I drive 70-100 miles per day.

So I think, I'm in big trouble. I think, I should have been more careful. Given that these things are often hereditary. And my father was permanently disabled by age 60 with DDD, stenosis, and two surgical fusions.

Post Edited (dreamsong_29) : 9/6/2014 9:51:16 PM (GMT-6)

Everything is mild & minimal. There are to be a lot of damage before a surgeon will operate & that level of damage is not in this MRI.

Have any of your drs said you might have nerve damage ? That might explain the pain in your legs. The fact that you're able to walk 5-8 miles a day is a Great sign.

I would try not to stress myself out & just take things one at a time. I am not a dr by any stretch & I have read plenty of MRI reports in my time. Mrs123 gave you correct info about your MRI. There was nothing in that report to be alarmed about back then. The ortho you saw then gave it to you straight.

Things over time can change or they can also remain the same. No one here can predict what will or will not show on the new report. The pain in your legs do sound like like nerve pain & if that turns out to be the situation, there is treatment for that too, Some people can take a round of steroids, get on one of the nerve meds & get relief, or some have epidural injections done to get relief.

Is there a specific reason you are thinking its AS? I am gathering the dr that ordered the new MRI is your new primary care dr is this correct? The thing about prolotherapy is it is expensive and not all insurance company's will pay for it.

Let us know how your visit goes.

I have it! And it's not that bad.

L1-L2 the disc is mildly desiccated without loss of disk space height, disc displacement, endplate spondylosis or facet joint arthrosis. Normal central canal and in vertebral neural foramina.

L2-L3 the disk height, hydration, and contour are preserved. There is no spinal stenosis or lateral recess compromised. The facets are unremarkable. The neural foramina are patent.

L4-L4 the disc is mildly desiccated without loss of disk space height, disc displacement, end plate spondylosis or facet joint arthrosis. Normal central canal and in vertebral neural foramina.

L4-L5 the disc is mildly desiccated without loss of disk space height, disc displacement or facet joint arthrosis far right lateral radial annular tear. Normal central canal and invertebral neural foramina.

L5-S1 the disk height, hydration and contour are preserved. There is no spinal stenosis or lateral recess compromise. The facets are unremarkable. The neural foramina are patent.

Conclusion:
1. mild disc dehydration is present at L 1-2, L 3-4 and L 4-5. Far right lateral radial annual tear.
2. no disc herniation. No central or foraminal spinal stenosis.

Hmmm....my research online and with friends suggest that an annual tear can be very painful, not just because of mechanical issues but because of irritants leaking from the disk.

Annular tears can be very, very tiny , mild, moderate or severe . Again, it is the descriptive terms and interpretation of the surgeon that matters. In mild and even moderate tears the chances of the discal fluid leaking are very small. The tear would have to significant and completely through the fibrous covering for there to be leakage of disc material.
The good news is that other than some arthritis , there isn't a worsening of your DDD. The doctor will probably recommend physical therapy and injections.

WOW Dreamsong,
Nowhere did I say that annular tears can't cause pain. I did say that it depends on the degree of the tear. I also explained that not all annular tears mean that discal fluid is leaking onto a nerve or any other structure.
The problem with reading things on the internet is that sometimes, the information is so general in nature, and the worst case scenarios are given to cover the broadest interpretation, that it may not apply to you.
I'm sorry that you aren't hearing what you want to hear at the moment, and I do hope that you will follow up with your doctor for a thorough evaluation and treatment plan but attacking the members here because we are trying to help you is just wrong.

Well I deleted the whole post since I'm hoping your pain caused you to be irritable and I know that can cause an irrational moment so here's your chance to get some rest and hopefully a bit of relief and come back with the right attitude. We all here understand pain and we all here try not to judge others pain but Dream everything everyone of us oldtimers have been taught is the best thing to do for pain? Diminish it's importance in your thinking! ! Don't give it power by largeness alone. Hope you understand what I am saying.

Dreamsong,
No where in your previous posts did you state that it was a radial tear. You said it was an annular tear, which is not quite the same thing.
http://radiopaedia.org/cases/annular-tear-l5s1
Degenerative disc changes are associated with the development of annular tears (it does not necessarily indicate a traumatic cause, as the word tear implies). Annular tears (or fissures) involve either part or the entire thickness of the annulus. They run perpendicular to the long axis of the annulus and occur more commonly in the posterior half of the discs, usually at L4-5 and L5-S1. The radial annular tear is considered by many to be responsible for pain.

MRI shows focal areas of high signal on T2WI or on contrast enhanced T1WI. On T2 sagittal images, radial tears appear as globular or horizontal lines of high signal within posterior annulus.
http://www.chirogeek.com/000_Anular_Tear_1.htm
And from the above link is lots of information on the various types of annular tears and it's effects.
I'm sorry that you took offense, and I am going to back out of this thread at this point.

Post Edited (mrsm123) : 9/10/2014 6:30:30 PM (GMT-6)