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What Doe The Following MRI Report Indicate?

Posted on Mon, 20 Oct 2014

Question: My Mother aged 70 is having lack of control on right leg, he can move it, no numbness but very slight control. Dr has advised her MRI, I have received the MRI Report, the report is as follows
MR IMAGING REVEALS ADVANCED LUMBAR SPONDYLOTIC CHANGES WITH
1. STABLE ANTERIOR WEDGE COMPRESSION FRACTURE OF L1 VERTEBRAL BODY CAUSING THECAL SAC INDENTATION
2. DIFFUSE ANNULAR BULGES L2/L3, L3/L4 & L4/L5 DISCS CAUSING THECAL SAC COMPRESSION WITH ASSOCIATED DEGENERATIVE LATERAL RECESSES AND FORAMINAL STEOSIS, MOST MARKED AT L3/L4 LEVEL
3. GRADE 1 SPONDYLOLISTHESIS L5, S1 LEVEL WITH SMALL POSTEROCENTRAL PROTRUSION L5/S1 DISC CAUSING THECAL SAC INDENTATION
SHE IS NOT HAVING BACK PAIN , BUT IT WAS 15 DAYS BEFORE, WHAT CAN I DO KNOW , AND EXPLAIN THE SITUATION.. Full report uploaded

Answered by Dr. Dr. Sudhir Kumar (45 minutes later)

Brief Answer:
Lumbar spondylosis. See for right hip fracture

Detailed Answer:
Hi,
Thanks for your query.

I'm Dr. Sudhir Kumar,

After going through your query and MRI report I concluded that your mother is suffering from lumbar spondylosis. It is degenerative disease of spine meaning related to aging. This type of report is expected at her age .I empirically treat my such patients by Diacerine, Glucasamine sulfate and Mecobalamin. Diclofenac sodium is given for pain relief.You can discuss with your treating Doctor about it.

As she has little control on his right leg and looking to her age I fear whether she has got fracture neck of right femur? I will like to get it excluded by getting x-ray right hip AP and lateral view before treating her for lumbar spondylosis. If x-ray shows no fracture. I will try above mentioned treatment for nearly 1month. If some improvement then I will continue this ,otherwise decompression of spine will be done to relieve symptoms.You can discuss with your treating Doctor about it.

I want to know answer to some questions:-
1. Whether she got fall ?
2. Whether she is able to walk unsupported?
3. Since when she is like this?
4. Whether she developed it suddenly or gradually?

Hope I have answered your query.

If you have any further questions I will be happy to help.
Wishing you good health.
Take care.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Dr. Sudhir Kumar (1 hour later)

History
1. till in her life span she got multiple fracture including elbow and hip. But theses episode are more than 4 years back ..
2. nearly 1 month ago she was having back pain with headache when she was at XXXXXXX .
3. nearly 15 days ago when she was at XXXXXXX feels problem in leg. (Now in Delhi)
4. As per my historical knowledge she must have very low calcium level.

answer of ur query

1. No
2. No ... she is trying herself but i cannot say that unsupported, she is just carrying the right leg with the help of left leg, but she is able to move fingers and leg on my direction, and also having sensation by touching.
3. last 15 days ..
4. history i have already given ...
my big concern is that is it curable through medicine or operation , and how much risk involve in it . Presently I am taking advice from Moolchand hospital new XXXXXXX

Answered by Dr. Dr. Sudhir Kumar (44 minutes later)

Brief Answer:
Exclude right hip fracture first.

Detailed Answer:
Hi,
Welcome back ,

After going through your query , follow up query and MRI report If I were her treating surgeon then I will first exclude fracture right hip(neck of femur) by prescribing X-ray right hip AP and lateral view .I am suspected it to be caused by fracture as it involve only only right side and developed in only 15 days and suddenly. Old patients with low calcium got fracture even without falling. Treatment of this fracture is by operation.

If it is due to lumbar spondylosis (after fracture is excluded) ,then I will try medicine for 1month, if improvement occur then i will continue to treat by medicines otherwise by operation as already discussed. As operation involves spine(back) so risk of paralysis of both lower limb is there but it is rare. All other risk of operation though rare are also there. Hope I have answered your query.

If you have any further questions I will be happy to help.

If you do not have any clarifications, you can close the discussion and rate the answer.

Wishing you good health.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Dr. Sudhir Kumar (17 minutes later)

last question :

1. As she has not having any pain , in my view there is rare chances of fracture, what is ur opinion .
2. pls brief me about operation, is this open or some more technique ?
3. approx cost of this operation, how many days of hospitalization tentatively? how will be choice of XXXXXXX XXXXXXX in this case ?

Answered by Dr. Dr. Sudhir Kumar (40 minutes later)

Brief Answer:
Open laminectomy-average cost 50000Rs-AIIMS-OK

Detailed Answer:
Hi,

Welcome back ,

1.15 day old fracture neck of femur will have little pain.I have seen many cases which were treated for neurological cases and turned out to be fracture neck femur( simple X-ray right hip AP and Lateral will exclude it).
2.As spinal canal has narrowed down compressing spinal cord. Operation require decompression by opening it posteriorly and relieving spinal cord.It is open operation called laminectomy.It is major operation.
3.Cost of operation depend upon hospital to hospital,I consider 50000Rs as average. Nearly15 days of stay will be required in Hospital, XXXXXXX XXXXXXX is good choice.
Hope I have answered your query.

If you have any further questions I will be happy to help.

If you do not have any clarifications, you can close the discussion and rate the answer.

Wishing your mother good health.
Take care.

Above answer was peer-reviewed by : Dr. Shanthi.E