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Dr. Andrew Rynne

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Exp 50 years

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Slight annular disc bulging shown in lumbar noncontrast MRI. What could be the reason for experiencing numbness?

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Dr. Sudhir Kumar

Neurologist

Practicing since :1994

Answered : 5694 Questions

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Posted on Tue, 3 Dec 2013 in Brain and Spine
Question: Lumbar noncontrast MRI shows L1-2 very slight annular disc bulging, L2-3 asymmetric annular disc bulging, L3-4 prominent asymmetric disc bulge which encroached upon ght left neural foramen resulting in moderate foraminal stenosis and mild bilateral facet joint arthrosis, L4-5 broad based 3 mm disc protrusion posteriorly which elevated the posterior longitudinal ligament but no associated spinal stenosis, with midline sagittal thecal sac diameter of 10 mm, bulging disc encroached upon the inferior aspect of both left and right foramina resulting in mild to moderate right and mild left foraminal stenosis, and L5-S1 shows asymmetrical annual disc bulging. I'm 66 years old, and have been experiencing leg numbness and weakness when I stand, not when I walk. Can you tell me what's going on?
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Answered by Dr. Sudhir Kumar 3 hours later
Brief Answer: My reply is below. Detailed Answer: Hi, Thank you for posting your query. I have read your MRI report of limbo-sacral spine (lower back). It shows slipped discs at multiple levels, resulting in pinching of nerves at those levels. These elves travel to the legs from lower back. Therefore, compression of these nerves result in weakness, numbness and pain in the legs. Initial treatment would consist of medications such as pregabalin to relieve pain and physiotherapy (including back extension exercises). You should avoid lifting heavy weights and bending forwards while standing. Some people may aloud require surgery, if the above measure do not help. I hope it helps. Please get back if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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MRI OF LUMBOSACRAL SPINE: -

PROTOCOL:

-     SE T1W & TSE T2W SEQUENCES IN SAGITTAL PLANE.
-     TSE T2 W SEQUENCE IN AXIAL PLANE.
-     STIR SEQUENCE IN CORONAL PLANE.
-     MR MYELOGRAPHY USING HEAVILY T2W SEQUENCE IN SAGITTAL AND CORONAL PLANES ON A 1.5 TESLA SCANNER.

There is some degree of straightening of lumbar lordotic curvature. Vertebrae are normal in height, alignment and marrow signal intensity.
Dessicative disc changes and anterior osteophytes are noted at multiple levels. Disc height is reduced at L4-5 with degenerative endplate changes at this level.

There is diffuse disc bulge, thickened ligamentum flavum & facet joint arthropathy at L4-5 compressing the thecal sac and causing spinal canal stenosis with bilateral neural canal compromise (L>R). The mid sagittal diameter and area of spinal canal are 0.8cm and 0.75cm² (lower normal limits are 1.0cm and 1.5cm² respectively. Effusion is detected in the facet joints.
Annular tear, diffuse disc bulge and facet joint arthropathy are visualized at L3-4 indenting the thecal sac.
Diffuse disc bulge is observed at L5-S1 mildly compromising the neural canals bilaterally.

Cord ends at L1 vertebral level and shows normal signal intensity. No abnormal pre or paraspinal soft tissue mass is seen. MR myelography confirms the above findings.

Impression      :     MR findings reveal lumbar spondylotic changes with
     -     Diffuse disc bulge, thickened ligamentum flavum and facet joint arthropathy at L4-5 compressing the thecal sac and causing spinal canal stenosis with bilateral neural canal compromise (L>R).
     -     Annular tear, diffuse disc bulge and facet joint arthropathy at L3-4 indenting the thecal sac.
     -     Diffuse disc bulge at L5-S1 mildly compromising the neural canals bilaterally.

-     To be correlated clinically.

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