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What Does This MRI Report Indicate?
Question: My MRI shows a few findings. I am having bilateral shin pain. The most specific finding my PCP said that could cause my pain is "moderate bilateral foraminal stenosis due to disc osteophyte complex encroachment with mild mass effect on the exiting L3 nerve roots. My question is: what does the word encroachment mean in this case?
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
It is true your MRI shows several findings which indicate chronic degenerative changes created over the years. They are due to age, genetic factors, heavy physical work, trauma etc.
Enchroachment means that the osteophytes (bony spurs) and the disc protrude into the tunnel where the nerve root is supposed to pass to exit the spine and as a result it can lead to mass effect, compression of these nerve roots, hence can cause pain.
I am not sure the shin pain can be explained only by L3 root compression as its symptoms are mainly in the thigh (the territory the L3 nerve covers), I think the canal stenosis (narrowing) leads to compression of other nerve roots as well.
In terms of management till you see the neurosurgeon though it doesn't change much, the aleve and lyrica you take are fine, physical therapy is advised as well.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
It is true your MRI shows several findings which indicate chronic degenerative changes created over the years. They are due to age, genetic factors, heavy physical work, trauma etc.
Enchroachment means that the osteophytes (bony spurs) and the disc protrude into the tunnel where the nerve root is supposed to pass to exit the spine and as a result it can lead to mass effect, compression of these nerve roots, hence can cause pain.
I am not sure the shin pain can be explained only by L3 root compression as its symptoms are mainly in the thigh (the territory the L3 nerve covers), I think the canal stenosis (narrowing) leads to compression of other nerve roots as well.
In terms of management till you see the neurosurgeon though it doesn't change much, the aleve and lyrica you take are fine, physical therapy is advised as well.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the information. I realize the neurosurgeon will answer my case specifically. Do you think the minimal grade 1 anterolisthesis could be causing the shin pain? Would that be more L4? Can the grade 1 possibly heal with proper PT , etc w/out surgery? Several doctors have asked me if I feel pain which in my foot-which I do not -I guess that is asked to rule out L5? Thanks
Brief Answer:
Read below.
Detailed Answer:
Hello again. I do not think that the minimal grade 1 anterolistesis is responsible for the symptoms, not alone at least, but it contributes to the narrowed canal hence less space for the nerve bundle. For shin pain L4 would be more likely, the L5 dermatome extends on the dorsum of the foot to the big toe, which is why your doctors have asked you, one more argument towards L4. Diminished or absent knee patellar reflex is also a L4 feature.
If in doubt the neurosurgeon might also decide to ask for nerve conduction studies which will confirm the nerve roots involved.
As for healing spontaneously with physio that is not likely. These are chronic changes created over many years. Physio is vital, but not to reverse rather than to stop progression. It enables muscles to better support the spine and lessen its load. Hence it is hoped for possible local inflammation (which also contributes to nerve compression) to subside and symptoms to improve spontaneously, as well as to slow/stop more changes over the months/years to come.
Let me know if I can further assist you.
Read below.
Detailed Answer:
Hello again. I do not think that the minimal grade 1 anterolistesis is responsible for the symptoms, not alone at least, but it contributes to the narrowed canal hence less space for the nerve bundle. For shin pain L4 would be more likely, the L5 dermatome extends on the dorsum of the foot to the big toe, which is why your doctors have asked you, one more argument towards L4. Diminished or absent knee patellar reflex is also a L4 feature.
If in doubt the neurosurgeon might also decide to ask for nerve conduction studies which will confirm the nerve roots involved.
As for healing spontaneously with physio that is not likely. These are chronic changes created over many years. Physio is vital, but not to reverse rather than to stop progression. It enables muscles to better support the spine and lessen its load. Hence it is hoped for possible local inflammation (which also contributes to nerve compression) to subside and symptoms to improve spontaneously, as well as to slow/stop more changes over the months/years to come.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Taka, Thanks again for the specific answers. One more set of questions, I should have given you a bit of my background. Specifically, I was a distance runner. Due to my shin pain and the MRI degenerative findings, I have grudgingly stopped running completely for last 8 weeks (period of that pain). I had run 20 + marathons. the last being 1/17/16. Ran once/year and usually just trained in fall for a XXXXXXX event on a soft grass/dirt surface. Previous MRI's in 2003, 2009, 2012 showed some changes but no stenosis. 2015 MRI showed L3 slightly pinched and other similar stenosis to 2016 findings, but my neuro (for 12 yrs )just sent a mail response to go to injections IF I was having pain -which I was not so I kept some running. Boy, I wish I had known what could happen.(or that my Dr had told me). I could have cut back or stopped. I know hindsight is 20/20. Anyway, do you think mowing the lawn(self-propelled), biking, swimming, elliptical are OK to do in my condition? and do you think , if surgery is indicated, that fusion will need to be part of that (realize the surgeon will have to answer that, but I'm wondering because it is 2 more weeks to get their opinion). Thanks
Brief Answer:
Read below.
Detailed Answer:
Sorry for the late answer.
In terms of physical activity, you should avoid activities which put more stress on the spine, which includes apart from holding weights, also prolonged sitting or standing, as with the spine erect there is more weight on the spine. So swimming is perfectly fine, biking leaning forward as well, while mowing the lawn or elliptical if for long periods of time can exacerbate the symptoms as you stand during those actions.
As for surgery, I do not think there will be a need for it in your case judging by that report, not right away as a first choice at least. If/when done fusion is a popular possibility, but at times only fixation with rods and screws may be done.
I hope to have been of help
Read below.
Detailed Answer:
Sorry for the late answer.
In terms of physical activity, you should avoid activities which put more stress on the spine, which includes apart from holding weights, also prolonged sitting or standing, as with the spine erect there is more weight on the spine. So swimming is perfectly fine, biking leaning forward as well, while mowing the lawn or elliptical if for long periods of time can exacerbate the symptoms as you stand during those actions.
As for surgery, I do not think there will be a need for it in your case judging by that report, not right away as a first choice at least. If/when done fusion is a popular possibility, but at times only fixation with rods and screws may be done.
I hope to have been of help
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. Ok so I should minimize any standing type exercises. Extended time I hope means I could try maybe 10 min of elliptical or mowing for a day. My pain doesn't seem to be very predictable as I know I have been told to do only what I can tolerate -but since the pain comes and goes almost no matter what I do, I am mostly biking and swimming with maybe 10-15 min of elliptical. The bigger problem is my job - analytical lab manager position-I am active, but do sit for awhile. Also, I am concerned that there needs to be some way to keep the bones strong with some limited impact or weight-bearing even in spine ? Maybe should be concerned in short-term for that. If this improves, maybe I slowly increase e.g elliptical? Lastly, is laminectomy or octomy perhaps applicable to my situation? THANK YOU
Meant to say that maybe I should Not be concerned about weight-bearing to keep bones strong in spine.
Meant to say that maybe I should Not be concerned about weight-bearing to keep bones strong in spine.
Brief Answer:
Read below.
Detailed Answer:
Hello again.
Yes I believe 10-15 minutes of mowing won't hurt. Elliptical if for 10-15 mins might not hurt either, but still would be preferable to have other sports like swimming or the exercises taught from the physiotherapist, strengthen the spinal muscles without putting weight on the spine (which is what increasing elliptical would do - do not think it would be beneficial).
Such sports/exercises are the ones which will enable your muscles to better support the spine during your work as well.
As for laminectomy, yes if we are speaking about the spinal stenosis it is one of the preferred methods. The fusion option was more for the issue of the spondylolisthesis. As I said I believe you do not surgery at all for now. If you are to have surgery depends on what is the primary issue, if it is spondylolysthesis, if that is the cause of the stenosis or is progressing in time, remains the fixation or fusion alternative. If spondylolysthesis is not much of an issue and doesn't progress in time, the spinal stenosis being in the setting of a congenitally narrow canal and arthritic changes, then laminectomy would be preferable.
I hope you will feel better without the need for any of that.
Read below.
Detailed Answer:
Hello again.
Yes I believe 10-15 minutes of mowing won't hurt. Elliptical if for 10-15 mins might not hurt either, but still would be preferable to have other sports like swimming or the exercises taught from the physiotherapist, strengthen the spinal muscles without putting weight on the spine (which is what increasing elliptical would do - do not think it would be beneficial).
Such sports/exercises are the ones which will enable your muscles to better support the spine during your work as well.
As for laminectomy, yes if we are speaking about the spinal stenosis it is one of the preferred methods. The fusion option was more for the issue of the spondylolisthesis. As I said I believe you do not surgery at all for now. If you are to have surgery depends on what is the primary issue, if it is spondylolysthesis, if that is the cause of the stenosis or is progressing in time, remains the fixation or fusion alternative. If spondylolysthesis is not much of an issue and doesn't progress in time, the spinal stenosis being in the setting of a congenitally narrow canal and arthritic changes, then laminectomy would be preferable.
I hope you will feel better without the need for any of that.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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