Can Anyone Read a Spine MRI ?

Off Topic
41

[quote]bushidobadboy wrote:

So, given that he has excellent hydration in his other discs, the dessication is not due to age.

What is it due to? Please enlighten me; I’m all ears.

BBB

EDIT: To cut you some slack, so that you can save a little face, I can see where you might have got the idea that the OP actually has ‘dessicated’ discs. You read that “A loss of fluid in the discs, as seen on MRI, indicates that the discs have become dry with age”. Or something like that.

But what you failed to grasp (a little knowledge being a dangerous thing and all that) is that in this case, there is perfect hydration in all the visible IVDs, except for two. This is a clear marker that his spine is not dessicated (since dessication is age-related and refers to a near-uniform loss of discal hydration) but instead that he has lost the nuclear fluid from 2 IVDs.

Since the healthy IVD is a sealed unit, the nucleus cannot just disapear for a holiday, to return later. No, the fluid is either there (intact, healthy nucleus), on its way out (a bulge), left the disc (extrusion) or has left, but shut the door behind it (sequestration).

Yes, dessication may be referred to as degeneration and a discal lesion is also degeneration, but the two are very different beasts, since dessication will happen to everyone, irrespective of lesions in the disc, eventually.

I await your reply, oh student of the spine. Better bring your A game though.[/quote]

i dont need you to save me anything boy.
you’re a complete moron. how dare you spew conjecture and nonsense to this guy who is scared as shit about having a surgical or otherwise permanent back condition?
how dare you tell him he’s guaranteed to have a protrusion yet lack the full set of axials to make this call? did he PM you the DICOM file?
what is this “nuclear fluid” you speak of? Do you have any idea what disk desiccation is? that is what he has. And guess what, it happens at 4/5 and 5/1 more so than other levels.
You seem to be unable to grasp that a lack of fluid signal within an intervetrebal disk (on both T1 and T2 weighted images) means there is less water there. Sorry, its a condition related to senescence. It does not mean the nucleus pulposis has “left the building”. its simple pathophysiology.
You need to review your extrusion/sequestration definitions, too. See, those are big words that make the audience clap for you. I dont care if i get the applause. I just dont want to fuck the OP. The annulus fibrosis has torn in an extrusion and the NP is no longer restrained. When it breaks free of the parent disk its a sequestration.
And you’re very sorely lacking on your understanding of degenerative disk disease. Your “sealed unit” of a disk isnt actually sealed. Because you’ve lost signal and/or height, that does not mean a giant hunk of NP has herniated. Loss of disk height happens. Period. Your sealed unit does not herniate into the endplates, it does not herniate into the canal, it does not herniate. Again, pathophysiology. And again, you’re very wrong in saying “dessication may be referred to as degeneration and a discal lesion is also degeneration, but the two are very different beasts”. Actually desiccation is part of the spectrum of degenerative disk changes. one in the same. Differing levels of severity. Much like the progression of annular tear to protrustion to extrusion etc is a spectrum. You would have been correct (for the first time) in saying that degenerative disk disease and disk “herniations” are different beasts. Yet you maintain they are linked, and loss of disk height indeed implies the latter.

if this is your A game…well.

42

[quote]seekonk wrote:
Hi guys, I have to wait a week to see the doctor. In the meantime I’m curious just how bad these discs are. I attached L4/L5 and L5/S1.

[/quote]

Why don’t you get a copy of the report and post it here when it’s available?

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The thing to remember guys is it’s best to see the patient in person to get an overall picture. Disc issues sometimes are not the sole cause of symptoms. I see people every day where the myofascial component is not properly taken care of and symptoms will not improve until it is.

but we’re talking to a fellow ion the net who wants some free info who has a doc and will see the doc. Nothing will be done for him until that time of any serious degree.

So you don’t have to get all pyscho urbanski. Whether or not you are right, you’re coming off as a complete tool. If this is your normal way of dealing with people, i would not send people to you or recommend anyone else do so.

45

Yep, but remember, you’re a para professional like me. actually, I’m full professional, since I get paid.

47

Partially unrelated question, but are there any doctors here on T-Nation? (MD or DO). I am fairly certain there used to be one who posted…

48

[quote]bushidobadboy wrote:
tom63 wrote:
Yep, but remember, you’re a para professional like me. actually, I’m full professional, since I get paid.

That’s funny; I swear the patient visiting me this morning for spinal adjustment has already paid me some money for all the successful treatments I have done on him.

Also, I’m pretty sure my professional indemnity insurance only covers qualified professionals.

BBB[/quote]

Sorry, I was not sure if you were in school yet or not, haha! One thing for everyone out there to remember, a lot of technical talk means nothing to a patient.

Me : You have some internal myofascioal derangement to your left posterior trapezoid causing some frapulation to your spinal accessory nerve resulting in a butt load of pain.

Pt: do I have a pinched nerve? Me : yeah, that’s another way of saying it.

I give simple explanations to people. When I go over an MRI report, i translate to the pt. with regular talk. Most want to know what’s going on and can you help me and what else do I do.

BBB is going to know a lot more fancy doctor talk than I will now. Because it doesn’t matter much when you practice 20 years. People want results and appreciate an explanation they can grasp.

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[quote]tom63 wrote:
bushidobadboy wrote:
tom63 wrote:
Yep, but remember, you’re a para professional like me. actually, I’m full professional, since I get paid.

That’s funny; I swear the patient visiting me this morning for spinal adjustment has already paid me some money for all the successful treatments I have done on him.

Also, I’m pretty sure my professional indemnity insurance only covers qualified professionals.

BBB

Sorry, I was not sure if you were in school yet or not, haha! One thing for everyone out there to remember, a lot of technical talk means nothing to a patient.

Me : You have some internal myofascioal derangement to your left posterior trapezoid causing some frapulation to your spinal accessory nerve resulting in a butt load of pain.

Pt: do I have a pinched nerve? Me : yeah, that’s another way of saying it.

I give simple explanations to people. When I go over an MRI report, i translate to the pt. with regular talk. Most want to know what’s going on and can you help me and what else do I do.

BBB is going to know a lot more fancy doctor talk than I will now. Because it doesn’t matter much when you practice 20 years. People want results and appreciate an explanation they can grasp.[/quote]

thats the gospel truth right there Tom , certainly no offense to any of the others commenting on this thing but people just want to know WTF they need to do to make the pain stop.

51

[quote]tom63 wrote:

So you don’t have to get all pyscho urbanski. Whether or not you are right, you’re coming off as a complete tool. If this is your normal way of dealing with people, i would not send people to you or recommend anyone else do so.[/quote]

you know what? fine. i’m a tool. great.

but i’m still so amazingly incensed at what was going on here that i lost all my restraint. thank god i’m not allowed to post in alpha or i would have done the same in the shoulder thread.

i’m very deeply offended at the profoundly wrong advice being handed out by certain individuals who spice up their wording to emit an air of credibility.

believe me or not, no matter. YOU are dead on with your sound advice…get the radiologist report and talk to a doc. free advice on the internet is worth every penny you pay.

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[quote]tom63 wrote:

One thing for everyone out there to remember, a lot of technical talk means nothing to a patient.
[/quote]

Actually, that may be unfair to educated patients. That may be the correct approach for an uneducated or uninterested patient, but I for one prefer the full explanation in the correct medical terminology. I am sick of doctors who tell me nothing useful, despite knowing that I have a hard-sciences doctorate and thus maybe have a little capacity and background to understand. Even if I knew nothing of spines (not true any more after six months of research), the correct terminology would help me research it.

I will post the report when I get it, but I can see for myself from the images that it is still the same as the previous one that I quoted. What I was maybe hoping to get from posting here was to check if I may have missed something and especially some indication of how bad it looked. In other words, a bit of a value judgment from people who have seen a few spines in their life. I know I am somewhere between “You’ll be fine in a month” and “You’ll never run again”. I was given the former prognosis, but that was four months ago… :frowning:

Then again, I am well aware that MRIs have little correlation to symptom severity, so I was probably asking the impossible.

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[quote]bushidobadboy wrote:

I tell you what, I’ll summarise, so that your angry eyes don’t mistake what I have written.

  1. All the discs, bar two appear normal.
  2. 2 discs show marked loss of fluid/water, however this is not ‘dessication’ since dessication is age-related and would therfore apply to the other discs, which are clearly hydrated.
  3. Saggital views are very often the primary diagnostic view for disc abnormalities. Why do you think Rockscar posted a saggital view?
  4. I never said he definitely had herniations (or protrusions/extrusions/sequestrations), I merely said ‘IMO’ it was likely. You do know that something like >50% of the adult population shows disc protrusion/abnormality on MRI, whether they be symptomatic or not? And hey, they seem to use saggital views to show this 9/10 times.
  5. Amitryptilene has been used often, to counter chronic back pain. Even his Dr agrees with me.

OK so we could argue semantics about whether ‘dessication’ refers to age-related loss of fluid or not. I tell you what, when you have read Adams/Bogduk, then McGill, then Herzog, then Byfield, then Cramer/Darby, like I have, you can make an informed descision. Until then, stop parroting everythig you read from google.

Cheers,
BBB[/quote]
2. wrong. you still dont understand desiccation and i wont continue to try to convince you otherwise. you really should seek a refund from the school you got a “degree” from. you claim “semantics” in our discussion of desiccation yet lack any understanding of what it means and how it applies to the OP.
3. its spelled sagittal. and to a layperson they appear to be “all telling”. they however are not. you need the axials, more specifically you need L1-S1 T1 weighted with T2 fat-sat in-plane w/ the disks to make any diagnosis about “herniations”. Your sagittal view will tell of disk height and hydration, but an abnormality of either does NOT mean there is a “herniation” as you maintain. Again, you said this “Are there likely to be herniations? IMO yes, because you don’t usually get a marked loss of signal (water) in two discs without some reason for it.”
You fail to comprehend pathophysiology of disk desiccation. You CAN and DO lose water signal as a senescent change related to a complex change in proteoglycans and hyaluronic acid in the disk. (big words yay). The “nuclear fluid” (again a made up term) does not “herniate” anywhere. Its just gone. Read about it.
4. I am glad you think a nice sagittal picture in a non-radiology textbook showing a pretty HNP is the true way to diagnose these. Its not. You’re wrong. You can’t make the full diagnosis without all the images. That’s why paraprofessionals are scary. You think you see an abnormality and treat based on that. Trouble is you have no baseline of normals and normal variants, and you have no exposure to the spectrum of pathology on images. Worse yet, you focus on the one easy “finding” you see and ignore the other finding(s) and the remainder of the imaged anatomy. That’s why I’m thankful SOMEbody pointed out getting the final radiologist report. That’s the answer. Not conjecture by a paraprofessional.
5. OK sure let’s use a 40 year old drug with a massive side effect profile and a narrow margin of safety as first line treatment. I never said it was not used. Its used by morons who dont understand proper mechanical back pain therapy…but i never said it wasnt used.

I dont know your degree although i expect its chiropractic. good for you. i dont believe in your profession. not at all. you’re quacks. some people do and good for them. its nice that you can provide relief to some folks. however dont go where you dont belong. you dont belong in real medicine and you dont belong anywhere near handing our advice about MRIs. I only wish I could reply in alpha to the guy you misled about his shoulder.

54

[quote]PimpBot5000 wrote:
Partially unrelated question, but are there any doctors here on T-Nation? (MD or DO). I am fairly certain there used to be one who posted…[/quote]

um…hello

55

[quote]bushidobadboy wrote:
As an osteomyologist, [/quote]

wow. i’ve never heard of that term before. much like “facet ligament capsule sprain”

so if the T-Nation collective’s mother had back pain, would they take her to an “osteomyologist” or an MD?

you guys tell me.

56

[quote]seekonk wrote:
tom63 wrote:

One thing for everyone out there to remember, a lot of technical talk means nothing to a patient.

Actually, that may be unfair to educated patients. That may be the correct approach for an uneducated or uninterested patient, but I for one prefer the full explanation in the correct medical terminology. I am sick of doctors who tell me nothing useful, despite knowing that I have a hard-sciences doctorate and thus maybe have a little capacity and background to understand. Even if I knew nothing of spines (not true any more after six months of research), the correct terminology would help me research it.

I will post the report when I get it, but I can see for myself from the images that it is still the same as the previous one that I quoted. What I was maybe hoping to get from posting here was to check if I may have missed something and especially some indication of how bad it looked. In other words, a bit of a value judgment from people who have seen a few spines in their life. I know I am somewhere between “You’ll be fine in a month” and “You’ll never run again”. I was given the former prognosis, but that was four months ago… :frowning:

Then again, I am well aware that MRIs have little correlation to symptom severity, so I was probably asking the impossible.[/quote]
you’re my age and you are wise to note that the MR has little correlation to symptoms.
nobody should (although some do) tell you the Radiologist report missed something based on the few images you posted. That annular tear they saw…very tough to see and you need the T2 axials. That itself hurts and is reason to follow you with MRs. There is however nothing operative to be done on you. You have early degenerative changes and an annular tear based on the MR report. Treatment is conservative. And its not amitriptyline. I caution you always critique where your information is coming from. I dont care if you listen to me. I do care if you’re being misled, and i’m going to speak up about it.

57

Okay, guys here is the report:

This is to me surprising. This radiology report disagrees with the previous report, which was taken at a different facility. That report found

Even I can still see both these features in the T2 axial views I posted in my first post in this thread, and I am sure you guys can as well, especially the central posterior abnormality in L5-S1 is quite obvious. They are still there and identical to the previous MRIs three months ago. Yet the second guy noticed nothing at L5-S1, WTF?

Perhaps a better question is: If the abnormalities are so damn mild, why am I doing so bloody badly?!

58

[quote]bushidobadboy wrote:
Well since my off-the-cuff analysis seems to be generating some amusement, I’ll add to it by saying that there is a very slight posterior displacement of the dura mater (the outer sheath of the spinal cord) at L4/L5 IVD. This appears to be far too insignificant to be impinging upon the lumbar spinal nerves. You actually have good saggital canal diameter Vs your spinal nerves, from what I can see.

Both of the dark/low signal IVDs display a mild loss of disc height, which is congruent with nuclear herniation/protrusion/extrusion.

I look forward to seeing more images. Also, a detailed list of your symptoms would help me to add to my internet diagnosis.

BBB

EDIT: Just for shits and giggles, I’m going to ‘predict’ your symptoms. I’m guessing that you do not have radicular (i.e. ‘nerve’ pain - though all ‘pain’ comes from nerves of course) pain, but instead have local, dull pain, maybe with some degree of sharp, but still local pain. Probably located just off to one side of the centre of the spine.

Pain may be worse on sitting (due to prolonged compression + flexion making the disc bulge further) or with compressive spinal loading.

Pain may be alleviated by lying down on your front. If pain is made worse in this position, then it points to causes other than discal herniation, most likely facet ligament capsule sprain or multifidus strain/rupture.

The localised pain is probably caused (like mine) by the bulging disc pressing on pain-sensitive structures, such as the PLL (posterior longitudinal ligament), dura mater, etc., but not directly on spinal nerves.

Of course I could be wrong, but I’m counting on the fact that if you had crippling radicular pain you would be seeing a Dr much quicker ;)[/quote]

Dr. House? Is it you?

59

OK I now zilch about backs I just want to know who won. Is it BBB or the Angry Doctor?

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[quote]Cockney Blue wrote:
OK I now zilch about backs I just want to know who won. Is it BBB or the Angry Doctor?[/quote]

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