Ask a doctor on the topic of Orthopedics

Two MRI findings intervertebral disc

April 11, 2012 | 20,00 EUR | answered by Dr. med. Hendrik Bernau

I received an evaluation of my MRI in August 2011.

My pain radiates from my disc to my left foot very slightly.

Findings:
The height measurements are based on assuming a 5-segment lumbar spine structure. Somewhat low-lying conus (LWK 2). No evidence of significant alignment disorder. No pathological decrease in height of the vertebrae examined (from mid BWK 11). Age-appropriate unremarkable presentation of configuration and signal of the disc up to the level of LWK 3/4. Slight decrease in height of the disc LWK 4/5 without significant protrusion. Decrease in height and T2 signal loss of the disc LWK 5/SWK 1 with dorsomedian protrusion and wide horizontal annular tear, no nerve root contact. Foraminal nerve exits are free. The included sacroiliac joints appear without conspicuous bone marrow edema zones.

Assessment:

Significant chondrosis LWK 5/SWK 1 with broad-based, dorsomedian protrusion with wide annular tear, no nerve root compression, no high-grade spinal or foraminal stenosis.

2nd Finding from April 2012:

Four weeks ago, I got my back stuck from coughing and as a result, I could not walk anymore!

For the past week, the pain has been radiating to my right foot.

It shows an almost harmoniously configured lumbar lordosis. At L5/S1, there is a signal- and possibly slightly decreased disc space with a medial bulging of the disc, leading to a broad-based dural sac pellet and also in close proximity to both S1 nerve root exits. In the other lumbar segments, the disc does not significantly exceed the level of the respective dorsal vertebral contours. The neural foramina and the bony spinal canal are overall normal width. There are no signal pathological areas in the included paravertebral soft tissue sections.

Assessment:
L5/S1 medial bulging nucleus pulposus with dural sac pellet and relatively close proximity to both S1 nerve root exits in chondrosis. No significant foraminal or spinal stenosis.

Could you please compare the two findings and explain the 2nd finding! Thank you!

Dr. med. Hendrik Bernau

Dear questioner,

You requested a comparison of the two findings you cited and an explanation of the second finding:

First, I will provide you with the explanation of the second finding:

2nd Finding:

The position of your lumbar spine is largely normal. The S1 root is most commonly damaged by a herniation of the lowest disc between the 5th lumbar vertebra and the sacrum (referred to as L5/S1). A "slightly reduced disc space" is a disc that has decreased in size due to the natural degenerative process of the discs (not a serious diagnosis). The resulting central bulge leads to an enlarged dural sac bulge (the dural sac surrounds the spinal cord / a bulge is a balloon-shaped pressure cushion). This "bulge" is reported to be very close to the sacral nerve roots. In the other vertebral segments of the lumbar spine, the discs are normal. The nerve exit channels and the bony spinal canal (of the spinal cord) are of normal width. No pathological changes are seen in the surrounding soft tissue layers.

Now for the comparison:

The second finding largely overlaps with the first finding; the most significant difference is the focus of the first finding on the tear of the L5/S1 disc; a tear in the fibrous ring (anulus fibrosus) results in the herniation of disc material into the spinal canal or into the lateral nerve canal, which can compress the nerves and interfere with their signal transmission, potentially leading to symptoms such as paralysis.

I hope I was able to assist you. If you have any further questions, please feel free to contact me at any time.

Wishing you good health.
Best regards,

Dr. med. - anonymized -