symptoms vs. lumbar MRI findings

[ridiculopathy]

I am a middle aged female with a fear of coming across as hypochondriacal. I generally don't tell doctors about minor aches and pains for this reason. I have had intermittent low back pain beginning in my early 20's; long stretches pain/problem free and then short periods with spasm and/or mild sciatica. Nothing that bothers me much most of the time. Recently I had several episodes of several minutes where I had numbness in both legs, with a sensation of weakness (could have been that it felt more difficult to walk because numbness in my feet made it harder to accurately feel the floor). Each time this happened, after (but not before) I started to feel the numbness/weakness, I began to have back pain/spasm and had to sit down for several minutes each time and wait for anti-inflammatories to kick in. These brief episodes of numbness/weakness/spasm happened several times over a period of several days, followed by 10 days or so during which I have not had back spasm, but continue intermittently to feel as though I have reduced sensation in both legs and feet, especially on one side. Again, it's intermittent. I had normal sensation when I saw the doctor (kind of like when you bring your car to the mechanic) and a normal neuro exam. If relevant, by the time I had my MRI, I no longer had back spasm, so the worst of whatever it is had subsided.

After getting my lumbar spine MRI results, my doctor felt they would not account for my symptoms. What it showed is central disc bulges at 3 levels: L2-3, L3-4, and more pronounced at L4-5. At L3-4 there was a central disc protrusion. At L2-3 and L4-5 there were central disc extrusions (didn't specify if still attached). There was thickening of the ligamentum flavum and mild stenosis at L4-5. Some other stuff like shmorl's node, facet arthropathy, and discogenic endplate edema were described in various places. None of the above resulted in any direct nerve compression. I think this is why my doctor felt it wouldn't account for my symptoms. To satisfy my curiosity, though (and my need not to be a hypochondriac)--couldn't the numbness have resulted from inflammation in the area even if a nerve root isn't directly compressed? That had always been my understanding of why disc degeneration can cause sciatica even if you don't have a herniated disc. Thanks!

[MG (Admin)]

Yes...for sure we often see these findings without nerve root compression in patients with symptoms compatible with a nerve root problem.
The thing to remember is your back moves, and therefore the position that the MRI was taken in may not be the same position in which the nerve roots are affected.
Also, yes inflammation can often be at play when there are exacerbations.
Did you get a neuro exam at the time (reflexes etc)?

[ridiculopathy]

[quote="MG (Admin)"]Did you get a neuro exam at the time (reflexes etc)?[/quote]

Sorry if double post--my other post may be in moderation purgatory. Yes, my primary care physician saw me and did a neuro exam (he didn't feel a referral to a neurologist was needed). I was feeling normal at the time I was seen, feeling okay and walking normally, and the exam was normal except that he couldn't get a reflex at the knees (but as I said in the other post, my feeling at the time was he wasn't hitting the right spot although of course I can't absolutely rule out that the reflexes were absent).

I also thought of some other questions if you have time. Nowhere did my report use the word "herniated" or "herniation" but am I correct (from my "University of Google" research, lol) that disc "protrusions" and "extrusions" are specific kinds of herniations?

The report noted a "small focus of fat" in the bone marrow at S1, but no marrow replacing lesions. Any idea what that "focus of fat" means? The tone of the radiology report sounds somehow unconcerned in describing this, so I am not unduly worried about it, just curious if it relates to disc disease in any way. Prior to getting my report back, I tried to map where I felt the numbness to dermatome charts (OK, yes, I'm a serious "University of Google" scholar...) and I had betted on something being found at L5-S1 rather than L4-L5.

[MG (Admin)]

Protrusions etc are like mild herniations.
The fat focus seems to be an incidental finding and no concern.
Where exactly was the numbness ?

[ridiculopathy]

I'm not feeling the numbness right now (except a bit in my feet) so may be hard to describe accurately. The part that I thought related to L5-S1 was the backs of the buttocks and thighs (I got burning at times as well as numbness there), and particularly the soles of my feet (toward the lateral or little toe half of the foot). The soles of the feet has been the most consistent part. Admittedly, I find numbness somewhat hard to localize though--so maybe it's some other part of the foot and just feels like the sole of it because that's where I notice diminished sensation when I walk). The experience of it when it was most pronounced was that it was the entire legs and feet (partial numbness--obviously diminished sensation but not complete loss of sensation). But when it was milder, it seemed like I could localize it to the backs of the legs and soles of the feet.

[MG (Admin)]

These symptoms could be consistent with the imaging data.
Hard to know for sure if you weren't examined at the time.
Glad you're feeling better .

All the best

[ridiculopathy]

Thanks for your feedback. This helps. I don't know why I'm so concerned with knowing I'm not imagining things--perhaps a matter of honor. I must admit that while awaiting your initial response to my question, I ran across another ask a neurologist web page at a major hospital near me. At the time, I wasn't sure whether I'd get a reply here, so I went ahead posted the same question to them, and their response (which came yesterday) was that one must have direct nerve root compression to have numbness at all. I'm embarrassed to admit this, but I have felt so tense about whether my doctor thinks I'm crazy (or whether it would look that way to other health providers who see my chart), that when I got their email about findings having to show direct nerve root compression, I broke into tears. I like your answer better--it makes me feel sane.