Q. I have chronic back pain and myalgic encephalomyelitis. Please see my reports and advise me.

Answered by
Dr. Atul Prakash
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Oct 24, 2020

Hi doctor,

I am 38 years old, and I am not overweight. Can you explain what this letter means, please? Multilevel heterogeneous marrow signal changes note that follow fatty marrow signal in articular lower thoracic, lumbar, and sacral spine follows fat signals. On the lower spine, L5/S1 showed mild to moderate diffuse changes and abutment of the transiting bilateral S1 nerve roots. At L4/5, there is mild to moderate degenerative disk disease again with bilateral transiting L5 nerve abutment. I have severe chronic back pain. I am diagnosed with myalgic encephalomyelitis and have some mild petechiae for three to four on various parts of the body. I take pregabalin 100 mg and amitriptyline 25 mg per day. I am always exhausted.



Welcome to icliniq.com.

I can only explain what had been written in the report (attachment removed to protect patient identity). As I do not have the films to see, it is an interpretation of an interpretation (also, I gather that neurologist is not convinced about something and wants to review the report with the radiologist).

The first part means that changes seen in the bony vertebrae at different levels that I would say are commonly seen in degenerative discs, often age related.

The next two para-state that the degenerative discs show some bulging backward into the vertebral canal where the nerve roots are traveling as they come out of the vertebral canal. But I must say this must be interpreted only with the clinical picture as bulging discs do not always cause symptoms despite significant abutment of traversing nerve roots.

There is no mention of any myelitis (inflammation of the spinal cord) that may be seen in the spinal cord, as you mentioned that you have a confirmed diagnosis of encephalomyelitis.

Are you on Steroids or Interferon therapy? What is your vitamin D level?

Hi doctor,

Thank you for your reply.

No, I do not take any Steroid or Interferon. Six months back, that specialist confirmed this, but I have had no treatment. The different departments are not great at communicating, and with lockdown, we have had no access to services. So are you confident that the first para is age-related? I was not too fond of the sound of marrow changes. Vitamin D, I am not sure. I have coeliac disease, but very strict if that is related. I worry that I am finding it hard to stand up for more than five minutes without significant pain. What would be your suggestion regarding the abutment of traversing nerve roots? Is it physiological or surgical? Thank you so much for all your help.



Welcome back to icliniq.com.

No, I cannot be confident enough to reassure you. This is my interpretation as the exact bony changes can only be seen to understand. Still, as everyday things are common, I will interpret that this is age related. Encephalomyelitis certainly will not affect your vertebrae and marrow unless this is an autoimmune condition. Again there is no information regarding this in the neurologist's letter. Was a biopsy ever planned? as the exact histological diagnosis may drive the treatment. Marrow changes are mostly inflammation, which is what the MRI (magnetic resonance imaging) is good at picking up. I again feel that nothing adverse is mentioned in the report (attachment removed to protect patient identity) to cause alarm if that thought is bothering you. The pain an irritated nerve root will cause is in the leg (sciatica (severe pain along the sciatic nerve from the lower back to the buttocks and legs)) and not so much in the back. Degenerative discs are more likely a cause for back pain. Vitamin D levels are something I will push you to ask your GP (general practitioner) to do straightaway. Normal levels will help with fatigue, immunity-boosting, and mood elevation.

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