Can MRI results of the lumbar region predict the cause of my lower back pain and numbness in my leg?

Question

Hello doctor,

I received my MRI results on the lumbar. I have a future appointment with a spine clinic. I understand some of it, but I would like to have them reviewed, as it is hard for a non-specialist to comprehend. For years I have had mild lower back pain, just a dull pain when I lift things or do things that exert pressure. The reason I had the MRI was numbness in the right lower leg and the top of the foot to the toes. It is constant. There is no pain associated with the numbness. Around 30 years ago, I was diagnosed with spondylolisthesis and ankylosing spondylitis. I take Advil for the pain. I have attached my laboratory test reports for you to review. What should I expect from the spine clinic in the review of the MRI result as treatment? Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

I have reviewed the reports (attachment removed to protect the identity of the patient). There are five issues mentioned in the report.

Spondylolisthesis and lysis: This is the movement of one vertebra on top of another, either back or forward. There is the forward movement of L5 on the S1 vertebra by a distance less than 25 percent of the horizontal width of the underlying vertebra (grade 1 listhesis). There is a backward movement of L4 on L5; the distance is not stated in the report. Listhesis is one of the mechanisms by which a vertebra moves forwards. This is present at L5, not at L4, and the most likely cause at L4 backward movement is wear and tear and the disc losing its water content.
Ankylosing spondylosis. This is a pre-existing condition and not directly related to the presentation. Romanus lesions are present, indicating some inflammation may suggest the disease is still active and may cause back pain.
Degeneration changes or age-related changes. These are present in the vertebral bodies, disc, and facet joints and are normal for this age.
Disc bulges and nerve root abutment. This is subtle and not marked at all the mentioned levels. The symptoms that you have, that is numbness on the top of the foot and extending to the toes, is the reflection of L5 nerve roots being pressed, but as your symptoms after right-sided, there is no clear evidence of that from the report as the L4-5 level there is only a bulge that is mainly left-sided and only some possible abutment of the right L5 nerve. There is afar right disc protrusion, but this is at L3 to 4, and certainly not pressing on the L4 nerve and well away from the L5 nerve. Thus the numbness in the lower leg on the right side cannot be explained based on the report.
Sacroiliac joint inflammation. This is an integral part of ankylosing spondylitis. The underlined parts of the reports are all about figuring out which nerve may be compressed and if that nerve is responsible for your current symptom.

I am afraid this report is not clearly answering your question, and it may be that the problem is not on the spine and may be local in the leg or the buttock. A nerve conductor study will help.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome to icliniq.com.

I hope this helps and find relief in the symptoms soon.

Regards.