# MRI Report on my spine



## kingrollo (10 Jan 2020)

Since my mid 20's I have needed injections in the facet joints to keep my lower back pain free. In September 2018 I had a major flare up - the worst ever. I had an NHS MRI - But the treatment was provided at a private hospital (NHS paid) - I had facet injections and nerve ablation - both of which failed to give any long term releif.

I requested and got a copy of my MRI report - which appears not to mention any problems with the facet joints - here is the report - does anybody with medical knowledge know what this means ?


_MR lumbar spine
There is perhaps minimal degenerative disc disease L4-5. Slightly more obvious signal loss are seen
within the lumbosacral disc. There is also posteriorly in the left tear in the L5-S1 disc manifest by a high
intensity zone within the annular fibres. There is a small posterior disc bulge here but is well contained by
the anterior extradural fat.
Elsewhere there is very little to see. There is minimal early for set and a bilaterally at L5-S1.
There is no evidence of a significant focal disc protrusion. Exit foramina appear normal.
Marrow signal is normal throughout.
Spinal canal is of good capacity throughout the lower cord and conus appear normal._


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## Cycleops (10 Jan 2020)

I should take it to your GP to translate.


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## Rocky (10 Jan 2020)

Wot he said ^^


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## kingrollo (10 Jan 2020)

Yes will do that - but :-

1.The GP doesn't have a copy of the report 

2.I don't enjoy a great relationship with my GP - 90% certain they will just tell me to take painkillers as and when - thats why I want some understanding of the significance of the report - which appears different to what I have been told. - and what my treatment options are.


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## tom73 (10 Jan 2020)

Right Mrs 73 just had a read 
In short 
Some signs of a Arthritis 
A tear in the disk 
Mostly effecting the lower spine 
If that helps ? Feel free to ask if you for more


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## kingrollo (10 Jan 2020)

tom73 said:


> Right Mrs 73 just had a read
> In short
> Some signs of a Arthritis
> A tear in the disk
> ...



What are my treatment options ?

Is it foolish to continue cycling ?


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## vickster (10 Jan 2020)

An experienced physio will also be able to explain and advise treatment options that don't involve surgery or solely drugs (they may well be part of an effective rehab / maintenance programme though). They'll also advise around cycling. I doubt they'd say it's foolish unless it causes you significant pain during and especially after.
Did you ever have a bike fit done by a physio if cycling does cause back issues?

Have you seen a specialist yet (pain/neurosurgeon/Orthopaedic) since the scan (which was over a year ago?)


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## tom73 (10 Jan 2020)

Basically painkillers (which I know your looking to avoid as much as possible) and Physio who can help you work out how to manage things. 
Operations on backs normally now are last option. 
She not an expert on backs so can only offer help going on what she's read and knows.
Based on this she can't see it making it worse If you can tolerate it then carry on but don't go over over doing it. 
She also say's talk to your GP I know your not the best of friends but look's like you need to talk things over with them. To help open up other options.
You need to find options that allow you to manage things which is more than likely going to be a combo of options .


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## kingrollo (10 Jan 2020)

vickster said:


> An experienced physio will also be able to explain and advise treatment options that don't involve surgery or solely drugs (they may well be part of an effective rehab / maintenance programme though). They'll also advise around cycling. I doubt they'd say it's foolish unless it causes you significant pain during and especially after.
> Did you ever have a bike fit done by a physio if cycling does cause back issues?
> 
> Have you seen a specialist yet (pain/neurosurgeon/Orthopaedic) since the scan (which was over a year ago?)



Yes - as a result of the scan I have had facet joint and nerve ablation injections. But these have 
not respondedd as well as previous jabs.


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## vickster (10 Jan 2020)

kingrollo said:


> Yes - as a result of the scan I have had facet joint and nerve ablation injections. But these have
> not respondedd as well as previous jabs.


Ah ok, but the specialist didn't explain the MRI report? Everyone I have ever seen (lots do specialists ) has explained the scan findings before anything else


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## kingrollo (10 Jan 2020)

vickster said:


> Ah ok, but the specialist didn't explain the MRI report? Everyone I have ever seen (lots do specialists ) has explained the scan findings before anything else


Yes they said I have some wear on the discs and facet joints. 
But the actual report seemed to suggest something different - but MRs Tom's interpretation is saying roughly the same.


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## vickster (10 Jan 2020)

kingrollo said:


> Yes they said I have some wear on the discs and facet joints.
> But the actual report seemed to suggest something different - but MRs Tom's interpretation is saying roughly the same.


Not every radiologist will report every last tiny abnormality, especially if it's wear and tear consistent with age. Presumably the Dr looked at the images and based on your description of symptoms, examination and history, felt the facet joint wear even if minimal worthy of mention / documentation to your medical records


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## screenman (10 Jan 2020)

One thing I would like to add is change to a different GP, soon.


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## kingrollo (10 Jan 2020)

screenman said:


> One thing I would like to add is change to a different GP, soon.


They are all as bad as each other aren't they ?

I put in a FOI request asking how many patients had been referred for orthopedic surgery in the last year.........the answer ....

60 !!!!!!

Presumably the others either went private or were given co cocadamol .....no wonder there is opoid addiction.


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## screenman (10 Jan 2020)

kingrollo said:


> They are all as bad as each other aren't they ?
> 
> I put in a FOI request asking how many patients had been referred for orthopedic surgery in the last year.........the answer ....
> 
> ...



No they are certainly not all the same, are all cyclist the same?


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## vickster (10 Jan 2020)

kingrollo said:


> They are all as bad as each other aren't they ?
> 
> I put in a FOI request asking how many patients had been referred for orthopedic surgery in the last year.........the answer ....
> 
> ...


My GP is excellent as are the others in the practice

Maybe other patients didn’t need surgery? Similar to yourself. Almost all backpain doesn’t


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## midlife (10 Jan 2020)

Did you have CT as well as MRI ?


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## kingrollo (10 Jan 2020)

vickster said:


> My GP is excellent as are the others in the practice
> 
> Maybe other patients didn’t need surgery? Similar to yourself. Almost all backpain doesn’t


Those stats are for all orthopedic surgiees - hip, knee, not just back - and injections count in that. Thats a large GP practice - typically six or 7 GPS consulting when open.

Had I not pushed - they would have just given me pain killers.


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## kingrollo (10 Jan 2020)

midlife said:


> Did you have CT as well as MRI ?



No just MRI tbh I think the diagnosis is correct. It's what to do now the injections have failed.


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## Rocky (10 Jan 2020)

My GP is excellent. I currently have back problems and have recently had an MRI. The GP referred me to a spinal surgeon who ordered the MRI. At the follow up appointment the specialist gave me the diagnosis and talked through treatment options. See your GP (or change to a new one). You should be getting specialist advice about the scan. You should not have to interpret it yourself. Given the risk of paralysis and incontinence from an L4/L5 prolapse, I’d seek help sooner rather than later.


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## kingrollo (10 Jan 2020)

screenman said:


> No they are certainly not all the same, are all cyclist the same?



No what I meant was if I moved GP I would have to stay under the same CCG - it is they who set the criteria for when a condition gets surgery - or when you are referred. See procedures of low clinical priority policies.


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## DCBassman (10 Jan 2020)

kingrollo said:


> No what I meant was if I moved GP I would have to stay under the same CCG - it is they who set the criteria for when a condition gets surgery - or when you are referred. See procedures of low clinical priority policies.


CCGs can be overridden if you push. Push. Very hard, if neccessary!


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## kingrollo (10 Jan 2020)

DCBassman said:


> CCGs can be overridden if you push. Push. Very hard, if neccessary!



Oh yes - I did that to get MRI - in some ways that s why I stay with current GP - they know I push if needs be..


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## Rusty Nails (10 Jan 2020)

kingrollo said:


> They are all as bad as each other aren't they ?
> 
> I put in a FOI request asking how many patients had been referred for orthopedic surgery in the last year.........the answer ....
> 
> ...



Orthopaedic surgery is a serious option that doesn't always lead to reduction in pain. It may well be right that your doctor does not refer a lot of patients for surgery. Incidentally can a GP refer someone for surgery, or just refer them to a specialist for more expert examination?


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## kingrollo (11 Jan 2020)

Rusty Nails said:


> Orthopaedic surgery is a serious option that doesn't always lead to reduction in pain. It may well be right that your doctor does not refer a lot of patients for surgery. Incidentally can a GP refer someone for surgery, or just refer them to a specialist for more expert examination?



I wouldn't think all referrals for orthopedic services lead to surgery.


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## kingrollo (11 Jan 2020)

The problem I have is that I seem to have both disc and facet problems.
My private Physio has given me some excercise s but told me to avoid backward bends as this closes the facet joints - said cycling would be ok as leaning forward opens facet joints.

My concern now is that as the facet joint injections have failed - is this disc more of a problem than the facet joint ? 

Following that theory then leaning forward isn't good for my back - so road biking might not be wise.

I have some more NHS physio coming up - so hopefully they can advise.


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## vickster (11 Jan 2020)

kingrollo said:


> I wouldn't think all referrals for orthopedic services lead to surgery.


However your stat of 60 referred specifically to referrals for surgery? GPs refer to orthopaedics for specialist opinions not specifically for surgery.

Do you get pain in your back when road cycling? What happens on a more upright bike?
Do you get pain in buttocks and backs of legs suggesting the discs are pressing on the nerves, either when active or at rest?
The injections which were presumably steroid only serve to reduce inflammation, they won’t heal damage to bones (the lack of inflammation should hopefully stop further damage but steroid can also be damaging which is why they restrict the number given)


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## kingrollo (11 Jan 2020)

vickster said:


> However your stat of 60 referred specifically to referrals for surgery? GPs refer to orthopaedics for specialist opinions not specifically for surgery.
> 
> Do you get pain in your back when road cycling? What happens on a more upright bike?
> Do you get pain in buttocks and backs of legs suggesting the discs are pressing on the nerves, either when active or at rest?
> The injections which were presumably steroid only serve to reduce inflammation, they won’t heal damage to bones (the lack of inflammation should hopefully stop further damage but steroid can also be damaging which is why they restrict the number given)




The 60 was for referrals for orthopedic services.

Get a fair amount of buttock pain. On the bike typically I feel a few twinges in the first few miles - then fine really.
The problems start either later that day or the following day.


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## vickster (11 Jan 2020)

kingrollo said:


> The 60 was for referrals for orthopedic services.
> 
> Get a fair amount of buttock pain. On the bike typically I feel a few twinges in the first few miles - then fine really.
> The problems start either later that day or the following day.


Right, you said surgery, hence confusion.
What's the demographic around you? Younger? I'd expect most Orthopaedic referrals from GPS rather than A&E are older/ elderly. Example, my 74 year old mum has been having severe hip pain for months, she's tried physio but finally went back to GP on Tuesday. Went for x-ray same day. Got called yesterday, orthopaedic appointment on 20th. It can be quick if deemed urgent. She was perhaps lucky as there's a specialist elective Orthopaedic centre at the local trust. However, I think similarly Birmingham has an Orthopaedic hospital?

Hopefully the physio can get you back on track  persevere with the yoga, and make sure you try to have rest days in between active days to let any muscle paid/DOMS subside don't forget the ice and / or heat of course


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## kingrollo (11 Jan 2020)

vickster said:


> Right, you said surgery, hence confusion.
> What's the demographic around you? Younger? I'd expect most Orthopaedic referrals from GPS rather than A&E are older/ elderly. Example, my 74 year old mum has been having severe hip pain for months, she's tried physio but finally went back to GP on Tuesday. Went for x-ray same day. Got called yesterday, orthopaedic appointment on 20th. It can be quick if deemed urgent. She was perhaps lucky as there's a specialist elective Orthopaedic centre at the local trust. However, I think similarly Birmingham has an Orthopaedic hospital?
> 
> Hopefully the physio can get you back on track  persevere with the yoga, and make sure you try to have rest days in between active days to let any muscle paid/DOMS subside don't forget the ice and / or heat of course



Reading on here - I don't actually do that many miles ! - I get up to about 100 a week in the summer months. Club training rides are 33 miles on Sat - and club runs 60 sun (I tend to do one or other!) - Right now 25 miles once a week and I would be happy with that.

Its the delayed pain - which makes it difficult - If I got on the bike and it hurt then of course I would stop - but the onset seems to be later - so never sure if it is the biking.

I would reluctantly quit cycling - but would really hate the resulting weight gain ! - couldn't run - and swimming seems to aggravate my back and neck


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## vickster (11 Jan 2020)

kingrollo said:


> Reading on here - I don't actually do that many miles ! - I get up to about 100 a week in the summer months. Club training rides are 33 miles on Sat - and club runs 60 sun (I tend to do one or other!) - Right now 25 miles once a week and I would be happy with that.
> 
> Its the delayed pain - which makes it difficult - If I got on the bike and it hurt then of course I would stop - but the onset seems to be later - so never sure if it is the biking.
> 
> I would reluctantly quit cycling - but would really hate the resulting weight gain ! - couldn't run - and swimming seems to aggravate my back and neck


What bike do you ride? Have you tried something upright? Maybe a riser stem if flipping doesn’t help.
I get pains swimming too but my technique (if you can call it that) is atrocious!

do you heat your back and then stretch after cycling?


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## kingrollo (11 Jan 2020)

vickster said:


> What bike do you ride? Have you tried something upright? Maybe a riser stem if flipping doesn’t help.
> I get pains swimming too but my technique (if you can call it that) is atrocious!
> 
> do you heat your back and then stretch after cycling?


Road bikes - but commute on an old MTB - might go out on that for 30 minutes.

Might just buy a motorbike.


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## vickster (11 Jan 2020)

kingrollo said:


> Road bikes - but commute on an old MTB - might go out on that for 30 minutes.
> 
> Might just buy a motorbike.


That could at least kill you quickly


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