MRI results, looks like the L3 and L4 nerve roots is the culprit? Definitely matches the symptoms I have had the past 2+ weeks, is a fusion in my future?

FINDINGS:

Diagnostic Quality: Adequate for interpretation and recommendations.

Numbering: Non-transitional anatomy.

Alignment: No significant alignment abnormality.

Bones: No acute fracture/injury. No aggressive or concerning bone marrow signal alteration. Modic type I endplate changes at the L3-L4 and L5-S1 level. Intraosseous meningioma at the L4 vertebral body. Schmorl node along the inferior endplate of L4 with adjacent fibrofatty signal.

Conus/Cauda equina: No epidural fluid collection. The cauda equina nerve roots are unremarkable.

Soft Tissues: No significant abnormality.

Included Thoracic Spine: Incompletely characterized thoracic spondylosis noted without significant sites of spinal canal or neuroforaminal stenosis identified.

Lumbar disc spaces:

L1-L2: Mild disc bulging. No significant facet arthropathy, spinal canal or neuroforaminal stenosis.

L2-L3: Symmetric disc bulge associated high intensity zone. No significant facet arthropathy. No spinal canal stenosis. No neuroforaminal stenosis.

L3-L4: Symmetric disc bulge. Superimposed right subarticular to foraminal disc extrusion with cranial migration abutting the exiting right L3 nerve root and transiting right L4 nerve root. No prominent facet arthropathy. No spinal canal stenosis. Bilateral neuroforaminal stenosis, severe on the right and mild on the left.

L4-L5: Symmetric disc bulge. Superimposed paracentral disc protrusion without mass effect on the transiting nerve roots. No prominent facet arthropathy. No spinal canal stenosis. Mild bilateral neuroforaminal stenosis.

L5-S1: Symmetric disc bulge. Mild bilateral facet arthropathy. No spinal canal stenosis. Mild bilateral neuroforaminal stenosis.

Included Sacrum: No acute or significant abnormality identified for limited evaluation.


IMPRESSION:
1. At L3-L4, right subarticular to foraminal disc extrusion with cranial migration abutting the exiting right L3 and transiting right L4 nerve roots. Associated with severe right neuroforaminal stenosis.
2. Additional multilevel lumbar spondylosis, characterize as above.
3. Modic type I endplate changes at the L3-L4 and L5-S1 levels.

I have a lot of patients taking peptides. I dont know much about them but they are in vogue now.

Have you talked with your doc since the MRI? Injection?

any particular PT workout you recommended for the outer shoulder pain?

reaching across my body is where I feel it most.

Waiting for that call, should be no later than tomorrow. Didn't get an injection at that visit, just Rx for oral steroid.

Dr is referring me to spine surgeon ...1st available appt is 12/16, yikes.

Would buying an inversion table in the meanwhile provide any relief?

Worth a shot can always return it. Remind where you are located? Which spine surgeon did they recommend? I would get multiple opinions before deciding on surgery.

Utah, north of Salt Lake City. Here is Dr i was referred to

https://doctors.intermountainhealth.org/provider/casey-c-bachison/2557448?utm_campaign=gmb&utm_medium=organic&utm_source=local

Yeah, don't want surgery, just getting recovered from ruptured biceps surgery had in the Spring and two rotator cuffs surgeries in past few years as well.

I would find a local neurosurgeon or two to get other opinions.

jsc8116 said:

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MRI results, looks like the L3 and L4 nerve roots is the culprit? Definitely matches the symptoms I have had the past 2+ weeks, is a fusion in my future?.

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Neurologist here.

Which level got operated on 15 years ago? You have a disk compressing the right L4 nerve root. Options for management include conservative treatment with core strengthening, NSAIDs, etc., steroid injection (more likely to help with pain than weakness, or surgical intervention.

With enough of a nerve root compression to produce muscle weakness, if this was me I would get the problem fixed surgically. You might well be able to have a less extensive procedure such as a laminectomy/diskectomy rather than a fusion, particularly if this level has not been operated on before.

You may eventually get most function back with time and PT, but this could take a really long time. Like well over a year, for example.

Thanks for the reply. I honestly don't remember what specific vertebrae the laminictomy was on, but I think it was 3 of them and L4/L5 rings a bell.

Pretty sure I have insertional achilles tendonitis on my left side. Anything else I should be doing in addition to massage, stretching, and heel drops? It's incredibly annoying for like half to a full mile, then goes away for the rest of the run.

I dont like stretching with insertional tendopathy. You can put in some heel lifts in your shoes. How old are your shoes? How is your mileage these days?

I'm rotating shoes and they're all probably about halfway through their life's. Currently running 28-30 mpw with plans to be back up to 40 by end of January.

What kind of heel drop do you have on your current shoes?

10-8mm. Same shoe styles I've used for years.

any tips for outer shoulder pain?

Ortho said no tear. PT is not working.

freind said I should go pain management route but I am scared that will just be a bandaid.

What are you doing in PT? You saw an ortho so I assume you had an MRI?

no MRI. He just did some tests on me and said he didnt think it was a tear.

I have an ortho routine. some side and back raises laying forward, Pulling a band apart, etc.

Well an MRI is the best way to see if there is a tear or not. How long have you been going to a PT?

about 6 weeks now. once a week. but I do the routine at home too

Give it a few more weeks and if not better consider pain management. Where are you located?

I am in Houston. Went to Fondren for Ortho, Houston Methodist for PT.

thank you for the advice

Have been battling shin splints on my right leg for awhile. On the posterior tibialis side. Have seen a PT and done exercises they recommend combined with rest and it gets better then after 2-3 runs it comes back.

Prior to PT I tried new shoes and took about a month off. Currently running in Altra shoes with a 4mm drop and they seem to lessen the pain a bit when I started in those.

Any suggestions to help with the recurring problem?

You need to really challenge the tendon with progressive exercises in order for it to tolerate running. The posterior tibialis is the main stabilizer of the arch. Do you have high or low arches? How did you choose the Altra's versus other shoes?

Settled on Altra after just trying to do research and some suggestions of a lower drop shoe may help.

I would say between normal and high arches.

Thanks! This is a really good video with similar strengthening exercises I have been doing at PT. Do you have thoughts or recommendations on orthotics or inserts?

I have been making custom orthotics for 13 years. They can be really helpful for the right person. You can start with a over-the-counter insert off of Amazon and see how that goes. If it doesnt help then consider custom.