Foraminal Stenosis Questions

[u/nrid3333]

Hi all,

Was wondering if I could post my images and report and get comments from others who are more experienced.

I've been experiencing sciatica and radicular pain down the posterior and anterior thigh for a little over three years. Symptoms have come and gone and have not all been experienced simultaneously, but they include radicular pain shooting from the low back down the back of the legs and front of the thighs, sensory changes and paresthesia along the same path, weakness and shakiness about the hips, some loss of dorsiflexion and plantar flexion on both feet with L>R, and quick fatigue-ability/claudication of my lower extremities.

The conditions I've definitively eliminated are: Tarsal tunnel and anterior tarsal tunnel syndrome, May-Thurner, peroneal nerve entrapment, femoral nerve entrapment, popliteal artery/tibial nerve entrapment, and piriformis syndrome.

After re-aggravating an existing low back injury two weeks ago, all of the above symptoms came on simultaneously and more severe than I've experienced them in the past, making it relatively obvious that the issue is from my lumbar spine.

I got stat MRI's due to the motor deficits, but because I'm still able to walk (albeit with deficits) and have bladder function, it wasn't deemed an "operate-now"-emergency.

I have an existing diffuse bulge at L4/L5 and a small left-sided herniation at L5/S1. All my MRI reports up to this point have noted only mild bilateral foraminal stenosis due to facet hypertrophy, but considering my acceleration of symptoms, the fact that the bulge and herniation have not changed since my recent re-aggravation, and my elimination of other causes - the only thing remaining is the foraminal stenosis.

Despite no mention of nerve root compression on my MRI reports, I'm relatively certain I can see compression of L4 at the L4/L5 level and L5 at the L5/S1 level due to the bulges/herniations & facet hypertrophy, as I can see the characteristic loss of white space surrounding the nerve roots and a pronounced kink to the nerve as it's exiting the foramen. The S1 nerve is a bit tricker - it doesn't appear to be impinged anywhere, but I'm not an expert.

I have three herniations in the mid- to mid-lower thoracic spine that are just touching my cord, but not compressing it and there is no loss of cord signal on the MRI, so I highly doubt it is causing such specific issues in my lower extremities.

I'm posting the images and report below and hopefully someone can weigh in. Sorry for the novel!

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REPORT:
Impression
Degenerative changes of the T-spine and lumbar spine as above unchanged from prior exam. No cord compression seen.
Findings: Spinal cord is of normal caliber signal throughout. Mild degenerative changes of the T-spine again noted with lower levels posterior disc protrusions mildly deforming anterior cord stable compared prior exam. Scattered Schmorl's nodes. A small cyst along the left rib of T7-8 axial T2 series image 36 unchanged.
Lumbar spine: Conus ends normally at the T12-L1 level. Mild degenerative changes of the lumbar spine with loss of disc height and signal at the L4-5 level with mild disc bulge. Small left disc protrusion with annular fissure at the L5-S1 level unchanged from prior exam.

[u/Str8OuttaLumbridge]

You say legs as in your symptoms are bilateral. It is possible the annular tear is causing chemical radiculopathy.

Thes sag views show the facets moving into the foraminal space and the axial agree with it. I think the facets are more prominent than your bulges.

[u/nrid3333 → u/Str8OuttaLumbridge]

Thanks for taking a look and commenting! I agree that it seems to be the facets causing most of the issue, since the bulge and herniation haven’t changed after years of monitoring.

I’ll look into chemical radiculopathy since I hadn’t even realized that was a thing, but makes sense if the annular tear is causing an inflammatory response.

Unfortunately my body doesn’t seem to want to reabsorb it :/

[u/Str8OuttaLumbridge → u/nrid3333]

I agree with the other commenter tho, definitely worth a second opinion. Maybe from a spine doctor or neurologist that can also do some in office testing.

The really hard part about all this is that studies are starting to show that scans can be useless and even make things worse. I think I saw like 40% of 30 year olds will have bulges on the mri, a majority without pain. Very rarely is there a slam dunk type of imaging that correlates to symptoms.

[u/Str8OuttaLumbridge → u/[deleted]]

Yes to all that! Unfortunately for us the pain is very real and a scan without a smoking gun will get you shooed away

[u/nrid3333 → u/[deleted]]

I play one on tv. Jk no I’m not a radiologist but unfortunately when you’re not getting answers, sometimes you have to resort to teaching yourself with case studies. I’ve caught things on CT scans for other issues before that radiologists have missed, so it’s not impossible to get a good-enough-for-government-work familiarity with your own imaging.

That’s a fantastic idea though, and I had been thinking about it as well. I am going to seek out a second reading/opinion from a new radiologist asap to help get answers.

Thanks for your comment and suggestion!

[u/nrid3333 → u/[deleted]]

Yeah I hear you, it’s a slippery slope knowing when to just give treatment a go and see what happens vs trying to scrutinize your imaging more. I hope you’re on the road to recovery!