Resolved question:
I am a 40 year old male. I recently had mild numbness in my left foot, S1 area. My dr ordered an MRI and he called me to tell me I had a bulging disc in L5-S1. He recommended physical therapy. I obtained a copy of the MRI results, and some of the results concerned me, and weren't mentioned to me. I assume they are common findings and sound scarier to me than what they are. Can you lend some insight on the following findings, and let me know if they are significant? Specifically concerned about the epidural lipomatosis and atypical hemangioma mentioned.
Findings: Mild disc space narrowing and dessication seen at L5-S1. A focal marrow signal abnormailty measuring 12mm by 6mm in the axial plane is seen in the posterior aspect of the L2 vertebral body. This lesion demonstrates homogeneously increased T2 signal, heteregoneous T1 signal, an increase STIR signal. No aditional marrow abnormalities are identified. The conus terminates at L1-L2. Spinal cord caliber and signal are within normal limits. The cauda equina images normally. Mild epidural lipomatosis is noted beginning at the superior endplate of L5.
Impression:L1-L5: No significant spinal or neuroforaminal stenosis.
L5-S1: Concentric disc bulge with mild spinal stenosis predominately secondary to epidural lipomatosis. No significant neuroforaminal narrowing evident.
Focal bone marrow signal abnormality in the L2 vertebral body as described above most likely represents atypical hemangioma. In the absence of worsening back pain, this can be followed with MRI in one yea to confirm stability.
Submitted:
4 Days
Category:
Neurosurgeon
Thanks for your query at DoctorSpring.com
I understand your concern
Both the conditions are non-scary ones.
Hemangioma is a common condition which should not bother you at all. But Atypical hemangioma is better followed up every year with an MRI.
similarly epidural lipomatosis is a very very under diagnosed condition. But in your condition I don't think it is causing a considerable problem at all. You can just ignore it.
Hope it was helpful
Feel free to discuss further
Regards
Thanks,
A quick followup question. In addition to the MRI, I had an EMG. the results are:
Normal NCV of both lower extremeties. EMG by needle examination of the left lateral gastrocnemius muscle reveals moderate chronic denervation/reinnervation which despite the normal NCV values suggests possible S radicular compromise.
Can you shed some light on this. Is this likely a result of the bulging disc mentioned in the previous question, or could it be related to the findings of atypical hemangioma or epidural lipomatosis? Does this mean there is nerve damage? Does the MRI and EMG results indicate something that can be handled nonsurgically? Sorry, just concerned even though the dr doesnt seem to be.
On MRI there is no neural foraminal narrowing at L5-S1 level. Mild stenosis should not produce EMG changes with normal NCV. I would suggest you to get a follow up repeat MRI LS Spine with NCV and EMG after an year. We can compare the reports at that time with those done now. If there are any progression of your symptoms then we shall do the tests earlier.
But as of now just relax.
Regards.