Hello, Thank you for your query at DoctorSpring.com.
I have noted your complaints and appreciate the detailed account that you have provided.
The nerves involved are mainly in the lower lumbar and sacral region, especially sacral (S2-4) nerves.
The common causes for the involvement of nerves in this region include tumors, infections, vasculitis and injury. Most of these can be seen on routine MRI of spine and pelvis, but contrast injections are required.
Also, detailed nerve conduction studies and electromyography (NCS and EMG) are also helpful.
In terms of treatment, medications such as pregabalin or gabapentin are useful.
I hope it helps. I would be pleased to answer any follow up queries.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Patient replied :
As per the attached documents, I have gotten 2 pelvic MRIs (one was 3T), and 1 lumbar/sacrum. If I have an issue with S2-S4, will it show up on either of these MRIs, or do I need to get one that focuses on coccyx? I researched and am worried about chordoma, or some other pinched nerve around coccyx. Thank you.
Thank you for getting back.
These problems would have been seen on the 3 tesla MRI, however, the radiologist reviewing the MRI should be told about the clinical picture and also what to look for in the MRI, as these symptoms are uncommon and we commonly do not look at sacrum or coccyx region. So, it would be better to get a second opinion from a radiologist after mentioning all the details. Also, the MRI should be done with contrast injection.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Patient replied :
The MRI on back said "L4-L5: there is disc bulge and right foraminal herniation. There is bilateral foraminal impingement more prominent on the right than on the left. There is no thecal sag impingment." Also, MRI of pelvis said there is nonspeciifc fluid in the deep pelvis of unclear etiology. Can you please help understand these findings. Thank you.
Thank you for sending the MRI reports.
L4-5 disc bulge means there is slipped disc at that level (lower back), causing minor compression or pinching of nerve at that level. This is a minor abnormality and generally would improve with pregabalin capsules and physiotherapy.
Non-specific fluid in deep pelvis could mean a local infection there, or it could also be due to inflammation. It would require further evaluation including clinical examination and repeat MRI with contrast if necessary.
I hope it helps.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)