Which is it - herniated disc or spinal stenosis?

[Weosephaul]

I got the results of my MRI scan a few weeks ago which reports a herniated disc (protrusion of the L5/S1 disc) compressing the S1 nerve and narrowing the spinal canal moderately. But now I'm confused because I don't know if it's a herniated disc that's compressing my sciatic nerve, or if its spinal stenosis (narrowing of spinal canal) that's responsible for the compression. Or could it be both? Is that possible?

I expect I'll be given a clearer answer when I've seen the ortho surgeon (still waiting on that) but I was hoping someone on here might know.

How do you get an accurate diagnosis for the cause of the compression? It can't just be based on an MRI. Are there any other tests I should be given or is a detailed description of my symptoms (where the pain is, how it's dveloped, what aggrevates it, what eases it, etc) combined with the MRI report enough for a diagnosis.

This has got me worried because if I'm to have surgery, I want to make sure I'm having exactly the right procedure, from the start.

 

[Love & Happiness]

Based on what you wrote - you have booth.

Your spinal stenosis is caused by disc herniation.

 

[newrose]

Accuracy of any diagnosis is a big subject, a vast number of diagnoses are incorrect or only partially correct.

There is another factor to this, which is that many people have silent features that would be seen on scan but are causing no problem whatsoever. Conversely, some people have all the clinical features of, say, disc damage, but nothing showing on the scan.

Hence, you can never be completely certain that what is found is the cause of your symptoms - it is the best guess based on what is known. Realistically, several factors will be involved in the problem, treatment is given to the things that can be identified and changed.

Spinal stenosis does mean narrowing of the canal, but usually refers to reduction of the actual space rather than encroachment into the space. It is usually the result of change to the bony outline by formation of osteophytes and/or calcification.

If it's an L5 disc and compression to an S1 nerve root then most likely this is the disc bulge (immediately) responsible. Stenosis is more likely to impinge on the spinal cord itself (or the cauda equina, the brush like branching of nerves below the cord) rather than a single nerve root. It would most likely give more confusing symptoms, or symptoms in several areas (for example sensory loss in both legs, difficulty with bowel and bladder control etc).

Further, true stenosis is likely to be aggravated by extension (backward bending), whereas a nerve root compression from a disc bulge will typically, not always, be aggravated by flexion (forward bending).

 

[KimbeeJ]

Thanks for that very detailed response, KVDP. It makes a lot of sense and I'm realistic in my expectations that there is no guarantee of 100% accurate diagnosis. But your last paragraph is exactly why I mentioned it might be spinal stenosis. All my pain is produced in extended positions - standing, walking, and bending backwards (I've tried this). The pain is alleviated by bending forward, sitting down, or lying down.
I know this is the opposite of most people's symptoms - the majority of herniated disc sufferers describe their pain as much worse when sitting or lying, and get relief by standing up/walking.

 

[Marlene Clements]

Woah there! Not so fast!

The only place you'll find a textbook case is in a textbook - a ruptured disc can sometimes hurt more with extension. Importantly, there are many other things that can be involved in generating your actual symptoms.

Facet-joint (zygopophyseal joint) inflammation also tends to hurt more with extension, and is neurologically uncomplicated. It is also very common, pretty benign, and often straightforward to treat with non-surgical methods. The pain is usually local, but can be referred into the leg. It may well be an additional feature of a joint strain involving a disc. It may even be responsible for most of your symptoms, disc bulges can be pretty silent, many people have them and have no idea whatsoever.

So the disc may be incidental to the symptoms, or other structures may be complicating features of the disc problem.

Stenosis may be painful, but a major hallmark is likely to be neurological, eg numbness, tingling, pins and needles in the limbs or saddle area, weakness etc. Also pain and difficulty walking that increases quickly with distance (claudicant symptoms). Typically sufferers report relief from pushing a shopping trolly.

It is quite possible that your problem involves several structures additionally, eg muscles, ligaments etc. And beyond that, the reasons why these structures have become strained thus include the mechanics of the whole spine and the entire physiology. Some systems (eg surgery) will go straight to the area of strain. Others, eg osteopathy, may avoid 'the bit that hurts' to try and balance the whole system around the area, thus creating a more favourable environment for the tissues.

Many of these things may also be treated by manual therapy, although discs and stenosis can be a bit tricky at the start. At the end of the day, one can never be entirely certain what is causing your pain, all anyone can do is look at what's there and treat what is found. Different systems will place the emphasis in various different places.

Hence most commendable that you're interested in what is going on, but beware the perils of self-diagnosis, a little knowledge can be very misleading.

 

[Nicole M]

I have also found that the information on the mri request form can actually affect the information given in the report. For instance if the request says the mri is necessary because of sciatica in the right leg the report will invariably emphasis or concentrate on things in that area, but on reviewing the actual scan there may be more going on all around that does not merit a mention, because apparently there is no discomfort or pain from it mentioned in the request?

 

[Rahul Chonkria]

Thats V interesting Cascara. It does make you wonder what the interpritation of the MRI report would say if those making the diagnosis were denied that request information.????

 

[red dye #2]

Well I have first hand experience of that Its not a nice thought is it. Shocked me and now I make sure I get a dvd of any scan or xray.

 

[Common Sense]

That is worrying, Cassie.

btw I asked for a copy of the scan on disk (so I could use it to get a second opinion). But they (NHS) denied it. Repeatedly fobbed me off with "we don't do that, etc".

 

[Yeddivanie]

You have every right to see your records, and have a copy, I see no reason why images and reports should be an exception, so stamp your feet. They are entitled to charge you for providing copies, however.

 

[obdajwyr]

I don't mind paying for it. I even offered when I made the requests.
But you're right, kvdp. Our medical records belong to us. I'll keep pushing them.

 

[stargirl]

Search online Jim for how to access them, they do have to provide a copy, but the NHS share information electronically so they won't like to make you a copy of any scan or xray on dvd as they paid for the scan, you didn't. So it is a grey area about if you were to get a copy they might possibly assume you were going to be a private patient and treat you like one in future, or else why would you need one as any nhs doctor/consultant/hospital can acccess them online now? They do have to give all paper records and to be honest until recently I never realised that they could be given on dvd.

In my case the nhs did one scan last year but I had an accident since then and they would not do another so my gp gave me a request form and I paid for the new lot myself and also paid for a copy to be put on dvd (£22 extra). There are specialist mri centres that are quite happy to take people that self pay if the work is requested by a medical professional.

 

[Brarlyflalsew]

If the worry is of what you will use the scan for, consult your favourite state regulated complementary practitioner eg osteopath and if they are interested in the scans a letter from them might well do the trick. At the end of the day, though, they hold information on you and you're entitled to have a copy. It's up to you how you choose to use it after that. Speak to the office of the information commissioner or CAB if you want ammunition.