lumbosacral Slr Finding Interpretations

[cannoncocker]

If someone that has experience with SLR findings could interpret this for me would be great and save a lot of digging and extrapolating:

Exam: SLR - + on L at 75 degrees; + contralateral at 75 degrees with pain to 1 leg.

LE DTR's - 2+ throughout

LE Motor: 4.5 5 1 Plantar Flex: otherwise 5/5 throughtout

LE Sens. - sl. decreased PP L lateral foot and left post. leg

babinski - down going toes bilat.

No ankle clonus

Toe Walk Mild weakness on L

Heel walk - nl

MRI

1. Alignment abnormalities, this degeneration and facet hypertrophy result in varying degrees of neural foraminal stenosis, as above. Disc material in the L5-S1 subarticular zone contacts the descending S1 Nerve Root and displaces it posteriorly towards the left facet.

2. Mild ventral deformity of the L1 ventral body with asscoiated kyphosis.

3. Mild focal levocurvature centered at the L4-L5. Minimal retrolisthesis of L4 on L5

4. diffusely hypointense marrow signal pattern most likely due to systemic stress.

lateral neural, flexion, and extension views of the lumbosacral spine are provided. Mild degenerative disease at multiple levels. there is stable grade 1 retrolisthesis at l3 on L4, and L4 on L5. this does not change on extension and there is approx. 1mm of correction on flexion views. at both levels. There is stable minimal antero-wedging on L1 with associated hyphosis. Smaill Osteophytes are again noted. No acute fracture.

Impression Grade 1 retrolesthesis at L3/L4 and L4/L5, does not change on extension, with approx. 1 mm correction on flexion views.

It has a bunch more history but this is the crux. Bilateral thigh numbness whic hot one has been able to isolate the orgin, but we are talking numb, not hurt, so I just roll with that, whatever the orgin.

They noted my options from meds to pt to epidural injections to surgery.

Any deciphering would be appreciated. I have some med. knowledge but this is pretty inside baseball for me.

Edited September 10, 2009 by cannoncocker (see edit history)

[deltaj]

If someone that has experience with SLR findings could interpret this for me would be great and save a lot of digging and extrapolating:

Exam: SLR - + on L at 75 degrees; + contralateral at 75 degrees with pain to 1 leg.

LE DTR's - 2+ throughout

LE Motor: 4.5 5 1 Plantar Flex: otherwise 5/5 throughtout

LE Sens. - sl. decreased PP L lateral foot and left post. leg

babinski - down going toes bilat.

No ankle clonus

Toe Walk Mild weakness on L

Heel walk - nl

MRI

1. Alignment abnormalities, this degeneration and facet hypertrophy result in varying degrees of neural foraminal stenosis, as above. Disc material in the L5-S1 subarticular zone contacts the descending S1 Nerve Root and displaces it posteriorly towards the left facet.

2. Mild ventral deformity of the L1 ventral body with asscoiated kyphosis.

3. Mild focal levocurvature centered at the L4-L5. Minimal retrolisthesis of L4 on L5

4. diffusely hypointense marrow signal pattern most likely due to systemic stress.

lateral neural, flexion, and extension views of the lumbosacral spine are provided. Mild degenerative disease at multiple levels. there is stable grade 1 retrolisthesis at l3 on L4, and L4 on L5. this does not change on extension and there is approx. 1mm of correction on flexion views. at both levels. There is stable minimal antero-wedging on L1 with associated hyphosis. Smaill Osteophytes are again noted. No acute fracture.

Impression Grade 1 retrolesthesis at L3/L4 and L4/L5, does not change on extension, with approx. 1 mm correction on flexion views.

It has a bunch more history but this is the crux. Bilateral thigh numbness whic hot one has been able to isolate the orgin, but we are talking numb, not hurt, so I just roll with that, whatever the orgin.

They noted my options from meds to pt to epidural injections to surgery.

Any deciphering would be appreciated. I have some med. knowledge but this is pretty inside baseball for me.

bilat. probably refers to bilaterally

L probably refers to left

DTRs probably refers to deep tendon reflexes.

LE possibly refers to left extremity

nl possibly refers to normal

post. posterior

SLR straoght leg raising

L3 lumbar 3

pp probably refers to pinprick

sens. possibly refers to sensory

sl possibly refers to sensation level

I don't know a lot but I recently took courses in anatomy and physiology, medical transcription, and medical terminology.

Edited September 11, 2009 by deltaj (see edit history)

[poolguy11550]

Strait leg raise

[cannoncocker]

Strait leg raise

Let me guess, you either lay around the pool a bunch or maintaina pool, which I think number 1 would be my first choice.

Thanks pool, for the reply, and i see you still get up early too. can't help it.

I am up on the acronym slr = Straight Leg Raise. more interested in the real world meanings in the findings and to what extent, if any, they hedged their interpretations.

Thanks Friend!

[poolguy11550]

I'll put on my VA raters thinking cap-

1. You have a mild to moderate back condition.

2. Based upon MRI findings, your back condition affects both your legs.

3. Your MRI findings show that some of your back condition is related to normal aging.

4. Physical exam correlates with the MRI findings.

If you are already S/C for your back then #3 is not concerning. If you are S/C for your back have you filed a claim for bilateral sciatica?

I am not a doctor so I cannot break down all the medical terms and give a diagnoses. I hope that this helps.

[cannoncocker]

I'll put on my VA raters thinking cap-

1. You have a mild to moderate back condition.

2. Based upon MRI findings, your back condition affects both your legs.

3. Your MRI findings show that some of your back condition is related to normal aging.

4. Physical exam correlates with the MRI findings.

If you are already S/C for your back then #3 is not concerning. If you are S/C for your back have you filed a claim for bilateral sciatica?

I am not a doctor so I cannot break down all the medical terms and give a diagnoses. I hope that this helps.

no to 1 they offered surgery for pinched S1 which is more than mild or moderare. Protruded/extruded discs. and epidural injections.

Degenerative disease is mild to moderate, so they say.

Degenerative disease MRI shows normal aging or at least some normal aging, depending which eval you look at. Wonder if carrying the projos far in excess of the NIOSH Lifting Equation played any part in this? Make a reasonable person consider that.

whether physician agrees is up to them i guess.

Denied after 6.5 years of field artillery lifting projos weighing 174 lbs across 100 yard repetitively.

The W-S VARO came to the conclusion which approximate= over my dead body.

Thanks though. DRO Hearing upcoming.

no to 2 (left only) but on slr move on rigt produces pain in left.

[deltaj]

no to 1 they offered surgery for pinched S1 which is more than mild or moderare. Protruded/extruded discs. and epidural injections.

Degenerative disease is mild to moderate, so they say.

Degenerative disease MRI shows normal aging or at least some normal aging, depending which eval you look at. Wonder if carrying the projos far in excess of the NIOSH Lifting Equation played any part in this? Make a reasonable person consider that.

whether physician agrees is up to them i guess.

Denied after 6.5 years of field artillery lifting projos weighing 174 lbs across 100 yard repetitively.

The W-S VARO came to the conclusion which approximate= over my dead body.

Thanks though. DRO Hearing upcoming.

no to 2 (left only) but on slr move on rigt produces pain in left.

First, I would point out that mild to moderate requires V.A. to assign the higher of two evaluations under 38 CFR 4.7 if service connection is granted. I do feel that for surgery to be recommended it must me at a somewhat advanced stage due to the decreased pinprick sensation. Are there any buddy statements you could get that would confirm in service injuries? You need copies of the recent exams and MRI to see what precisely was written about this condition.

Edited September 11, 2009 by deltaj (see edit history)

[cannoncocker]

bilat. probably refers to bilaterally

L probably refers to left

DTRs probably refers to deep tendon reflexes.

LE possibly refers to left extremity

nl possibly refers to normal

post. posterior

SLR straoght leg raising

L3 lumbar 3

pp probably refers to pinprick

sens. possibly refers to sensory

sl possibly refers to sensation level

I don't know a lot but I recently took courses in anatomy and physiology, medical transcription, and medical terminology.

deltaj, the courses you took in: anatomy and physiology, medical transcription, and medical terminology, were of great service to me and right on the money from the bits a pieces I gathered from the net already. I took human anatomy and physiology about the time the ice age ended so it helpd but the med terminology and probably transction both nailed it for me.

I pretty much have a handle on the MRI(they were abbreviatted from 2-they cut and pasted what they decided to use.

But here is where you get it or got it. A negative SLR was stated in a denial (I am guessing from a QTC C&P Exam Physician DO, but don't know for sure since they will not release the records till i use a crow bar). that is such nonsense. Google SLR and you have the responses required for a positive minus some reflex actions/but that varies from the nerve root invovled. a sixth graded could derive that. Not to mention the fact that the MRI states

"Disc material in the L5-S1 subarticular zone contacts the descending S1 Nerve Root and displaces it posteriorly towards the left facet."Can you say Sciatica ? Evidently the VA Neurologists were on board with that or they would not have approved injection or surgery.

In your opinion do you believe the above indicates a positive SLR? This is only a small point, the big one is the nexues that is in the works as we speak.

Thank you so much for sharing your knowledge. I hope you do well at your studies!

Thank you also pool guy for your input.

Edited September 11, 2009 by cannoncocker (see edit history)

[john999]

I can't believe a back injury or condition that affects both legs could be mild or moderate. Who did the MRI and was the neurologist your own private doctor or the VA's? I have what they refer to as mild arthritic changes and bulging disc and it hurts like hell. You know for sure that if it is affecting your legs a nerve is being compressed.

[cannoncocker]

Of course, both were the VA, but when they use mild and mederate tey usually refer to say degenerative back disease, whic in fact covers a full 5 discs which have zero fluid left in them and are completely flat. They also use that in conjunction with extruded heneriations, protruded herinations, Osteophytes,Mild focal levocurvature centered at the L4-L5. Minimal retrolisthesis of L4 on L5,Mild ventral deformity of the L1 ventral body with asscoiated kyphosis....

You would have to read both evaluations since they cut and paste....

They do not use mild or moderate with:Alignment abnormalities, this degeneration and facet hypertrophy result in varying degrees of neural foraminal stenosis, as above. Disc material in the L5-S1 subarticular zone contacts the descending S1 Nerve Root and displaces it posteriorly towards the left facet.

Which in fact is the scitica issue. All I need is one approval of one isse and the dominoes will fall. I am way beyond fair/commonsnse/reasonable preson would believe...I am just looing for the foot in the doormwith one issue and it is all over.

Take degenerative disc disease (Mild degenerative disease at multiple levels) 1mm of correction on flexion views, sounds like ROM issues to me. What do you think a reasonable arbitor wold believe precipated that, or any other problem in the Lumbar area? Given they broke federal guidlines, NIOSH (Lifting Equation chart), I use that since I am a sefty andd occupational health specialist and am familiar with the things they have to adhere to, and what leads to what. that is why i want to be at the conference/hearing. I am not rich but I can verbally defend myself.

Hopefully this Neurologist will throw in with me. why wouldn't they? they have a pr. that for 6.5 years lifted 174lbs projos which of course have no handles, which provide leverage, part of the equation.

They also said in a denial I hade no, which we aren't schucking and joking on the street corner, range of motion problems, and the Flexion x-rays shows wedging on L1 with associated hyphosis (1mm of correction on flexion views, sounds like ROM issues to me).

Sciatica diagnosed and ready for surgery and no ROM problems, please! Constant pain from degenerative disease and no ROM problems? Again, please.

whichever, whatever, take an issue and tell me with a straight face, along with SMR's there is no conection, especially since i've sat for a living, so little possibillity it all happened afterwards.

"mild arthritic changes and bulging disc and it hurts like hell. You know for sure that if it is affecting your legs a nerve is being compressed." at least equals:

Alignment abnormalities, this degeneration and facet hypertrophy result in varying degrees of neural foraminal stenosis, as above. Disc material in the L5-S1 subarticular zone contacts the descending S1 Nerve Root and displaces it posteriorly towards the left facet.

Deal is like we already said, and we all know the deal, they don't want to hand me a 100%.

I will not rol over and play dead. I felt like it but on further thought, naw not quitting.

Field Artillery for 6.5 years on 8' guns. Like they said with my ears=conceded!

Edited September 12, 2009 by cannoncocker (see edit history)