Which is it - herniated disc or spinal stenosis?

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Weosephaul

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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.
 
Based on what you wrote - you have booth.

Your spinal stenosis is caused by disc herniation.
 
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).
 
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.
 
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.
 
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?
 
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.????
 
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.
 
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".
 
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.
 
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.
 
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 (ยฃ22 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.
 
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.
 
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  36. SL Spa:
    ๐Ÿ’†โ€โ™€๐Ÿ’–WooHoo Wed๐Ÿ’– Ultimate destination for Asian massages๐ŸŽ‰ Two fab spots: Richmond Hill & Oakvilleโœจ Your passport to paradise with 10 enchanting girls fr China, HK, Japan & Korea โ€” ๐Ÿ†•Luna, Cindy, Coco,Cici, Jenny, Amber, JPN Yui, Akino, Jasmine & Lucyโ€” ready to pamper you๐ŸŽ๐Ÿ Ring us ๐Ÿ“ž647-695-6354 or text us ๐Ÿ“ฑ647-578-8169โœจ 160 East Beaver Cr., Unit 12, RichmondHill ๐Ÿ’ฐWhere Eastern charm meets Western comfort - your bliss awaits๐Ÿ™Œ
  37. Lulu1980:
    Phoenix Blossom Spa ๐ŸŒน๐ŸŒน๐ŸŒน2 girls ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ5124 Dundas St W Etobicokeโ˜Ž๏ธ416-817-3366๐Ÿ‘ Table Shower Sea Salt Bath Body Scrub๐Ÿ˜˜ Japanese girl Nina โค๏ธ Natural Big Boobs 38 DD ๐Ÿ˜˜Pink Mini Nipples Hot body slide, super enjoyable๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜ very provocative service๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜, professional super Luna deep tissue massage, has therapeutic effect to loosen bones and relieve muscle pressure and will bring you unexpected service effects, she will bring you a little surprise๐Ÿ˜๐Ÿ˜๐Ÿ˜๐Ÿ˜โค๏ธYou are welcome to make an appoint
  38. SpringGreen.:
    Today we have 5 girls on downtown Toronto 72 gerrard st west๏ผš๐Ÿ’‹๐Ÿ’‹ New girl gaga Serving The Queen ๐Ÿ’‹๐Ÿ’‹Bunny- Tanned Spanish beauty with large melons and a fun booty too Wendy- exotic goddess with a gymnasts body and corresponding flexibility Jennifer- Exotic beauty with... Call and text 647 891 0699 ask questions Thanks ๐Ÿ’‹๐Ÿ’‹
  39. Jennyโ€™s Spa:
    ๐ŸŽ‰๐Ÿ’JENNYโ€™S SPA๐ŸŽ‰๐Ÿ’ โœ…5170 DUNDAS STREET WESTโœ… ๐Ÿ‘ŒETOBICOKE ONTARIO M9A 1C4๐Ÿ‘Œ โ˜Ž๏ธ( 647-893-5196)โ˜Ž๏ธCall or Text โ˜Ž๏ธ( 437-888-3759)โ˜Ž๏ธCall Only (ETOBICOKE) OPEN 10am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…GRAND OPENING๐Ÿ’ฏNEW GIRLS EVERYDAY๐Ÿ”ฅEXCELLENT MASSAGE + SERVICE QUEENS NOW AVAILABLE AT JENNYโ€™S SPA FOR ALL YOUR MASSAGE AND SPECIAL EXTRA NEEDS๐Ÿ”ฅ๐Ÿ’ฏ๐Ÿ˜˜๐Ÿ”ฅโค๏ธ๐Ÿ‘Œ ๐Ÿ”ฅTWO BEAUTIFUL NEW YOUNG ASIAN GIRLS EVERYDAY๐Ÿ”ฅ ๐Ÿ’ฏREAL PICTURES OF ATTENDANTS๐Ÿ’ฏ ๐Ÿ”ฅ๐Ÿ’‹Limited Time Special Promotion๐Ÿ”ฅ๐Ÿ’‹ โœ…๐Ÿ’ฆ30 Minutes Nude Mass
  40. Red Rose Spa:
    ๐ŸŒธ We have 5 hot brown girls today ๐ŸŒธ MONICA, PAOLA, MALIYA, MONIKA, AMANDA, ASHA, JAZMINE, PREETI, ANGELINA, KIRAN ๐ŸŒธ 2588 Birchmount ๐ŸŒธ 2 Invergordon ๐ŸŒธ 647-702-8800 ๐ŸŒธ Please visit for a great erotic massage
  41. wilson holistic centre:
    ๐Ÿ’•๐Ÿ’•Beautiful Korean girl working at 382 Wilson Ave ๐Ÿ’•๐Ÿ’•โ˜Ž๏ธโ˜Ž๏ธ416-840-0071โค๏ธโค๏ธ
  42. wonderspa:
    ๐ŸŒบWonder spa,(9421Jane st unit127)call416-5000-800โ˜Ž๏ธbest massage in vaughan,Wednesday RMT available,๐Ÿ’„sexy face young girl Joey natural c cup,very good looking nice body slide,really popular ๐ŸŽlong hair Q Lucy good strong to relax oil massage, Relieve pain and remove stress,more experience,๐ŸŒนvery nice new girl CiCi, amazing the end,give you warm time,must try๐ŸŒน๐Ÿฅค
  43. AliceSpa:
    WEDNESDAY at ๐—”๐—Ÿ๐—œ๐—–๐—˜ ๐—ฆ๐—ฃ๐—” 416-298-0898, 4915 Steeles Ave. E, Scarborough 3 very nice girls here today. Open 10am to 9pm: CLOUDIA (11am-8pm): is Vietnamese, young, petite 5'2" & 96 Lbs, B Cup, best rim deep bbbj cim. $40 Room Fee + $80 (incl bbbj & fs). +$20 for rim/cim. Excellent open minded services. DORIS (12pm-9pm): from Taiwan, is young & petite with loing thick black hair, 105 Lbs
  44. Annie Spa:
    ๐Ÿ’‹๐Ÿ˜˜Sexy Petite Korean๐Ÿ‡ฐ๐Ÿ‡ทGirl Eva working with Sweet Beautiful Japanese New Cummer to Canada Feifei ๐Ÿ‡ฏ๐Ÿ‡ต and Sensual Pleasing Busty Coco๐Ÿ‡จ๐Ÿ‡ณtoday๐Ÿ’‹๐Ÿ˜˜Call or text ๐Ÿ“ฒ647-891-9688 or 416-291-8879๐Ÿ“ฒ
  45. EMSpa_schedule:
    Hey! Where have you been? Today (Wednesday), our amazing attendants are Carla โ€, Cici ๐Ÿ˜, Opal ๐Ÿคฉ, Sandy ๐Ÿค— and Yoyo ๐Ÿ˜. Call us at โ˜Ž๏ธ (905) 479-6668 โ˜Ž๏ธ to book your favourite and head on over to 7665 Kennedy Road, Unit 4, Markham!
  46. ForeverWarden:
    Wednesday at ๐Ÿซฆโค๏ธ๐Ÿ”ด๐ŸŸฅโ™พ๏ธ๐“•๐“ž๐“ก๐“”๐“ฅ๐“”๐“ก ๐“ข๐“Ÿ๐“โ™พ๏ธ๐ŸŸฅ๐Ÿ”ดโค๏ธ๐Ÿซฆ2190 Warden Ave, Unit 201, Scarborough ๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿด๐Ÿฌ๐Ÿฌ-๐Ÿณ๐Ÿด๐Ÿด๐Ÿณ: Bella, Cindy & Sasa. Bella is around 5โ€™3โ€ with a thin to medium build, C Cups, and a pleasing personality. She can offer dfk, bbbj and cfs as well as a good massage experience. Cindy is a slim beauty, 5โ€™4โ€, natural C Cups. Her massage is nice, her services will drive you wild & her finish is a dream
  47. HolidaySpa:
    Wednesday at ๐ŸŒด๐Ÿ˜Ž๐ŸŒ…๐“—๐“ธ๐“ต๐“ฒ๐“ญ๐“ช๐”‚ ๐“ข๐“น๐“ช๐ŸŒ…๐Ÿ˜Ž๐ŸŒด3517 Kennedy Rd, Unit 4, Scarborough โ˜Ž๏ธ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฎ๐Ÿฐ๐Ÿณ-๐Ÿญ๐Ÿญ๐Ÿต๐Ÿตโ˜Ž๏ธ: FIONA, KIKI & CINDY. FIONA is a slim hottie with long dark hair, great melons and ass, and nice services. Kiki is very attractive, young, about 5โ€™4โ€ and 110 Lbs., slim with a banging body. Kiki is very popular for her great attitude and services. CINDY is slim & incredibly sexy
  48. SugarLoveSpa:
    Wednesday at โค๏ธ๐Ÿ’™ ๐Ÿ’œโŽ๐—ฆ๐—จ๐—š๐—”๐—ฅ ๐—Ÿ๐—ข๐—ฉ๐—˜ ๐—ฆ๐—ฃ๐—”โŽ ๐Ÿ’–๐Ÿ’—๐Ÿ’˜: SARAH, SUSAN, TIFFANY & VIVI. 1270 Finch Ave W (at Keele St), Unit 18. North York, ON โ˜Ž ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฏ๐Ÿฒ๐Ÿฑ-๐Ÿฎ๐Ÿฒ๐Ÿด๐Ÿด โ˜Ž SARA is a beautiful Thai lady with C Cups, 160 Cms and 50 Kgs, with a full set of services to delight you. SUSAN is a small, slim & sexy Latina girl, 5'4" & 116 Lbs, with nice boobs and ass, very versatile services.
  49. ใ™ใฟใพใ›ใ‚“:
    Top notch line up with superstars like sunny , gabby , elena , kiki , Ella and cindy. At top notch wellness
  50. bnwellness_wilson:
    We have 4 young girls are working today, young Taiwanese Victoria slime 26โ€™s and young flirty Mia 25โ€™s with curly body , pretty Ella and cute GFE Lina are providing deep tissue massage, pls call 4163985777 book appointment and walk in always welcome,back entrance and parking available, 350 Wilson Ave North York
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