请教－腰背，臀，小腿，脚，坐骨神经痛，针刺麻

[qianlao]

好不容易做了MRI，又要等3个月，才有下一个appointment。请感兴趣的大侠看看提提建议。多谢了。
MRI:
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MR LUMBAR SPINE WITHOUT CONTRAST: 10/12/2023 9:44 AM

INDICATION (as provided by referring clinician): Low back and leg pain, 6 weeks or more

TECHNIQUE: 3T MR imaging of the lumbar spine without intravenous contrast

FINDINGS:

Anatomy: Five lumbar-type vertebral bodies are present. The most inferior well-formed disc space will be referred to as L5-S1 for purposes of numbering in this report.

Prior surgical findings/hardware: None.

Vertebral bodies: Normal in height. Retrolisthesis at L2-3 and grade 1 anterolisthesis at L4-5. Mild left convex curvature of the lumbar spine.

Bone marrow: Normal for age. Small hemangiomas in L4 and L5. Mild fibrovascular and fibrofatty end plate changes at L2-3 and L4-5.

Intervertebral discs: Multilevel disc desiccation worse at L1-2, L2-3 and L4-5..

Conus medullaris: Normal. Positioned at: L1. Mild redundancy of the cord of fibrous at the lumbosacral region

Paraspinal muscles: No evidence of denervation or inflammation.

The following axial levels are detailed below:

T12-L1: Unremarkable.

L1-L2: Mild broad-based disc bulge with mild narrowing of the spinal canal. There is also mild bilateral neuroforaminal narrowing.

Exam(s):

MR LUMBAR SPINE WITHOUT CONTRAST

Exam Status:

Final

L2-L3: Small annular tear. Small disc extrusion. Moderate spinal canal and bilateral neural foraminal narrowing.

L3-L4: Mild broad-based disc bulge, no significant spinal canal and mild bilateral neuroforaminal narrowing. Mild facet arthropathy.

L4-L5: Annular tear and moderate extrusion. Severe spinal canal and moderate bilateral neuroforaminal narrowing left more than right. Severe facet arthropathy.

L5-S1: Broad-based disc bulge. Moderate left neuroforaminal narrowing. Mild spinal canal narrowing. Severe left facet arthropathy right.

Visualized sacrum and bony pelvis: Mild degenerative changes of the SI joints.

IMPRESSION:

Multilevel moderate to severe degenerative changes of the lumbar spine, most pronounced at L4-5 where there is severe canal stenosis and moderate neural foraminal narrowing.

[cng]

醫生是建議physical therapy 還是surgery?

[littlek]

MRI的结论简单点说就是L4-L5有cord compression, L4-L5是骨盆上的那2段。至于为啥有cord compression,可能是年轻是受过伤（比如干重体力活，比如生小孩），也可能是肿瘤造成的。进一步预约的目的是发现原因和确定治疗方案。

美国现在这个MRI和PET-CT实在太离谱了，我们这里MRI预约都要半年以上，PET-CT 3个月。还有 surgeon, initial consultation 都要等半年，除非是做隆胸的，那是随到随做。。。当然，MRI快的也有，比如你是in patient,当天就能做。如果你大喊医生我cash,连waiting room都不用坐。总之，帝国余辉啊。

好不容易做了MRI，又要等3个月，才有下一个appointment。请感兴趣的大侠看看提提建议。多谢了。
MRI:
==================================================

MR LUMBAR SPINE WITHOUT CONTRAST: 10/12/2023 9:44 AM

INDICATION (as provided by referring clinician): Low back and leg pain, 6 weeks or more

TECHNIQUE: 3T MR imaging of the lumbar spine without intravenous contrast

FINDINGS:

Anatomy: Five lumbar-type vertebral bodies are present. The most inferior well-formed disc space will be referred to as L5-S1 for purposes of numbering in this report.

Prior surgical findings/hardware: None.

Vertebral bodies: Normal in height. Retrolisthesis at L2-3 and grade 1 anterolisthesis at L4-5. Mild left convex curvature of the lumbar spine.

Bone marrow: Normal for age. Small hemangiomas in L4 and L5. Mild fibrovascular and fibrofatty end plate changes at L2-3 and L4-5.

Intervertebral discs: Multilevel disc desiccation worse at L1-2, L2-3 and L4-5..

Conus medullaris: Normal. Positioned at: L1. Mild redundancy of the cord of fibrous at the lumbosacral region

Paraspinal muscles: No evidence of denervation or inflammation.

The following axial levels are detailed below:

T12-L1: Unremarkable.

L1-L2: Mild broad-based disc bulge with mild narrowing of the spinal canal. There is also mild bilateral neuroforaminal narrowing.

Exam(s):

MR LUMBAR SPINE WITHOUT CONTRAST

Exam Status:

Final

L2-L3: Small annular tear. Small disc extrusion. Moderate spinal canal and bilateral neural foraminal narrowing.

L3-L4: Mild broad-based disc bulge, no significant spinal canal and mild bilateral neuroforaminal narrowing. Mild facet arthropathy.

L4-L5: Annular tear and moderate extrusion. Severe spinal canal and moderate bilateral neuroforaminal narrowing left more than right. Severe facet arthropathy.

L5-S1: Broad-based disc bulge. Moderate left neuroforaminal narrowing. Mild spinal canal narrowing. Severe left facet arthropathy right.

Visualized sacrum and bony pelvis: Mild degenerative changes of the SI joints.

IMPRESSION:

Multilevel moderate to severe degenerative changes of the lumbar spine, most pronounced at L4-5 where there is severe canal stenosis and moderate neural foraminal narrowing.

[qianlao]

醫生是建議physical therapy 還是surgery?

我经过了理疗，才好不容易争取到MRI。三个月后看能不能得到评估，即手术否。

[qianlao]

MRI的结论简单点说就是L4-L5有cord compression, L4-L5是骨盆上的那2段。至于为啥有cord compression,可能是年轻是受过伤（比如干重体力活，比如生小孩），也可能是肿瘤造成的。进一步预约的目的是发现原因和确定治疗方案。

美国现在这个MRI和PET-CT实在太离谱了，我们这里MRI预约都要半年以上，PET-CT 3个月。还有 surgeon, initial consultation 都要等半年，除非是做隆胸的，那是随到随做。。。当然，MRI快的也有，比如你是in patient,当天就能做。如果你大喊医生我cash,连waiting room都不用坐。总之，帝国余辉啊。

谢谢你，三个月后看能不能得到评估。

[cng]

我经过了理疗，才好不容易争取到MRI。三个月后看能不能得到评估，即手术否。

理疗和MRI的时间颠倒了。这是医生(或保险)不负责。不看损伤，也不查原因，就去做理疗？万一做错伤了别处呢？MRI的报告既然有了，就打电话去问医生的看法。自己的健康要aggressive点。祝你好运。

[MaLaRabbit]

MRI的结论简单点说就是L4-L5有cord compression, L4-L5是骨盆上的那2段。至于为啥有cord compression,可能是年轻是受过伤（比如干重体力活，比如生小孩），也可能是肿瘤造成的。进一步预约的目的是发现原因和确定治疗方案。

美国现在这个MRI和PET-CT实在太离谱了，我们这里MRI预约都要半年以上，PET-CT 3个月。还有 surgeon, initial consultation 都要等半年，除非是做隆胸的，那是随到随做。。。当然，MRI快的也有，比如你是in patient,当天就能做。如果你大喊医生我cash,连waiting room都不用坐。总之，帝国余辉啊。

多约几个点，不同的地方等待时间差异很大。

[mrmaja]

我经过了理疗，才好不容易争取到MRI。三个月后看能不能得到评估，即手术否。

你得去和你的primary 不停的去哭诉，痛啊，睡不着啊，没法生活啊，
才可以推进的快一点，因为医生被保险公司牵制，必须按部就班走流程
你的情况如果是第一次急性发作，很大概率两三个月内可以自然恢复到不错，那么保险延缓推迟你的各项检查可以省掉一大笔费用，这也是为啥总是让费用最低的PT介入，就是指望你不治而愈或者以最低成本自愈。

但手术一定要慎重，如果你到骨科医生那里去评估，显然他们推荐手术的概率很高，说的好听点是他们是个锤子，看见的都是钉子，小人之心一点就是利益相关，开一个刀赚一笔。

所以一是耐心，相信人的身体有很强的自愈能力，二是应该继续试试好的PT。

另外如果是资源的问题，考虑扩大搜索医生的范围，周边300miles以内都可以看看，你只是要诊断，不是手术，应该可以找到还不错的。

Primary 家庭医生其实挺重要的，他们知道谁好谁坏，有connection的甚至可以帮你到专科医生那里插队。

[大巨魔]

为啥不找个老中医生贿赂一下

[qianlao]

谢谢大虾们的指教。我的理疗其实就是网上常见的一些动作，没有什么效果。
针灸也做了4次了，据说要几个月。

[mrmaja]

谢谢大虾们的指教。我的理疗其实就是网上常见的一些动作，没有什么效果。
针灸也做了4次了，据说要几个月。

还是先要有诊断结果，排除肿瘤等可能（但MRI照理说能看出肿瘤的），
不然任何的治疗方案都是盲人摸象,

不停的去骚扰家庭医生和保险公司，要求早点约专科，

而且你现在就要去调研专科医生，美国医疗资源紧缺，好的专科医生约到半年一年以后也很常见，取决于你那里的医疗资源。

也可以要求PT和家庭医生去说，认为PT没有任何效果，病人很痛苦，无法开展手法等等，加速等待过程。

如果你只是小关节紊乱，错位的话，国内中医手法复位治疗是非常有效的，好的医生一次治疗可能就消除大部分症状。

[qianlao]

谢谢MRMAJA指教。迄今确实都是在摸象。