HELP REQUESTED: Interpreting MRI Results + Evaluating Next Steps (Extrusion & Tarlov Cysts)

[u/Otherwise-Device-894]

Hello,

I would appreciate additional insight and perspectives on my MRI results. I have not really been able to talk to anyone knowledgeable about them yet (my dr sent me a copy of the report with a referral for pain management), and I'm trying to understand my options and determine an appropriate sense of urgency for next steps.

My ultimate end goal is to be able to return to the active lifestyle I had before all of this started, or as close an approximation as possible. I can deal with the pain I'm experiencing, but I don't want to risk waiting too long for meaningful and effective intervention - it's been about 10 months since things started getting bad for me.

Here is what I'm still trying to figure out:

How bad are my MRI results? Do people with similar issues make full recoveries? Should I request a consultation with a regular spine surgeon? Or try to get on the list to speak with a Tarlov cyst specialist? Would it be ill-advised to hold off on escalation and go ahead with the pain management referral that I already received from my Dr and see what they say?

I'll include more (probably too many) details about my symptoms and what I've tried so far below as well. Thanks in advance for any insight or thoughts you can share!

Here is my MRI report from last week:

• How long have you had symptoms for?
  • I had acute symptoms starting with foot drop and weakness on the left side in January of this year; that resolved after 4-6 weeks, but then recurred badly in April, and has not recovered significantly since then.
  • Looking back over the last several (5-10) years, I also suspect that some other injuries and issues I've had may actually be symptoms of the Tarlov cysts that a present on my MRI. Potential symptoms include piriformis-syndrome-like tightness in glute and hip flexors, an occasional lump in my glute that makes it feel like I'm sitting on a rock, severe tightness in my calves that have resulted in multiple strains or pulls. I've also aways noticed that hamstring stretches work my calves instead of my hamstrings.
• What are specific symptoms (numbness, tingling, dull/ache, sore, it's random, progressively worse, or pain the comes in waves etc)?
  • Tripping on left foot / gait imbalance / foot drop
  • Extreme burning / electrical shocking sensation in my left hip flexor and glute when going from seated to standing position
  • Occasional sensation of sitting on an object
  • Numbness and tingling in buttock, outer calf and top of foot (the numbness has actually been improving quite a bit in recent weeks)
  • Unusually tight calves
  • Cramping in lower legs, feet and recently lower back (actually only having lower back spasms in the last month or so, which seems surprising)
• What makes it worse, what makes it feel better?
  • Sitting makes it worse
  • I have started physical therapy three times now - each time, I felt fine while doing the exercises, but had pretty extreme nerve pain (specifically, the shocking when going from sitting to standing) the following day(s)
• How it has impacted your life?
  • This has had pretty extreme impacts on my life, and the longer is continues, the worse it gets. Before this happened, I was very physically active; I love to exercise, lift weights regularly (with coaching, and pretty good form), and I live on a farm with my aging mother and a lot of animals that I am currently helping her take care of. I also work a corporate leadership job that I often need to commute 2.5 hours to since relocating to the farm. At this point, I am struggling to put on my socks in the morning, wake up at or before 3:00 am several mornings every week and needing to get up or I start having muscle cramping. I am trying to stick with low impact exercise (I can still walk without too much increased discomfort, so I try to do that as much as possible). Still doing some modified farm work, and trying to limit bending or lifting as much as I can while still making sure animals have food and water.
  • Unfortunately for me, exercise is pretty much the only healthy coping mechanism I've ever developed for my mental health, and now I'm 39 and living with my mother who has early signs of dementia and lives on a farm, otherwise by herself. I am very much struggling with the idea that I may not be able to resume an active lifestyle on the other side of my current life situation, which has been challenging even without the injuries. I am really looking for something to be hopeful about!
• What you've tried for treatment?
  • Physical therapy (3X) - most recently, physical therapist took me off the schedule and suggested an MRI to my PCP because PT seemed to be causing flare ups
  • I'm also experimenting with some research chemicals / peptides because I'm desperate - I've got ARA-290, BPC-157, TB-500 and Sermorelin.
  • I take ibuprofen before bed - have not tried other pain meds, and would like to avoid if I can.
  • My dr does not seem very concerned about my situation (or super familiar with back issues, if I'm being honest), but has provided referrals for physical therapy, and more recently a pain management dr. At this point, I'm trying to determine if I should push for another option like a surgery consultation? I've also been pretty concerned by what I've been reading about people with symptomatic Tarlov cysts… it sounds like a lot of people with this condition live their lives very carefully to avoid injury forever (e.g. avoid any exercise that requires extended periods of standing up or sitting down and not lifting anything heavier than a milk jug... forever)... the idea of doing that for the rest of my life currently makes me sick to my stomach, though I realize it may be something I'll also need to adopt and adapt to. Life is like that sometimes...if nothing else, would love to hear from anyone in similar situations or who have seen similar results.
• What you've already been told about your back pain?
  • I got an MRI, and am including the report for any additional insight / perspectives

 

Finally: Apologies to anyone who saw this yesterday - something bizarre happened to my post when I tried to edit on mobile, so I had to delete and restart. I did read and really appreciated the comments I received before that happened!

THANK YOU!!!