Viewing 6 posts - 1 through 6 (of 16 total)
  • Author
    Posts
  • texasspondy
    Member
    Post count: 25

    Hi Dr. Corenman. First off, I’d like to say, I’ve seen a number of youtube videos where you explained how to look at an xray or mri, and I was impressed by your detail, patience, and energy you put forth. Thanks, I’ve enjoyed those.
    Onto my questions, first, my Mris
    2008…Transitional vertebrae at lumbosacral junction labeled s1. With rudimentary s1-s2 disk.
    Subtile disk desiccation without disk space reduction involving lumbar intevertabral disks.
    Mid curvature of lumbar spine convexity leftward.
    L1-l2 through L4-5 do not show significant posterior disk bulge, protrustion or hernation or central canal or foraminal stenosis, however there is mild facet arthrosis bilaterally at l4-5.
    At l5-S1, there is bilateral L5 spondylolysis without spondylolisthesis of l5-S1. There is minimal 1-2mm posterior broad based disk bulge slightly indenting ventral thecal sac without mass effect on s1 roots or sleeves. There is facet arthrosis. No central can stenosis. Mild inferior foraminal disk bulge and spondylolysis seen with mild bilateral foraminal narrowing. Also large hemangioma involving l5 vetebral body without vertebral body collapse. No paraspinal soft tissue mass seen.
    Sep2011 MRI…
    Hemangioma of the L5 vertebral body seen. No scoliosis, normal lordosis. No compression fractures t12-s2. Disc space, foramina and spinal canal of L1-L2 through L4-L5, no abnormalties.
    L5-S1 shows bilateral pars defects at L5, without spondylolisthesis. Mild asymmetric left disc bulge and left facet hypertrophy result in mild left foraminal stenosis. The spinal canal is patent.

    I’ve had off and on little mild flareups in low left back, always on the left side near the si joint area, for the last 10 years. The last few months, it is not a flare up, it stays all the time now. I have done 3 months of P/T now. Saw a neurosurgeon 3 months ago, nice fella. He gave me 2 trigger point injections in low back muscles, put me in a corset for 6 weeks. I stretch every day, and do back/stomach/abdominal p/t 5 days a week. I can’t seem to get any better here. Some days pain is just manageable, 1-2, other days it’s 3-5. I’m afraid to bend over or bend backwards, Lumbar section seems tight.
    Not sure what kind of course of action is next, epidural injection or facet joint injection? I’m afraid my future is very bleak with this condition. I’m guessing the stenosis is what is causing discomfort, maybe the facet joints, don’t know. I dread the though of major back surgery, I’m guessing with bad facet joints a fusion is in my future, but how many levels. How would you fuse a hemangioma vertebra, wouldn’t that be like drilling into sponge cake and the anchors would pull right out.
    I would very hard to maintain what I have, I feel like my back is like a house of cards, with a crumbly foundation, it’s just a matter of time? I’m a mechanic, I use to golf, and ski, these feel like things of a long ago past. Your interpretation if I walked into your office with this mri, and what my future holds? Thanks Doctor

    texasspondy
    Member
    Post count: 25

    I should also add some information I note that you mention in a number of other posts. I really can’t say I have leg or foot pain/tingling. It’s mainly left low back/si/QL area. I do have couple lipomas (so I’m told) around this L5 area that feel sometimes bruised from sitting but I’m guessing that’s referral pain. Honestly sitting seems to aggrivate it worse. Walking feels better, and just standing doesn’t seem to aggrivate it as bad. My P/T generally makes it feel less aggrivated but that’s usually short lived.
    I actually yesterday purchased your new book, I don’t expect my symptoms go away with your book, but maybe I can get an even better visual as to what is happening when. One of my biggest dilemmas with this problem is knowing how to do the correct excercises to not aggrivate it. My P/T folks gave me a number of things for core work, I’ve worked on that 3 months now. My chiropractor took a couple things out, said he didn’t like em and added a couple other things (superman and back extension raises 30deg only), then I read online superman is the worst thing one can do for foramen problems. It so frustrating to know what to do and not with all the information out there. The neurosurgeon said yoga was great and really only prohibited me from squats and axially loading the spine from above the shoulders.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8408

    Your symptoms are 10 years’ worth of left SI region pain, intensity about 1-5 (0-10 VAS scale) depending upon the day and increasing in consistency over time. You have no leg symptoms. Your trade is that of a mechanic and your back feels fragile. Sitting increases symptoms and walking decreases them.

    The diagnosis needs to correlate the MRI findings with your symptoms. X-rays are valuable in your case as with pars fractures and degenerative facet disease noted on the MRI, you could have developed a spondylolisthesis. Standing views with flexion and extension films are needed to look for slip and instability. Now for the MRI.

    Your main problem is the pars fractures and slip (isthmic spondylolisthesis) at L5-S1. The reason you have no leg pain or paresthesias is that you have no nerve compression as identified by the MRI. I imagine you have moderate degenerative disc disease of L5-S1 but this is not noted on MRI.

    Rehabilitation for isthmic spondylolisthesis involves a flat back posture program. You should not do extension exercises as this will aggravate pars fractures. Any yoga position that causes bending backwards should be avoided and in general, you want your lower back to become stiffer. Manipulation of the L5-S1 level should be avoided.

    If rehab and injection therapy does not help, this problem is most likely surgically treatable.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    texasspondy
    Member
    Post count: 25

    Thank you Doctor for your response and information.
    I am suppose to see the neurologist again on the 10th and I’m going to see what would be the next step for me. I would assume a epidural injection since I have had the trigger point injection already.

    I am also going to ask him, since I do not have an xray, if he could request one for me including bending and flexion, if I understand you correctly.

    Also thank you for the flat back program visual. I kind of thought that too but my chiropractor has said adjustments and bending over stretches were to get new blood to the area for healing. My thought is the more I take adjustments in the l5 area and any bending there, is retearing the fracture fibers.

    As to surjical, which sooner or later, I would gather could be my outcome. Are you referring to a TLIF for this condition? If so, can my l5 vertebral hemangioma be fused? I don’t know enough about it, but the theory scares me that tumorous bone couldn’t withstand a fusion. Again, thanks for your time.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8408

    If you end up with a fusion at L5-S1, the TLIF procedure is the one that is most likely to be used. A normal hemangioma is not a factor in a fusion. These are quite common and typically ignored with treatment.

    You are correct that no extension of the back should be employed with rehabilitation. Extension will tear or at least aggravate the pars fracture pannus.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    texasspondy
    Member
    Post count: 25

    Hi Dr. Corenman. Since I last replied, I had an office visit with my neurosurgeons PA. Very nice guy and seemed very informative as well to my questions.
    He was pleased and impressed I had done much research on my condition and was asking questions, he said he wished more patients did so.
    Anyrate, as we talked he did mention one thing which I found interesting/confusing.
    In the topic of when does one decide to have surgery, I said to him I will deal with it as long as I can tolerate the pain/symptoms conservatively, and when I can’t bear it any more, I will give in to surgery. He responded with, you really should consider having surgery when or if your quality of life has degraded to a point that you no longer enjoy much of the things you use to enjoy, so have surgery to give yourself a quality of life back.
    Then he said, you should not have surgery due to pain, because we can give you quality of life back, but can’t guarantee pain removal. I guess I thought they went hand in hand but it kind of took the wind out of my sails, your thoughts??

    He was all for setting up a Epidural spinal injection with a Pain Management Specialist. So they referred me to a doctor. I got into see him and he had my images and report. He also did a few tests of holding my hips and having me try to bend over to touch my toes (which was poor and difficult) benc back (which was easy), and try to turn to the sides, he concluded that he felt my spondy had not slipped yet, there was enough holding things in place, and has me scheduled for next wed a epidural I believe around the area of minor disk bulge L5 and one or two other nearby locations.

Viewing 6 posts - 1 through 6 (of 16 total)
  • You must be logged in to reply to this topic.