[Donald Corenman, MD, DC]

#21348

To Sperryguy-

You already had a CT scan and an MRI. Generally, a myelogram is only needed when instrumentation obscures the canal and a CT myelogram is necessary to visualize the spinal canal and any compression that could be missed by an MRI. A bone scan generally is not necessary using an MRI with STIR images.

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.

[sperryguy]

#21361

Thank you again Dr Corenman. Can you provide any advice on the procedure to avoid issues? I will continue keeping the forum up to date.

Thanks

Steve

[Donald Corenman, MD, DC]

#21396

Which procedure are you talking about? The myelogram, the bone scan or ……?

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.

[sperryguy]

#21406

Hi Dr. Corenman

Sorry for any confusion. I was referring to the Myelogram. The surgeon was quite insistent that it is done prior to a CT Bone Scan. My concern was the possible side effects of the Myelogram. At this juncture I am quite certain that I will require some sort of revision surgery. Though the surgeon feels that the revision wont be as intense since the rods and screws are in good shape and holding “all” open.

Will continue to keep the forum up to date

Thanks

Steve

[Donald Corenman, MD, DC]

#21407

The myelogram is necessary to view the nerve roots in conjunction with the CT scan. If there is any question of nerve compression and the instrumentation obscures the CT imaging, the myelogram can be helpful. This test is performed by injecting a “dye” in the spinal canal. Generally, the only risks are allergy to the dye and spinal leak causing headache. Both are uncommon. The spinal leak can generally resolve with bedrest or on rare occasion, a blood patch. This is where 20cc of your own blood is injected on top of the dura (extra-durally).

If however, the nerves are well visualized on the MRI scan, the myelogram is generally not needed.

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.

[sperryguy]

#21523

Hi Dr Corenman

As suggested, I did have the myelogram. These are the results(will only include the pertinent lines):

L3-L4: Step retrolisthessis of L3, mild bilateral foraminal bulges greater on the left, no herniations. The roots are intact, mild central canal narrowing in extension, normal in neutral, intact posterial element

L4-L5: Intact instrumentation, no angulation in flexion and in extension, fused left and right sided interbody fusion, minimal normal bilateral postoperative recess scarring, patent canal, foramina

L5-S1: Mild diffuse bulge, clear recesses and canal, patent foramina, normal alignment, intact posterior elements, no arachnoid adhesion

Findings

Vertebra: The L4-L5 instrumentation is intact. There is a step retrolisthesis of L3. The remaining AP alignment above and below the fusion is intact in flexion in extension. heights , shape and density are intact.

Discs: There is osseous fusion of the right portion of the intervertebral cage. There is no gaseous change within the residula disc to indicate motion. There is ild bilatereal foraminal L3-4 bulge on the left and mild diffuse L5-S1 bulge. The remainder of the disc are normal in size, shape, and height, and density.

Canal: Mild L3-4 central canal narrowing in extension, normal in neutral, the contained nerves and conus are normal. Thoracis cord and canal are intact.

Foramina: Minimal narrowing of the L3-L4 Foramina due to bulge, the roots and ganglia are intact

Lateral recesses: The l4/4 appear fused. The facets and lamina above and below the fusion are intact. The pedicles, and sacrums are intact

Soft Tissue: Normal diameter aorta bifurcates at L3/4, the IVC at L4/5, normal postoperative changes in the dorsal musculature, the rest are intact. The plexus is clear.

Sorry for the repetition. I didn’t want to miss anything. Thank you again for all your patience.

Just so all are aware, the left leg weakness(as per my PT) and lower back pain and pressure continue with some progression.

Steve

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