[gm1973]

#29813

Dear Dr

I have a history of fractures from secondary osteoporosis. I am treated with zoledronic acid. I have a solid interbody fusion at L2-L3 that is also held with lateral plate and screws.

4 weeks ago, I experienced sudden pain at top of my left buttock/back of pelvis while exercising. This developed into pain when sitting and burning sensation over the top of my left hip. This has now improved. But I still have discomfort or inflammation in the area with the screws.

I had an MRI recently and was told I had an ‘endplate fracture’ at L2. There is signal change in the top half of the bone. The bottom half where the screws are placed looks normal. I am a bit freaked out by this. Is there a difference between an endplate fracture and a compression fracture? (It looks like there is a very small compression in the middle of the bone) I have a ski holiday planned for the end of January. Will that be enough time to heal?

I am also due to have new DXA scan. Would this give a false reading to my results?

Thanks for your kind help

[Donald Corenman, MD, DC]

#29820

There has been notations in the literature that repair of an osteoporotic fracture with PMMA cement (a vertebroplasty or kyphoplasty) can lead to a relative “stiffening” of that repaired segment and stress increases of the adjacent segments leading to increased chance of fracture.

Your situation here is similar with a fusion of L2-3 using a large interbody cage would do the same thing. An endplate fracture is very similar to a compression fracture, just less deformity of the vertebra. It takes about 3 months for these fractures to heal so you should be close to being healed. I would however make sure that your bone quality is acceptable as a bone density T score that is too low means you have a higher chance of fracture with a fall or abnormal load on the spine.

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.

[gm1973]

#29846

Dear Dr

Thank you for your kind reply. I have another question following up from this.
I have had some pain injections done at T12-L2. These have helped with the back pain. I still seem to be experiencing sensory disturbance in the front and inside of my thigh that stops around the knee. It isn’t painful, more of a fuzzy sensation, if that makes sense. I also get some needle like stabbing sensations in the waistline between the navel and groin, on the path of the psoas muscle.
I suppose these are due to nerve irritation L1-L2?
I am worried about the leg sensations. My diagnosis suggests foraminal narrowing. On my scan, I can see a shadow that appears to be a piece of disc or bone material that has extruded at L1-2. Is it possible that this will be resorped over time? (What is the natural history?) Or am I looking at a surgery to fix that?

thanks as always

[Donald Corenman, MD, DC]

#29847

You are correct in your assumption that these anterior thigh symptoms are from a radiculopathy (probably L1 or L2). Both disc and bone spur can shrink down over time but also may remain and be a permanent compression. Bone spurs can also grow larger. Since you have no reported weakness which would be noted climbing stairs or hiking, you are probably safe from significant nerve damage living with these symptoms (at least to this point).

Surgery would probably fix this disorder but could require a fusion of the offending level so you might want to try and live with these symptoms if you can.

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.

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