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  • Obstruct
    Participant
    Post count: 2

    Hi Dr>

    I’m 26, I had an incident where i fell 10 feet off an extension ladder about 9 months ago. I landed flat on my belly.My pain at the time was at a 10, as the months passed it became 7-8. I’ve taken pain meds and muscle relaxers for the first 3 months. This is my first time ever going to hospital about any injury or trauma. I was given 4 weeks of acupuncture and did not help. Last month the companies insurance finally allowed an MRI test to see whats going on. My pain is radiating from lumbar spine to my neck.My lower back pain worsens as i sit for longer than 15 mins. It feels better when i stand. I have spasms on the left side on my back. When i try to bend over or to sides and lay down my back hurts the most. Like i need to lubricate my spine. I sleep on flat floor because sleeping on bed does not keep my spine straight. My questions :Can you explain the report so i can understand ? Did these findings happen way before my incident(is it possible)? Has doing nothing ever since incident allow more problems to exist? Can i recover from these findings like doing everything possible as to avoid surgery? How long for recovering from these findings? What would you recommend someone who’s in my situation to do with these findings?

    EXAM: MRI LUMBAR SPINE WITHOUT CONTRAST

    TECHNIQUE: Using a 3 Tesla scanner, the following sequences were obtained: Sagittal T1, T2 FSE and
    STIR, axial T1 and T2. Slice thickness is 4 mm.

    COMPARISON: None available.

    FINDINGS:
    There is a normal curvature of the lumbar spine.

    The vertebral body heights are maintained.

    The disc spaces are desiccated at L4-5 and L5-S1. The paraspinal soft tissues are normal.

    The conus medullaris terminates at L1.

    Vertebral numbering assumes the presence of 5 lumbar-type vertebral bodies and for the purposes of this report,
    the last large intervertebral disc space will be designated as L5-S1.
    Disc spaces are described as below:

    T12-L1: There is no disc protrusion or extrusion. There is no spinal canal or neural foraminal stenosis. The
    facet joints are normal.

    L1-L2: There is no disc protrusion or extrusion. There is no spinal canal or neural foraminal stenosis. The facet
    joints are normal.

    L2-L3: There is no disc protrusion or extrusion. There is no spinal canal or neural foraminal stenosis. The facet
    joints are normal.

    L3-L4: There is no disc protrusion or extrusion. There is no spinal canal or neural foraminal stenosis. The facet
    joints are normal.

    L4-L5: There is a broad-based 3 mm disc bulge with mild to moderate bilateral facet disease resulting in mild
    bilateral neural foramen stenosis without spinal canal stenosis.

    L5-S1: There is a 2 mm grade 1 spondylolisthesis of L5 on S1 with bilateral spondylolysis. There is a broadbased
    3 mm disc bulge with mild to moderate bilateral facet disease without spinal canal stenosis. There is
    moderate bilateral neural foramen stenosis.

    There is a T2 hyperintense cystic structure posteriorly within the sacral canal at S1 measuring 4.0 cm
    craniocaudad by 2.1 cm AP. This displacing the thecal sac towards the left. This is also impinging on the
    traversing right S1 nerve root within the right lateral recess region.

    IMPRESSION:
    1. Intraspinal cystic structure measuring 4 x 2.1 cm displacing the thecal sac towards the left at the level of L5-
    S1 and also compressing on the traversing right S1 nerve root within the right lateral recess region. This may
    reflect a large Tarlov cysts or perineural root sleeve cysts.
    2. Mild degenerative changes at L4-5 and L5-S1. Moderate bilateral neural foramen stenosis at L5-S1 and mild
    bilateral neural foramen stenosis at L4-5.
    3. Grade 1 spondylolisthesis of L5 on S1 measuring 2 mm with bilateral spondylolysis.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    You have an isthmic spondylolisthesis of L5-S1 (see https://neckandback.com/conditions/isthmic-spondylolisthesis-slipping-of-a-vertebra-because-of-fracture/). This could have been preexisting but asymptomatic or could have occurred with the fall. If you have had symptoms for 9 months that are impairing, you should consider getting treatment. This might include physical therapy and injections. IF conservative treatment does not give you good relief, you may need surgery on this level.

    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.
    Obstruct
    Participant
    Post count: 2

    Thanks Dr. Corenman, i was referred to Pain Management Dr. and i believe there is possibility of such injections. I was wondering can doing a Spect scan reveal how long ago spondylosys occured? If there is uplift around the injury or nil uplift, not sure if those are proper terms. Regarding the cyst i have, is that normal that i have it close to where all my pain is ? Could it be worsening , because i see the findings say “This may reflect a large Tarlov cysts or perineural root sleeve cysts.” Is there a specialist that specifically handle such cyst?Appreciate your input and time , hope your having a great day!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Spect scans are generally not needed in this age of MRI with STIR images (fat suppression scans). With a slip at the vertebral level, this scan would actually be worthless as the slip precludes a repair of the pars (which is why the Spect scan should be performed in the first place).

    Generally, Tarlov cysts or cystic root sleeve dilation are non-symptomatic and are not causing your problems.

    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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