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  • hart
    Member
    Post count: 34

    Dr. Corenman:

    Sorry! My last post was very confusing!! I had misread something that you had made quite clear earlier. I realize that the jelly is not going back in the donut :)

    A question that has been bothering me. I assume any scar tissue is not as strong as the original annulus. However, is there not less pressure exerted by the nucleus pulposis once it has lost volume?

    More: In the medium term, can a detached fragment of the nucleus pulposis move about and cause trouble? Are these lesions considered more or less “stable” after some period of time? If so, how long generally speaking? Is the decrease in space between the ninth and tenth vertebrae likely to be a problem going forward? I realize there are no hard fast answers!

    Another concern. This is my first disc herniation. Should I be especially concerned about getting disc herniations in the anatomically more vulnerable segments of the spine? Can one just write something like this off as a “fluke”?

    Do you think there is enough force here to herniate a thoracic disc http://www.sinheeflowyoga.com/photo%20gallery/images/SIDE%20CROW.jpg ? I have a sneaking suspicion that this is how I did it. I felt something sort of “funny” but not pain. After some days or weeks, the pain became intolerable. All a bit insidious.

    Thank you so much for addressing my questions. While it confirms much of what I have found in my research, it is very helpful to hear it here!

    This is a great site! I love the motto! I had figured the best way to avoid spine surgery was to avoid spine surgeons. I am reconsidering :) I am going to order the book.

    Cheers

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    You are very intuitive. You make a great point that the scar that covers the annular tear is not as strong as the original collagen tissue that had torn. You are also correct that the pressure drop in the nucleus reduces the stress on the torn annulus.

    Interesting that there are no case reports of recurrent thoracic disc herniations that I know of in the literature. There would be no recurrent hernations after surgery as surgery is designed to remove the herniation and fuse the level. The recurrence rate for lumbar disc hernations in an active population is about 10%.

    A sequestered fragment (one not attached to the tear of the disc) can migrate but normally will migrate out of the canal and usually not cause further problems.

    The chance of another disc herniation is limited. If you have Scheuermann’s disease (see website), you do have a higher chance of a herniation at another site, but still that chance is small. The positions of yoga you have sent by itself should not cause a herniation. However, if you already had a complete tear and load the disc in that manner, the herniation could occur.

    There are some spine surgeons that think “If I have a hammer, the world looks like a nail” and everything is a surgical answer. I would like to think these individuals are rare. The surgeon should be the best person to determine if surgery is right for you. Many spine surgeons are also great diagnosticians and will discuss with you your options and should not push surgery unless it really is indicated or you are well informed of your options.

    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.
    hart
    Member
    Post count: 34

    G’day Dr. Corenman:

    Ha ha. I suppose the hammer and nail analogy applies to all fields of surgery. Spine surgeons seem to be enjoying the limelight lately. Don’t worry, WSJ will tire and move on.

    No Scheuermann disease. I am told I lack even normal kyphotic curvature. Is there an eponym for this? I do have bothersome SI joints. Back in Australia, I asked my GP for a plain film of the pelvis and there was no sign of Ankylosing Spondylitis. Family history of AS and psoriatic arthritis. You can chase rheumatology forever but what good does it do. Like a dog chasing its tail. (If you can’t qualify a patient to a clinical trial of toxic agents, should you be giving the drugs?)

    It is unsettling to have an injury that is not that easy to do and have no clue how you did it.

    This may be a re-herniation for all I know. There is another finding. Perhaps some suggestion of an older lesion? I don’t have the report in digitized form so I will type it in…

    “Findings: There is probably focal fat versus hemangioma of the T9 vertebral body. A focal T10 inferior endplate defect is compatible with a Schmorl’s node as at T12 superior endplate….”

    Do you make anything of that? I looked up Schmorl’s node and I have concluded that they don’t form over two weeks (the period between my acute presentation and the MRI).

    Epidurals: I am 9 months post acute presentation. Radicular pain resolved after a about 3 months. I had no back pain at the time of presentation, only maddening radicular pain at the costal margin. Now I have a sore thoracic spine. I do not like to do twisting exercises — PNF with cables. Even at minimal resistance. I can bear the pain of the exercises — it is just uncomfortable. After I get home, I start to hurt and can’t sleep well. Is an epidural warranted to help me comply with my exercises?

    Cheers

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    Your Schmorl’s nodes go along with soft endplates when you were young. This can be a form of Scheuermann’s disorder associated with degenerative disc disease in the thoracic spine which has a higher chance of herniation. Classic Scheuermann’s has wedging of vertebra and deformity but there is a variant that only has endplate changes without deformity. It is what it is- so don’t think too long and hard about it.

    I still think at your point that epidurals can be effective. The success rate is not 100% but I believe relief can be gained in about 60-70% of patients. The question is how long the relief may last. It may be 3 weeks or 9 months. The pain level may drop by some percentage also permanently.

    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.
    hart
    Member
    Post count: 34

    Thanks Dr. Corenman!

    I had not considered Scheuermann’s disease! I was familiar with the kyphotic presentation. Very interesting. I am reading up on it. Characteristic deformity aside, all pretty wishy washy. Rheumatology?

    I checked out some of the other threads here. You are very good at piecing information together!

    Cheers

    hart
    Member
    Post count: 34

    Dear Dr. Corenman:

    OK, this question was coming!

    Again: “T9-T10 RIGHT SUBARTICULAR ZONE LARGE DISC EXTRUSION EXTENDING 4.7 MM POSTERIORLY AND 10 MM SUPERIORLY WITH RIGHT LATERAL RECESS STENOSIS AND MASS EFFECT ON THE EXITING RIGHT T9 NERVE”

    “Findings: There is probably focal fat versus hemangioma of the T9 vertebral body. A focal T10 inferior endplate defect is compatible with a Schmorl’s node as at T12 superior endplate….”

    Do you think the radiologist is saying that there are Schmorl’s nodes at both T10 and T12? (The rest of the finding were just statements of the normal.) If so: I have a herniation of the T9-T10 disc (?terminology) and a Schmorl’s node at T10. Does the presence of a Schmorl’s node at T12 suggest a susceptible disc at T11-T12? [Imaging (or just select images) is available if there is a mechanism to present it.]

    Do you know what “focal fat versus hemangioma” means in the above findings? I interpret it (with VERY minimal experience) to mean “old” or possibly “normal”. (BTW: I effectively ordered this test in pain and amidst the xmas holidays and chose to forgo gadolinium, thinking “what’s next?”)

    While probably not strictly indicated, I’m keen to get a followup scan. Will gadolinium add anything in this context? I realize reactions are rare but so are T-spine herniations.

    Cheers

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