[Donald Corenman, MD, DC]

#4946

I do think the radiologist is describing Schmorl’s nodes at T10 and T12. Do not be concerned about future herniations. Just find your limitations regarding the current herniation and do your best.

Hemangiomas are usually normal areas of the bone that have an excess of blood vessels. These normally mean nothing. They can be confused with fat excess in the bone which also normally means nothing.

As long as you are improving, you need no further MRIs.

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]

#4953

Trying message in 2 parts. Encountering spam control :(

Dear Dr. Corenman:

I ventured into the office of a local spine surgeon today. It wasn’t all that bad, I guess.

I was motivated to see a physician at this time as in addition to persistent soreness of my thoracic spine (note: this was not part of the initial disc herniation presentation which was simply radicular pain at the costal margin), I am having a great deal of pain and soreness in the neck — pain with lateral flexion and rotation and bad (and different) headache. Forward flexion and extension with head supported is only minimally sore. Yes, it definitely could be just “stress”. Basically, I figured I had enough spine stuff going on to finally consult a spine surgeon. I reasoned then I will know where to go if in the event of future spinal woes.

The staff obtained a C-spine plain film on scene prior to my visit with the surgeon. BTW, this film showed degeneration at C5-C6 (wouldn’t think this with jive with my current neck pain and headache) according to the surgeon; and evidence of a 20+ year old C7 fracture that I was well aware of. I have requested a copy of the study and report. I do not have them yet.

[hart]

#4954

(OK, here goes another try at part 2. What is so spam-y about this?)

The surgeon thought my disc had herniated approximatley 5 years ago when I complained about the annoying sensation in the T9 distribution and that it had re herniated this past December with the acute radicular pain. And that it would re-herniate again! Couldn’t a little bulge (annulus intact) have caused the dysethesia 5 years ago? Based on information from this excellent forum and my own research, I am skeptical. Increased risk over a perfectly good disc, yes.

Is there a way to suspect, based on MRI, if a disc has re herniated? Scarring, calcification, shriveled up disc jelly in addition to fresh disc jelly, water content? The surgeon did not have the CD until he was in the room with me. He only viewed the little thumbnail images on a smallish screen mounted on the wall in the examining room.

In regard to your earlier comment about the possibility (in general, I think) of an annulus tearing at time zero and then the disc herniating at a later date — would this have to happen over a fairly short period of time? If an annulus tore and the toxic jelly managed to stay inside the annulus for months, wouldn’t the annulus just “heal” around the jelly, thereby containing it? I might be missing something!

PS. I got my book today. Amazon is almost sold out.

[Donald Corenman, MD, DC]

#4960

you have not mentioned your neck pain in this discussion. Let’s leave that for another thread.

The surgeon might be correct regarding a recurrence of the herniation with new onset pain five years after the first onset. You are correct that an annular tear with leakage of nuclear contents can cause nerve irritation. An intact annulus would not allow chemical irritation of the nerve.

To determine a recurrent herniation without a previous MRI is generally speculation except in certain specific circumstances. Remember that the disc has no blood circulation so healing does not occur.

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]

#4961

Dear Dr. Corenman:

“To determine a recurrent herniation without a previous MRI is generally speculation except in certain specific circumstances.” You mean like autopsy or some other way :) In the US, can patients get consultations with radiologists? At my assigned hospital in Sydney and on rotation in Dunedin, I could just poke my head into radiology with questions about anything — patients, personal. In fact, radiologists liked the fact that students and trainees might actually be interested in what they are doing. They’d even bring out some of there prized films just for fun — I wonder if all radiologists have a collection of films revealing miscellaneous objects that just happened to end up in the rectum. Enough silliness!

OK, no healing. Does the annulus tend to scar such as to complete the annular ring and thereby contain what is left of the nasty “jelly”?

I had no “event” to cause this. I didn’t pick something up and have my “back go out”. Presumably there is a mechanism of action for this injury. Broadly, I read simultaneous forward flexion and torsion.

I am about 5’5″ and 50 kg and pretty sturdy for someone with these dimensions. Ever since I was a young child my torso has been riddled with muscle. I was like this ripped baby! (This injury has taken care of that. For 2 months, I imagined myself in a brace from shoulders to hips — it was the only way I could carry on ADLs.) Of course this apparent muscle-iness is likely genetic and doesn’t necessarily mean that I am strong! I like all sort of sport and outdoor activity. I am not a couch potato. In respect to the general population, I don’t think I would have been considered weak last December when this presented.

I am hitting physio HARD. I hate the gym. But I am doing it ’cause I need those smooth rotational movements to ski, etc!

This surgeon didn’t seem familiar with a non-kyphotic variant of Scheuermann’s disease. He said everyone has Schmorl’s nodes. I do read they are relatively common in back pain sufferers and can be present in those with no complaints. I suppose it’s an academic matter without much bearing on mgt. However, I’m curious. Looking for reasons this happened and hoping to avoid it in the future. If re-herniation is likely to be a recurrent problem, it changes my view of surgery. From what I have read, I would probably opt for the definitive approach — which I assume is thoracotomy with fusion or some variation thereof — should surgery become indicated. I do consider this a BIG operation and want to avoid at all costs! Less invasive procedures are not always less destructive. Of course it would depend on the surgeon and his expertise in one approach over another. This may be a case where you pick a surgeon based on his approach to the problem, IMO.

This is a great forum. I have told lots of people with back trouble to come here.

Thank you

[hart]

#4995

Dear Dr. Corenman:

This MRI got passed around a bit. I remember hearing that one neuroradiologist indicated that there was some calcification consistent with an older lesion. This MRI took place about 3 weeks after initial acute onset of symptoms. 5 years previously, I had an annoying sensation in what I recall as the same distribution as the new acute pain. I would be interested if there is MRI evidence suggestive of reherniation.

I have viewed some of your videos on youtube (which are excellent!) and I think you are posting much higher quality images. If my videos aren’t good enough, I can try to improve them!

Cheers

[Author]

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