gonehikingMemberFebruary 15, 2012 at 8:30 pmPost count: 2
Can you explain my MRI and is there a surgical option. I’ve done injections.. different types of PT..chiropratic..pain management..etc I have ongoing daily middle spine & left chest wall pain.. breathing pain, coughing, twisting, laying flat..can’t left, walking is limited to 15 minutes. Sitting. standing..etc I deal with different types of pain thoracic area. Swelling over my spine, and under my left front rib cage under breast. Told I may also have slipped rib from surgery and SI causing lower back & leg pain.. I’m a hiker that need to get back hiking, working and enjoying life. I keep hitting brick walls in treatment.. any Advise would be very helpful.. I’m not very good a figuring out this medical stuff, which makes it very frusrating when your trying to get better & back into life.
MRI THORACIC SPINE WITHOUT AND WITH GADOLINIUM
INDICATION: Back pain in the thoracic region. History of prior
thoracic spine surgery at T9-T10.
COMPARISON: Thoracic spine MRI 1/12 and 12/5/2006.
Pre- and postgadolinium enhanced imaging is obtained following a
left-sided laminectomy at the T8-T9 level identified on the
12/5/2006 study. Similar postoperative findings are again
identified today. There is some persistent artifact at the level
of surgery. I cannot identify that there is any ventral
abnormality at this level. On the post gadolinium axial image at
table position -99.19 there is a focal region within the neural
foramen that does not enhance, but I cannot identify any definite
abnormality on the pre-gadolinium imaging other than artifact
that might create this appearance. The preoperative MRI did
reveal a left paracentral disc herniation and it is possible
there is a small amount of architectural distortion or a small
amount of residual disc material in this location, for example on
the pre-gadolinium axial T1 image at table location -103.2. There
is some persistent disc narrowing at this level, although the
overall morphology of the endplates has not changed.
There is some new endplate edema, however, at the superior T6, T7
and T7 endplates also identified at the T9-T10 disc level. At T9-
T10 there may be a tiny central disc herniation or spur that
results in only minimal deformity of the ventral sac without any
obvious cord deformity. This is easiest to identify on the T1
axial pre-gadolinium imaging at table position -131.1. This
region undergoes some enhancement with gadolinium. I cannot
identify any significant myelopathic signal abnormality. This
does not lateralize and there is normal preservation of foraminal
fat at every thoracic level. The lateral alignment and native
canal dimensions remain normal.
IMPRESSION: There has been a prior laminectomy in the left side
at what I believe now is the T8-T9 level when counting from
above. In any event it is not obvious that there is any recurrent
abnormality at this level. There is a small central disc
herniation suspected at T9-T10 that may come in contact with the
ventral cord, but does not result in significant deformity or
myelopathy. If there are symptoms referable to this level CT
myelography may prove beneficial in further evaluation if the
symptoms are severe enough to warrant surgery There are some new
.findings of marrow edema described at the disc levels above and
below the levels of surgery.Donald Corenman, MD, DCModeratorFebruary 16, 2012 at 4:09 amPost count: 8459
It is my understanding that you have local pain in the mid thoracic spine that radiates into the left chest wall. I assume the pain is worse with walking and lifting and better with lying down. Does vibration (sitting in a car/ on a plane) cause increased pain?
You have had previous surgery on the T8-9 vertebra (laminectomy). What was that surgery performed for? What were the results of surgery?
When did the mid thoracic pain occur? Was it present prior to your surgery and became worse or is this new pain that occurred immediately after the surgery. Did the pain develop much later?
Dr. CorenmangonehikingMemberFebruary 16, 2012 at 10:24 pmPost count: 2
Yes..local pain in the mid thoracic spine that radiates into the left chest wall.
Yes…the pain is worse with walking and lifting and lying down flat on back.
Yes..sitting in a car cause increased pain.
What was that surgery performed for herniated disc ..causing pain & weakness … (fell off a catwalk..broke rib..and herniated disc)
What were the results of surgery. “good surgery.. bad outcome” Adding new and increasing pain issues in the spine thoracic area & left side chest wall/ribcage area.
Woke up from surgery with this pain 2006. New and increasing pain issues that wasn’t present prior to surgery.. worse than before surgery.. Tried to get through to surgeon something wasn’t right..but no luck. So I figure I was being a spas and drove myself even harder in PT and returned to my sawmill hard labor job 7 weeks after surgery in sever pain.. PCP disabled me from the saw mill in 2007..
Its been a struggle trying to get medical help to remain active & functioning, so I can achieve my goals to work again, finishes college and thru-hike the AT. Right now, the last 6 months has become just my chair and heating pad..It doesn’t take much to spike my back pain. Just normal daily activities increase pain. Somedays are better than others depending on my activity level. Sleep is an onging issue because wake up in pain every few hours.
Injection & trigger points last a day or so.. I’ve kept myself on the
least amount of meds possible.. The thoracic issues are also effecting my breathing also.. I’m under the care of a pain management PA-c that is willing to talk with surgeons about my case. He’s doing all he can to help me. I’m trying to get back into PT again.. I’ve done it all for treatments except the RFL..because of insurance issues. I need to hike like I need to breath..somehow there has to be away to get me back doing well & active again.I know I can get better & achieve my goals.. just need a treatment plan & providers that match my drive to overcome this pain..
Lower back pain I’m told is from the sacroiliac joint because of how I stand & sit..to relieve pain. I have both Thoracic & lumbar MRIs on CD’s.
Thank you,Donald Corenman, MD, DCModeratorFebruary 17, 2012 at 2:44 amPost count: 8459
Increased pain after thoracic pain surgery is worrisome to me if it was done for a “herniated disc”. Was there significant cord compression that called for surgery? What were your symptoms prior to the surgery?
The surgery you mention can occasionally destabilize the thoracic spine. This can cause local pain. The radiation of pain around your chest most likely is from nerve root irritation. In addition, some of the changes in your spine could be consistent with Scheuermann’s disease (see website) or significant degenerative disc disease with IDR (isolated disc resorption- see website under lumbar spine to describe this disorder).
You have had MRIs but have you had standing X-rays of the thoracic spine?
Have you undergone facet blocks and if so, what were the short term results (the first three hours)?
Dr. CorenmanlyndyMemberJanuary 13, 2014 at 2:05 pmPost count: 6
I have just joined this site and came across this thread. I asked why my thoracic vertebrae that was crushed to the right wasn’t picked up, every specialist thought it was crushed to the front, or that my T4 was slipping out of place. Dr Corenman I noticed you asked about standing Xrays. I honestly believe my damage was not picked up because every test was undertaken in the prone position. I have researched the difference by the company that makes both and by their own statistics there seems to be around 20% miss rate for spine damage on prone MRI’s. Do you believe this as well? It seems like common sense to me.Donald Corenman, MD, DCModeratorJanuary 13, 2014 at 9:24 pmPost count: 8459
You are probably talking about the “Stand-up MRI” company and their claim that 20% of disorders are missed due to the prone position of most MRIs. This is not really true. It is true that MRis are generally performed in the supine (face-up) position. This is because the image capture time is slow and motion artifact can cause ghost images.
This is like an old time cowboy picture where the individuals who could not stay still for the picture were blurred or “ghosted”.
The stand-up MRI does allow for the effects of gravity but the image quality is not very good and the images I have seen are generally not up to my standards.
If the surgeon does not perform standing X-rays along with a good quality MRI, I would agree that valuable information is lost. The stand-up MRI however is not the answer as any good spine surgeon should be able to recognize the diagnosis based upon a supine MRI and standing X-rays.
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