[kmg3333]

#6008

Hi Dr. Corenman,
My name is Karin Goodreau, and I am hoping you can help me.
I am new here, and I am desparate for help from someone to explain to me my daughters MRI’s. In August of 2010, my 14 year old daughter was hospitalized after loosing all feeling in her left leg, and a disk tear which ended up as a “goose egg” on her back filled with fluid. She had a set of 3 spine injections over 3 months at that time, which helped for about a year. She ended up with cushings symptoms, and so we have not had them done since.
We’ve had 2 MRIs done in 2010, and 2011. She is now going to be seen by a neurosurgeon at U of M Motts childrens hospital. She is barely moving anymore, and cannot keep up. She lives at pain level 6-8 everyday.
I am hoping you can help me understand her MRI’s before we go. I have done alot of reading, but feel like I need someone to give it to me in plain english.
Below is her most recent MRI, done 2/2011 (prior one was 8/2010)

Keep in mind as you read, this all started with no injury, at age 14. I was called home from work because she could not get off of the floor, and lost the use of her left leg, when that happened she had her first ever MRI. She has tried traction, hours in PT and lives now at pain level 6-9 everday. She cries alot, and connot do all of the ehings her peers do, and often cannot get through a school day. She is just now turning 16.
Here goes:

FINDINGS:

Anatomic alignment of the lumbar vertabrae is appreciated.
The vertabral body heights are preserved

The intervertebral disc spaces show degenerative signal, more pronounced at L3-4 and L5-S1 levels.

Broad based disc annular bulge is present at L2-3 level and midly flattens the ventral aspect of thecal sac.

At L3-4 level asymmetric to the right disc annular bulge with focal central disc protrusion is noted.
There is a mild narrowing of the central canal due to described disc bulge.

At L4-5 level broad based mild disc annular buldge, with suggestion of small central disk herniation, protrusion type.

At L5-S1 level asymetric to the left disc annular bulge with left foraminal extension is noted. There is mild interval retraction of the voluminous component of the disk bulge that was present in the left paracentral location. There is slightly less pronounced left foraminal component of the bulging disc annulus. The disc annular bulge still mildly flattens the ventral aspect of thecal sac, abuts and mildly flattens the left S1 in the superior lateral recess. The left neural foramen is mildly narrowed at the entrance. The right neural foramen is within normal range.

IMPRESSION:
1. Further interval decrease in signal intensity and height of the intervertebral disc at L5-S1 level. Progressive dehydration of the disc material at L5-S1 results in mild retraction of the left paracentral component of the disc protrusion that was present on the previous exam in August 2010. The disc annular bulge and the left paracentral broad based disc protrusion are less voluminous.

2. Asymmetric to the left broad based residual disc protrusion and mild osteophytic ridging of the endplates flattens the ventral aspect of the thecal sac and left S1 at the level of superior lateral recess. No evidence of significant central canal compromise. Mild narrowing of the left nueral foramin.

3. Mild narrowing of the central canal at L4-5 level. Mild bioforaminal narrowing, slighly grater on the left, at L-4 level.

*also noted on 8/2010 MRI was a left S-1 Tarlov cyst, not noted on this MRI*

If you can help me decipher this I would hold you in great regard forever,
Karin

[Donald Corenman, MD, DC]

#6013

Your daughter has precocious degenerative disc disease. This is a genetic problem where the collagen in the disc is somewhat brittle and tends to tear more easily.

Is her pain more lower back pain or is it more leg pain? What is the percentage of one versus the other? Is it 70% low back pain and 30% leg pain or the reverse?

At L2-3, she has a degenerative disc (degenerative disc disease- DDD)with a posterior disc bulge. Think of a car tire that is low in pressure. When the pressure drops in a tire, the side walls bulge out. This is a similar phenomenon with this disc. There is an illustration under the category of lumbar degenerative disc disease on the website that explains this finding. The disorder at this level can cause lower back pain but generally not leg pain.

L3-4, again DDD. Like L2-3, there is a posterior bulge but this one is somewhat to the right. There is an associated disc herniation which is a through and through tear in the disc wall with some of the inside jelly pushing through (disc herniation). This herniation is central in the canal which does not compress the nerve (which is to the side of the canal and not in the center).

L4-5 is very similar to L3-4 in almost all aspects.

L5-S1, again a disc bulge but this one is focuses on the left. By the report, there was a previous MRI and the comparison demonstrates a reduction of the left disc herniation from the prior study. The left neural foramen is somewhat narrowed. This could cause left leg pain either with sitting or with standing.

Generally, your daughter has multilevel DDD which can cause significant local lower back pain. She could also suffer from left leg pain from the L5-S1 left foraminal stenosis.

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.

[kmg3333]

#6015

Thank-You very much for helping me to understand better what is happening.
I wish I had an updated MRI, as the last one is over a year old now, but will wait until next week to see the neurosurgeon at Motts.

Do you think that it is possible that she may have some sort of arthritic condition relating to this?

Her pain is 70% lower back in multiple areas, and 30% intermittent right and left leg. She can no longer function as others do at her age, nor can she do all of her normal daily activities without help.

What are your thoughts as far as further progression, or expectations of?

Are there surgical options available for her at her age and level of progression, to alleviate the back pain and get her back to being able to doing normal activities?

What questions would you suggest for me to ask the neurosurgeon?

Your help is so very appreciated,
Thanks for caring
Karin

[Donald Corenman, MD, DC]

#6016

There are some children that have an “arthritic condition” like juvenile rheumatoid arthritis but this is not one of those. Her genetics are such that the disc walls tear easily and this is what causes the pain. This condition is called precocious degenerative disc disease. There is no way to induce the disc walls to heal and management is the key to treatment.

Her pain distribution is typical of this condition and raises no concerns by itself. At this point, surgery should not be considered in my opinion. A pain specialist may consider facet blocks to determine what role the facets have in the total pain picture.

Progression of this process does not necessarily mean more pain. The condition is not dangerous but is painful obviously.

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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