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#7267 In reply to: One in a Million? T9-T10 Symptomatic Disc Herniation |
This is a very good reply. The general guidelines are very appropriate. Try to avoid surgery unless there is a clear compression of the spinal cord with myelopathy (very rare).
The Santa Barbara chiropractor is spot on with “posterior chain muscle” strengthening. The thoracic spine has a built in forward curve (the kyphosis) which loads the discs. Herniations in the thoracic spine will actually increase this curve which obviously increases the load on the discs. Increased disc load increases the pain.
The antagonists to this kyphosis or forward curve are the posterior thoracic muscles (the extensor muscles or posterior chain muscles). Strengthening of these muscles will reduce the load on the disc. Extensor training is as simple as using a rowing machine and extension “sit-ups” while lying on an exercise ball.
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.#7262Topic: Help MRI Thoracic and Lumbar spine in forum GENERAL |I have been having issues for quite some time now I finally got a MRI of my thoracic and Lumbar spine. I don’t know if I can be helped or not, I am having a hard time understanding the report:
It reads:
Thoracic spine: small focal disc protrusion in the right paracentral location at T3-4 This impresses upon the ventral lateral thecal sac and may contact the spinal cord. No significant spinal stenosis. There is a more broad based disc protrusion in the left paracentral location at T6-7 Again this impresses upon the ventral thecal sac and possibly flattens the spinal cord. An additional small focal disc protrusion in the right paracentral location is noted at T7-8 again this impress the ventral lateral thecal sac and may contact the spinal cord. There are no aditoinal focal protrusions, extrusion or free disc fragments. There is a mild degenerative disc disease at T7-8 and T9-10 tehre is mild posterior facet arthrosis throughout. No spinal stenosis mas,contusion syrinx or mylemalcia.Lumbar:mild degenerative disease at L2-3 with disc space narrowing and decreases signal consistent with desiccation. There is a minimal disc bulging at L3-4 accentuated off to the left. At L4-5 there is mild diffuse disc bulging. There is also a small central disc protrusion at L5-S1 There is minimal superior extrusion of the disc material. This impress upon the ventral thecal sac although no obvious nerve root compression is noted. The intervertebral foramina do not appear significantly narrowed. The spinal canal is capaclous with no spinal stenosis. There is incidental note of bilateral small Tarlov cysts in the upper sacrum.
I have tingling all over, buring down both of the back of my arms to my elbow.Index finger and thumb twitching often arms fall asleep at night as well as right leg As well as numbness mid back and shooting nerve pains from the spinal area. Major muscle twitching with cramping in both legs and arms.
My right hip hurts shooting nerve pains in lumbar area/hip area and buttocks are numb,groin pain both sides with some numbness and numbness down the back and side of my right leg as well as my calf and top of my foot. most numbness lower right side of my leg near my foot Weakness also and tingling and shooting nerve pains in both legs. Also some numbness in my knee on the right side and behind the knee. Both legs are weak but my right is the weakest…. My neuro I saw didn’t really say much gave me my report and sent me on my way…. Question is do my symptoms match my mri? I have had so many negative tests, brain mri as well. Is surgery a option for me?
#7256 In reply to: I've done L5 S1 Microdescectomy.. need help. |Dear Dr. Corenman,
Thank you for your explanation.
I have done New MRI last week. kindly have me your thoughts about it.
CLINICAL INDICATION:
Post-lumbar decompression 5 months back, now complains of weakness in right lower limb.multiplanar multiecho imaging of lumbosacral spine is carried out with and without contrast according to departmental protocol.
No previous imaging is available comparison.FINDINGS:
There is evidence of right laminectomy at L4 and L5 levels consistent with previous history of decopressive surgery.
There is normal alignment and durvature of lumbosacal spine.
Vertebral body heights and signals are well preserved.
Disk dehydration is identified at L4-L5 and L5-S1 levels.
Diffuse posterior disk bulge is noted at L5-S1 level compressing the thecal sac and resulting in mild right lateral recess narrowing.
Mild posterior disk bulge is noted at L4-L5 level causing indentation on thecal sac, however, no neural foraminal compromise or radicular compression seen at this level.
Mild abnormal signals are identified in L4—L5 and L5-S1 disks posteriorly with enhancement on post-contrast imaging raising the possibility of focal discities.
Enhancing granulation tissue is identified at laminectomy site extending into posterior spinal soft tissues.
There is minimal intraspinal extension of this granulation tissue at lower L5 level without any significant thecal sac compression. No intraspinal fluid collection or abscess formation is seen.
The rest of the disks show no significant protrusion or herniation.
Conus medullaris terminates at its normal position.IMPRESSION:
Status post partial laminectomy at L4 and L5 levels with postsurgical changes. Mild diffuse posterior disk bulges are noted at L4-L5 and L5-S1 levels with mild right lateral recess narrowing at L5-S1 level. No radicular compression seen on either side at these two levels.
Focal abnormal signal with post-contrast enhancements identified involving L4-L5 and L5-S1 disks posteriorly rasing the possibility of focal discitis.
Clinical correlation and follow-up are recommended.#7253 In reply to: One in a Million? T9-T10 Symptomatic Disc Herniation |There are surgical options for thoracic disc hernations but the surgery is long, extensive and sometimes the surgery can cause new pain by itself. This is why most surgeons do not recommend thoracic surgery for disc herniations.
Now if the cord is compressed and causing myelopathy (chronic cord injury), surgery is generally recommended as the bad effects from cord injury are greater than the problems generated from the surgery to remove the disc herniation.
Your history for treatment is spot on. Epidural injections by a skilled injectionist, therapy and medications are important treatment guidelines.
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.#7252 In reply to: neck and shoulder pain |Degenerative changes in the neck can lead to four different problems at the same level; radiculopathy, cord compression, neck pain and instability. Radiculopathy occurs when the nerve exit holes (foramen) narrow and compress the exiting nerves. Symptoms increase with neck extension (bending backwards) and leaning to the side of the narrowing. Symptoms vary depending upon the nerve involved. In your case, the right C5 nerve is affected. This can cause pain and numbness radiating into the shoulder.
Cord compression causes myelopathy or dysfunction of the cord. Symptoms are not of pain but of patchy numbness, incoordination of hand or leg movement, occasional “electrical strikes” with neck position and possibly bowel and bladder involvement. There is a risk of central cord syndrome (see website) with a fall.
Degenerative disc changes in the neck can cause neck pain just like arthritis of the knee can cause knee pain. The pain is normally worse with activity or a prolonged stationary positioning (sitting at a computer). Some patients develop increased pain when exposed to vibration forces (driving, running, airplane travel).
Instability develops when the two vertebra have lost the restraining couplers that normally stabilize the vertebra (discs, ligaments, facets). Sharp pain develops with quick motions and the neurological structures are possibly at risk for injury with falls and impacts.
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.#7246 In reply to: SI Joint: Update and Question |Joints are typically filled with synovial fluid and are distensible. This means that no matter what the position of the joint, there is always synovial fluid that fills the entire joint. When the joint (or disc space for that matter) wears out, there will be certain positions that increase the joint space that the synovial fluid cannot fill. This will create a vacuum and something has to fill that vacuum.
What fills the vacuum is nitrogen gas. This gas is pulled out of solution similarly to opening up a can of soda and watching the gas bubbles form out of the liquid.
Good luck with the surgery. Please report your progress to allow forum members to see your progress.
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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