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#6743 In reply to: Failed L5-S1 Fusion |
If you have a failure of fusion (pseudoarthrosis), especially if the original surgeon only place one sided pedicle screws, there could be instability. Even if the MRI does not reveal severe compression, compression can be underestimated on the MRI. Remember that the MRI is performed with you lying down and not under the influence of gravity.
Flexion/extension X-rays and AP standing and supine X-rays can reveal instability that the MRI will not. If your pain is increased with standing or walking, this would help to confirm this instability. Symptoms that do not follow this pattern do not mean instability is not present.
Nerve pain can be eliminated or reduced if the compression is removed but there is a 10% chance of chronic nerve injury with chronic compression.
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.#6741Topic: understanding my MRI report. in forum GENERAL |Dear Dr, I am 42 years old .since the past 3 years i have been having low back ache which has been intermittent.Since the last two weeks the pain is acute in the lower back ,more towards the left side .i have been unable to move much these last two weeks.i am on painkillers . Could you please offer your opinion on the MRI report .Thanks
MRI REPORT OF LUMBO – SACRAL SPINE
(Procedure : Sagital – T1 , T2, STAR; Axial – T1, T2; Coronal – STAR)
1. Partial loss of signal intensity of disc at L4 – L5 & L3 – L4 level……… Suggestive of degenerative change.
2. Early anterior end plate osteophytes at L3 to L5 vertebral bodies.
3. Mild diffuse disc bulge at L3 – L4 with mild compression upon thecal sac, no significant narrowing of neural foramina at this level.
4. Central and right paracentral disc bulge with left paracentral disc protrusion at L4 – L5 level seen with compression upon thecal sac and bilateral narrowing of neural foramina (left > right).
5. Conus medullaris ends at L1 level with normal cauda equina & medullaris.
6. Lower dorsal cord is normal in size and signal intensity.
6. Paraspinal muscles are normal in size and shape with normal signal intensity.
7. Focal end plate sclerotic change at upper end plate of L3 and early schromol’s node at upper end plate of L2.
8. Spinal canal dimension :
D12 – L1 – Level – Canal – APD 19.8 mm.
L1 – L2 – Level – Canal – APD 16.4 mm.
L2 – L3 – Level – Canal – APD 16.4 mm.
L3 – L4 – Level – Canal – APD 14.4 mm.
L4 – L5 – Level – Canal – APD 11.6 mm.
L5 – S1 – Level – Canal – APD 14.5 mm.#6740Topic: Help in understanding MRI report. in forum GENERAL |Dear Dr, Could you please give your opinion on my MRI report. Thanks .
MRI REPORT OF LUMBO – SACRAL SPINE
(Procedure : Sagital – T1 , T2, STAR; Axial – T1, T2; Coronal – STAR)
1. Partial loss of signal intensity of disc at L4 – L5 & L3 – L4 level……… Suggestive of degenerative change.
2. Early anterior end plate osteophytes at L3 to L5 vertebral bodies.
3. Mild diffuse disc bulge at L3 – L4 with mild compression upon thecal sac, no significant narrowing of neural foramina at this level.
4. Central and right paracentral disc bulge with left paracentral disc protrusion at L4 – L5 level seen with compression upon thecal sac and bilateral narrowing of neural foramina (left > right).
5. Conus medullaris ends at L1 level with normal cauda equina & medullaris.
6. Lower dorsal cord is normal in size and signal intensity.
6. Paraspinal muscles are normal in size and shape with normal signal intensity.
7. Focal end plate sclerotic change at upper end plate of L3 and early schromol’s node at upper end plate of L2.
8. Spinal canal dimension :
D12 – L1 – Level – Canal – APD 19.8 mm.
L1 – L2 – Level – Canal – APD 16.4 mm.
L2 – L3 – Level – Canal – APD 16.4 mm.
L3 – L4 – Level – Canal – APD 14.4 mm.
L4 – L5 – Level – Canal – APD 11.6 mm.
L5 – S1 – Level – Canal – APD 14.5 mm.#6734 In reply to: thoracic herniation |A thoracic disc herniation associated with degenerative changes at multiple levels in the thoracic spine makes me think of Scheuermann’s disorder (see website). Lifting loads cannot be limited to any specific weight. The lifting technique is also important to reduce the strain on the thoracic spine. Strengthening of the extensor muscles will help to reduce the load on the discs. Unfortunately, there is no single restriction that will prevent further herniation.
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.If you need a lumbar fusion (the rods and screws) this would be for three potential problems; back pain as the major pain complaint, a third disc herniation at the same level or instability. By your description, you pain appears to be more buttock and leg located than back pain. If this is true, we can rule the first reason for fusion out.
You report this is your second disc herniation at this level (at least second surgery), so we can rule the third disc herniation reason for fusion out.
The last reason for fusion is instability. Instability can cause disc herniations to occur. The flexion/extension views are valuable to determine this problem. If the vertebra move 3mm or more on flexion vs. extension, instability is present and a fusion may be warranted. The exception is for a preexisting isthmic spondylolisthesis (IS). Even without instability, a disc herniation in the presence of IS requires a fusion.
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.Sir,
continue with prevoius comments, sir i have consult orthopaedic spine
surgeon upon examination and investigation he arrived at conclusions
that there is spinal instability in lumbar region in lateral radiograph in flexion and
extension there is upward and downward movement of L5 L5 vertebrae,
now he put me on lumbar built for three months and certain lower back
exersices, moreover the surgeon says if this therapy fails then we have to
go for surgery in order to fix the spine by rods and screws. sir plz let me know
about ur valuable suggestions? thanks alot. -
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