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Sorry but I had to delete your images as this is an anonymous forum and identifying features cannot be used.
You have typical isolated disc resorption at L5-S1. This is characterized by complete loss of the entire disc, endplate overload and endplate fractures. This is a “bone on bone” disc space. You also do have mild degenerative changes of L3-4 and L4-5 but these are most likely asymptomatic or minimally symptomatic.
The “bending backwards” phenomenon could be from antalgia as I don’t identify (in this very limited series) any sagittal plane deformity (unusual postures from pelvis or upper spine deformity) but this is an incomplete series.
Antalgia is posturing to avoid pain. This disc space should be painful with standing upright and bending forward as well as lifting. Pain should be somewhat reduced with bending backwards (this position loads the facets and unloads the disc). This disorder is also known for delayed onset pain (pain onset some hours later after a loading or impact activity). Vibration typically will also cause pain (prolonged sitting in a car, airplane or even on a mountain bike).
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.in reply to: Recent Diagnosed Bilateral Pars Fracture with Pain #6962I appreciate the comments. I agree in general with the comments.
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.in reply to: Myelogram vs. MRI post-ACDF (with plate) #6961A myelogram is not the miserable test that you generally think of. I do use these tests when necessary and most patients do not have significant after-effects.
Part of the successful myelogram is the skill of the radiologist who performs the injection. If you have a skilled, meticulous radiologist with lots of experience, the injection can go very well with very little risk of dural leak. Prior lower back surgery does not preclude a myelogram as long as the L2-L3 level has had no prior surgery.
If you really are against the myelogram, you could first have an MRI of the cervical spine with an experienced radiology technician on a very good MRI machine. I typically will get an MRI as the first test when I work up a patient with prior surgery and it is unusual that these images can’t be interpreted.
If the images are good (the canal can be seen), then a plain CT scan by itself can be used to determine the status of the fusion and any bone in the canal. If the images obscure the canal, then a CT myelogram is necessary.
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.in reply to: L-4 herniation and bone fragment #6960What typically happens to athletic young individuals (males much greater incidence than females) is an avulsion of the growth plate with a disc herniation. Normally, in an adult, the fibers of the annulus fibrosis tear as the weakest portion of the disc are the annulus fibers themselves.
In kids and young adults with open growth plates (up to the ages of 17-20) the weakest point is not the annulus but the growth plate (where the annulus inserts). This bony ridge “breaks off” and the disc herniation (the nucleus that bulges out) pushes this bony fragment into the canal.
This fragment will typically reunite with the bone of the vertebral body but will not “be pulled back into place”. Most likely, there will be a residual bony spur left behind. This spur may or may not cause nerve compression or irritation. Interestingly, most kids do not develop leg pain from this type of hernation but will have lower back pain and sacroiliac or buttocks pain only.
A good physical therapy program is helpful and on occasion if the symptoms warrant it, an epidural steroid injection will also be helpful.
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.in reply to: What does this mean? #6959Your history is typical for your lower back pain. Pars fractures that cause spondylolisthesis normally occur between the ages of 8 and 15 (see website for further explanation). Pain in the lower back is not unusual for this disorder.
Your neck pain is a different story. You apparently have multilevel cervical degenerative disc disease (pretty much the same as “degenerative changes”). This can cause local neck pain and stiffness. The facets can also cause neck pain and stiffness (see anatomy of the cervical spine, degenerative disc disease and degenerative facet disease also on the website).
Hopefully, your doctor has started you on a rehab program and has suggested various medications to help. Chiropractic care could also be considered for treatment for your neck.
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.in reply to: TOTAL NECK FUSION? #6957I am somewhat confused. Did you have a surgical fusion of C3-7 or did your neck auto-fuse? I will assume that you had a surgical fusion as auto-fusion has other connotations.
With a 4 level fusion of your neck over ten years with what I will assume is that of a normal and not sedentary lifestyle as there is concern of wearing out the levels above and below. This is not just from the fusion itself, but also from preexisting genetics of degenerative disc disease.
You probably have greater and/or lesser occipital neuralgia. The C2 and C3 nerve roots exit out from behind C1-2 and C2-3. These nerves run from the back of the skull over the head to the top of the eyes and around the ears. Nerve irritation will cause exactly the symptoms you describe.
You might find a physician that can perform facet blocks or nerve blocks. Rhizotomies might be an appropriate treatment if you get diagnostic relief from the facet blocks. Rarely, surgery might be indicated.
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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