Forum Replies Created
-
AuthorPosts
-
in reply to: Back pain caused by isthmic spondylolysthesis at L5 #4501
You have been given a diagnosis of isthmic spondylolysthesis at L5 which is very common. This disorder is estimated to occur in one of every twenty individuals- especially ones involved in sports at a young age. Your report states that one side was “fully fractured” and one side “partially” fractured. I would have the radiologist and spine surgeon go back to that scan as most likely, both sides were fully fractured. Bone is generally brittle and partial fractures are very rare.
The chance of healing of those fractures depends upon the type of fractures and the reactivity of the bone fracture ends. Sometimes, the MRI can indicate how reactive the fracture ends are by using a skilled eye and the inversion recovery images (STIR images). This judgment would be beyond your ability to look at the scans yourself. The CT scan can indicate if the ends are atrophic (no reactive bone changes) which makes the healing of the fracture less likely. Trophic changes indicate a better chance of healing.
In general, when the patient is placed in a well made brace and with serious reduction of activity, about 50% of these fractures will heal. If the fracture doesn’t heal, then a decision needs to be made. I do believe that another limited CT study of your back would be helpful to your surgeon to determine if the fractures are healed (doubtful).
The fracture places more stress on the disc and the disc is not well equipped to handle this stress. If the disc develops a tear and then develops degenerative changes, then repair of the fractures will most likely not help to relieve back pain and a general physical therapy rehab program is appropriate. If the pain continues and interferes with daily life- a fusion of that level needs to be considered.
If however, the disc is still intact without tears, a surgical repair of the two pars fractures can eliminate instability and protect the disc.
Hope this helps.
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: A Month of Back and Leg Pain! #4500The MRI to my understanding revealed a large herniated disc at L5-S1. I assume that the physician ordered an epidural injection and between that and some rest, your pain disappeared. That is very good. Make sure you have no motor weakness as can happen with a large herniated disc compressing the S1 root. Can you stand on one leg (the leg that is affected) and lift up your heel 10 times without significant fatigue? This tests the gastroc-soleus muscle (calf muscle). If you are not sure about weakness, perform the same maneuver on the “good leg” to compare.
If you notice weakness, bring this to your surgeon’s attention. It is my opinion that if there is weakness present, the nerve will need to be decompressed surgically. If there is no weakness- so much the better. Only 30% of herniated discs need to be surgically removed. Expect about 4-6 months for full recovery.
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: c5-6 disc herniation #4491The thoracic pain could be from degenerative disc disease. Type 2 changes refer to the bone changes noted on MRI that occur after significant disc disease and vertebral endplate damage. Since the injury occurred while serving our country, you might be able to get a VA doc to help you. Different VAs have vastly different skilled spine physicians so you will have to do your research to find the best one.
Chiropractic manipulation can be quite helpful for your mid-thoracic pain. Get a consultation to see if the Chiropractor agrees if you can be helped.
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: Central Protruded disc at c5-c6 #4490I am not sure by your statement that you are HIV positive or HLA- B27 positive. Both have ramifications of the diagnosis. Ankylosing Spondylitis can affect the neck but normally later in the disease process. There are some X-ray changes that can lead to the diagnosis- especially of the sacroiliac joints and the lumbar spine.
You note bone spurs at C6-7 and a herniated disc at C5-6. Either or both can cause neck pain that radiates down to the shoulders. The MRI will signify the disorders (either spur or herniation) but by itself may not reveal what is causing your pain. You need a respected surgeon to look at your MRI and go over your complaints.
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: Central Protruded disc at c5-c6 #4486Pain in the neck that radiates to the shoulders equally may not be from nerve compression but from disc or facet disease. You mention a perineural cyst at C7-T1 and one at T10. The T10 cyst is most likely not causing your symptoms and the cyst at C7-T1 is most likely unilateral (one-sided) and again- most likely not causing your neck and shoulder pain.
First- what do your discs look like on a normal X-ray and on flexion-extension X-rays? If there is substantial narrowing and bone reactivity (increased spurs and bone deposition), this could be the source of pain. If there is a slip of the upper vertebra on the lower one (degenerative spondylolysthesis), this could also be causing your pain. Finally, nerve compression can also cause this type of pain but more rarely.
You need to get a new set of eyes from an expert in this field.
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.You are now going to enter the world of “image dyslexia” and confusion by reading MRIs. Persevere as these images open up a great new world. There are two standard views that need to be projected at the same time to read an MRI, the axial view and the sagittal view. When you initially view the MRI, bring up the T2 images as these are the easiest to understand. Most programs have “scout lines” which will allow you to know where you are on the images. It will show by a “cut line” where you are on the corresponding image. You have to surf the program embedded in the image system (eFilm, Stryker or Dicom) and with trial and error, you will find the right application.
Almost all of us in the profession would assume that when looking at an axial image, you would be looking at the cut section from the top down, but no- radiologists do this in a dyslexic fashion! When you have an axial image- you are looking at the bottom up view. It takes some time to get use to, but once you do, even though it will infuriate you, it does make understanding the images easier to comprehend.
The T2 images are the easiest to gain the most information as water and fat are both white. The T1 images make fat white but water dark, good for looking at the nerve root in the foramen and for malignant processes in the bone. The STIR images (inversion recovery) are very useful for bone inflammation as the fat in the bone is suppressed (dark) but water (inflammation) in the bone is bright. Sagittal images are normally filmed left to right but that is not always the case- so be wary and use your cut lines.
Really- just spend lots of time looking at any MRI teaching films to understand the subtlety of the brights and darks and what they mean. Also, know your anatomy hands down so you will know what structures reside in the area you are viewing.
Good Luck!
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. -
AuthorPosts
