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Thread: Please advise

  1. #1

    Please advise

    Dear Dr. Young,

    With strong hope and optimism, I am posting on the forum

    Please advise

    The following is the MRI report. What is the problem and what are the possibilities of cure including stem cell treatment, please? Also, the MRI suggests Arachnoiditis with two question marks. If there is no pain or no burning sensation, can Arachnoiditis still exist?

    EXAMINATION PERFORMED : MRI LUMBOSACRAL SPINE (PLAIN WITH CONTRAST)

    Multiplanar MR images of the lumbo-sacral spine were obtained using T1 and T2 weighted TSE and FFE sequences. The T1 weighted images were repeated after contrast administration.

    There is straightening of the lumbar spine with loss of lumbar lordosis.

    There is mild grade-1 retrolisthesis of L3 over L4 vertebral.

    No evidence of any abnormal enhancement seen along the vertebral bodies or disks seen.

    There is seen evidence of previous surgery with laminectomy of L3, L4 and L5 vertebra. Diffuse hypointensity of T1 weighted and T2 weighted images seen in posterior paravertebral muscles on the midline, post operative in nature.

    There is degenerative posterior bulge on L3-4, L4-5 and L5-S1 disks, with indentation of the anterior thecal sac. The signal intensity of these disks is low on T2 weighted images due to disk degeneration/ dessication.

    There are seen degenerative facet joint hypertrophic changes at L3-L4, L4-L5 and L5-S1 level. There is resultant narrowing of the neural foramina and lateral recess at L3-4, L4-5 level with indentation of the existing L4 and L5 nerve roots in the lateral recess.

    There is seen clumping of nerve roots within the thecal sac with enhancement along the nerve roots through the neural foramen.

    No evidence of any abnormal enhancing collection seen.

    Conus ends at L1 level.

    Lower dorsal cord and conus do not show any abnormality.

    No paraspinal soft tissue abnormality.

    IMPRESSIONS: MR features are suggestive of:

    Post operative status with laminectomy at L3, L4 and L5 levels

    Degenerative facet joint hypertrophic changes at L3-4 and L4-5 with narrowing of neural foramen and lateral recess with indentation on the existing nerve roots.

    Degenerative disk bulge of L3-4, L4-5 and L5-S1 disk causing indentation of the anterior thecal sac.

    Clumping of nerve roots within the thecal sac with enhancement of nerve roots within the thecal sac and exiting nerve roots suggestive of ? Arachnoiditis ? post operative.

    Related Medical reports
    (NCVs, SSEPs)

    Paraparesis, flexor spasms and slight band sensation across waist, residual sequelae following Cx spine surgery in 2005. Past h/o L4-5 laminectomy for left foot drop in 1994, with good resolution of pain and paresis (completely cured), non-diabetic , vegetarian dietary habits.
    1) NCVs for all limbs revealed a NORMAL background with no evidence for a generalized peripheral neuropathy,
    2) There was evidence for bilateral Peroneal pressure neuropathies and residual Left L5/S1 intraspinal axonopathies (surgery in 1994),
    3) SSEPs from the median nerves (C7/6) were normal while from the legs, failed to reveal conduction through the spinal cord (dorsal region).

    MRI CERVICAL SPINE
    1) Multiplanar MR images of the cervical spine were obtained using a combination of T1, T2 turbo spin echo and FFE sequences.
    2) Loss of cervical lordosis.
    3) Internal fixation screws with metallic artifacts seen in the body of CV5 and CV6.
    4) Posterior osteophytes seen at C3, C4 and C5 level.
    5) Marrow signal from vertebral body of CV3 and CV4 is bright on fat suppression and T2 weighted images getting iso to hypointense on T1 weighted images
    6) Intervertebral disc at multiple level is reduced in signal intensity on T2 weighted images with loss of height at C3-C4 level.
    7) Transaxial images show central and bilateral, posterolateral protrusion of intervertebral disc and associated osteophytes at C3-C4 level compressing, the cord and bilateral nerve root.
    8) Central and right lateral protrusion of intervertebral disc at C5-C6 compressing the anterior epidural spaces and right sided nerve root.
    9) Bright signal acquired on T2 weighted images from cord from C2-C3 to C6-C6 level getting isointense on T1 weighted images.
    10) Spinal canal is capacious.
    11) A synovial cyst is seen at T1-T2 level on left side.
    12) Posterior osseous and soft tissue elements are normal.
    13) No pre/ paravertebral collection seen.
    IMPRESSION: FOLLOWUP POST OPERATIVE CASE SHOWS:
    - Internal fixation device in body of C5-C6
    - Cervical spondylosis with degenerative disc disease at multiple level
    - Central and bilateral posterolateral protrusion of intervertebral disc at C3-C4 compressing the Cord and bilateral nerve root
    - Central and right lateral protrusion of intervertebral disc at C5-C6 compressing the epidural space and impinging the right sided nerve root
    - Altered signal from cord from C2-C3 to C5-C6 level
    - Synovial cyst at T1-T2 foraminal level on left side


    Thanking you in anticipation.

    May God bless everyone. Amen
    Last edited by Godbless; 09-21-2009 at 03:01 AM. Reason: Additional information

  2. #2
    Quote Originally Posted by Godbless View Post
    Dear Dr. Young,

    With strong hope and optimism, I am posting on the forum

    Please advise

    The following is the MRI report. What is the problem and what are the possibilities of cure including stem cell treatment, please? Also, the MRI suggests Arachnoiditis with two question marks. If there is no pain or no burning sensation, can Arachnoiditis still exist?

    EXAMINATION PERFORMED : MRI LUMBOSACRAL SPINE (PLAIN WITH CONTRAST)

    Multiplanar MR images of the lumbo-sacral spine were obtained using T1 and T2 weighted TSE and FFE sequences. The T1 weighted images were repeated after contrast administration.

    There is straightening of the lumbar spine with loss of lumbar lordosis.

    There is mild grade-1 retrolisthesis of L3 over L4 vertebral.

    No evidence of any abnormal enhancement seen along the vertebral bodies or disks seen.

    There is seen evidence of previous surgery with laminectomy of L3, L4 and L5 vertebra. Diffuse hypointensity of T1 weighted and T2 weighted images seen in posterior paravertebral muscles on the midline, post operative in nature.

    There is degenerative posterior bulge on L3-4, L4-5 and L5-S1 disks, with indentation of the anterior thecal sac. The signal intensity of these disks is low on T2 weighted images due to disk degeneration/ dessication.

    There are seen degenerative facet joint hypertrophic changes at L3-L4, L4-L5 and L5-S1 level. There is resultant narrowing of the neural foramina and lateral recess at L3-4, L4-5 level with indentation of the existing L4 and L5 nerve roots in the lateral recess.

    There is seen clumping of nerve roots within the thecal sac with enhancement along the nerve roots through the neural foramen.

    No evidence of any abnormal enhancing collection seen.

    Conus ends at L1 level.

    Lower dorsal cord and conus do not show any abnormality.

    No paraspinal soft tissue abnormality.

    IMPRESSIONS: MR features are suggestive of:

    Post operative status with laminectomy at L3, L4 and L5 levels

    Degenerative facet joint hypertrophic changes at L3-4 and L4-5 with narrowing of neural foramen and lateral recess with indentation on the existing nerve roots.

    Degenerative disk bulge of L3-4, L4-5 and L5-S1 disk causing indentation of the anterior thecal sac.

    Clumping of nerve roots within the thecal sac with enhancement of nerve roots within the thecal sac and exiting nerve roots suggestive of ? Arachnoiditis ? post operative.

    Related Medical reports
    (NCVs, SSEPs)

    Paraparesis, flexor spasms and slight band sensation across waist, residual sequelae following Cx spine surgery in 2005. Past h/o L4-5 laminectomy for left foot drop in 1994, with good resolution of pain and paresis (completely cured), non-diabetic , vegetarian dietary habits.
    1) NCVs for all limbs revealed a NORMAL background with no evidence for a generalized peripheral neuropathy,
    2) There was evidence for bilateral Peroneal pressure neuropathies and residual Left L5/S1 intraspinal axonopathies (surgery in 1994),
    3) SSEPs from the median nerves (C7/6) were normal while from the legs, failed to reveal conduction through the spinal cord (dorsal region).

    MRI CERVICAL SPINE
    1) Multiplanar MR images of the cervical spine were obtained using a combination of T1, T2 turbo spin echo and FFE sequences.
    2) Loss of cervical lordosis.
    3) Internal fixation screws with metallic artifacts seen in the body of CV5 and CV6.
    4) Posterior osteophytes seen at C3, C4 and C5 level.
    5) Marrow signal from vertebral body of CV3 and CV4 is bright on fat suppression and T2 weighted images getting iso to hypointense on T1 weighted images
    6) Intervertebral disc at multiple level is reduced in signal intensity on T2 weighted images with loss of height at C3-C4 level.
    7) Transaxial images show central and bilateral, posterolateral protrusion of intervertebral disc and associated osteophytes at C3-C4 level compressing, the cord and bilateral nerve root.
    8) Central and right lateral protrusion of intervertebral disc at C5-C6 compressing the anterior epidural spaces and right sided nerve root.
    9) Bright signal acquired on T2 weighted images from cord from C2-C3 to C6-C6 level getting isointense on T1 weighted images.
    10) Spinal canal is capacious.
    11) A synovial cyst is seen at T1-T2 level on left side.
    12) Posterior osseous and soft tissue elements are normal.
    13) No pre/ paravertebral collection seen.
    IMPRESSION: FOLLOWUP POST OPERATIVE CASE SHOWS:
    - Internal fixation device in body of C5-C6
    - Cervical spondylosis with degenerative disc disease at multiple level
    - Central and bilateral posterolateral protrusion of intervertebral disc at C3-C4 compressing the Cord and bilateral nerve root
    - Central and right lateral protrusion of intervertebral disc at C5-C6 compressing the epidural space and impinging the right sided nerve root
    - Altered signal from cord from C2-C3 to C5-C6 level
    - Synovial cyst at T1-T2 foraminal level on left side


    Thanking you in anticipation.

    May God bless everyone. Amen
    Godbless,

    As you know, you have severe vertebral degeneration that has already caused substantial damage to your spinal cord and roots. While there is some hope that mesenchymal stem cells might be able to slow down or reverse bony and disc degeneration, none have reached clinical trial stage and certainly none have been shown to reverse severe vertebral degeneration. No stem cell therapy has been shown (or claimed) to reduce neuropathic pain, to my knowledge.

    My advice to you is to minimize the fusion surgery, and it seems that you already have had a lot, because every fusion just reduces the flexibility of your spine and imposes more mechanical stress on the remaining spine and thereby accelerate the degenerative process. If there is something that is compressing on your spinal roots, and you have several places where it is likely to be causing you severe pain, you should have surgery to decompress but not fuse.

    My hope is that some company will come up with stem cells that can be used to rebuild discs and allow them to repair degenerated discs and worn out facets. Because this is such a huge market, many companies (such as Medtronics and Johnson & Johnson) are investing in such research. Almost every major orthopedic department has some kind of research into stem cell therapies of discs and bone. So, I hope that there will be advances.

    Wise.

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