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Thread: Lumbar MRI results-related surgical procedures done?

  1. #1

    Lumbar MRI results-related surgical procedures done?

    Hello. Below is the interpretation of my current lumbar spine MRI. I've had low back problems for > 10 years, mainly diagnosed as DDD; pain has progressively worsened, to the point where I've been sleeping upright in a chair for the past 4 years (unable to lay flat on my back due to the pain); even purchased a $2000 mattress specific for back problems, & didn't last a month on it! (it now serves as a very expensive place to keep folded laundry...) I also cannot spend more than 2 minutes standing still because of the pain (ok if walking - I'm able to walk fairly long distances w/ no problems). Had lumbar/facet injections in the past, initial injection gave relief, but none following (if anything they seemed to exacerbate the pain). As such, family doctor was referring me to pain mgt. in the past, but based on current MRI results now being referred to a neuro-surgeon (nurse reiterated that it should be a neurosurgeon & NOT an orthopedic...).

    Can you please tell me based on current MRI results what the usual surgical protocol would be? I just want an idea what to expect, if there is/are procedure(s) commonly performed to repair these disorders, as well as the expected down time related to the surgery, and if it's a difficult healing process? My other concern, the referred surgeon is completely booked & cannot see me for a few months; I'm currently on Cobra (insurance) which will expire soon, so I’d like to know the approx. time frame of related treatment post surgery. Something needs to be done soon, as the pain is getting worse and making normal, routine activities unbearable (and putting me in a depression). Personal info: I'm a 48 y.o. Caucasian woman, with no other real 'major' health problems, but do suffer with chronic fatigue & sleep disorder (CRD) & related muscle pain (possible fibromyalgia); I take Vicoprofen for the back & muscle pain – have been on it long-term so not as effective, but do not want to go on anything stronger with negative side effects (i.e. Lyrica or Oxycontin) or other Rx's with unpleasant side effects such as Cymbalta & SSRI anti-depressants, etc...

    I truly appreciate your professional advice & assistance with this. Thank you!

    Current MRI Results

    Normal appearance of conus medullaris

    Levoscoliosis, mild diffuse facet & ligamentum flavum hypertrophy.

    Adjacent Schmorl’s nodes & moderate reactive change anteriorly along T11/12 endplates and at L5 inferior endplate.

    There is desiccation of T11/12, L4/5 & L5/S1 discs.

    T11/12: there is central disc protrusion indenting thecal sac causing mild canal stenosis.

    T12/L1, L1/2 & L2/3: minimal physiologic bulging, facet & ligamentum flavum hypertrophy & slight flattening of thecal sac without significant canal or foraminal stenosis.

    L3/4: there is shallow disc bulging, left posterolateral annular tear and tiny protrusion, facet and ligamentum flavum hypertrophy. There is flattening of thecal sac with mild canal and foraminal stenosis, greater to the left.

    L4/5: there is annular tear, shallow central protrusion, facet and ligamentum flavum hypertrophy causing mild to moderate central canal stenosis; mild foraminal stenosis.

    L5/S1: there is spondylosis, shallow diffuse bulge, facet and ligamentum flavum hypertrophy with mild canal stenosis. Mild to moderate bilateral foraminal stenosis, greater on the right.

    Compared with prior study of 2006:

    L3/4 & L4/5: new small protrusions

    T11/12: new or increased disc protrusion

    CONCLUSION: Levoscoliosis with degenerative disc and facet disease. Central protrusion at T11/12 without cordimpingement. Small protrusions at L3/4 & L4/5 and diffuse disc/osteophyte complex at L5/S1. Mild canal and foraminal stenosis as above.
    Last edited by AngelaBunn1; 07-07-2011 at 07:08 PM.

  2. #2
    Of course you should be discussing the results of your MRI with the physician who ordered it. You cannot make a diagnosis or determine needed treatment via internet, or just from an MRI alone (without an accompanying assessment, history, and physical exam).

    I will ask Dr. Young to comment when he has the time.

    (KLD)

  3. #3
    Angela, I am sorry to hear of your pain. What you describe is unusual, in my experience. Specifically, your pain appears to be worst when you are lying down. Usually, it is the other way around. I assume that this is true in every position, including side-lying and prone.

    Regarding your MRI, the good news is that there does not appear to be compression of you spinal cord. There appears to be partial occlusion of your right L5/S1 foramen. If that corresponds to your pain and other neurological symptoms, this may be a surgical goal. This has to be evaluated by an experienced neurosurgeon.

    But, as I pointed out above, I am puzzled by why your pain is worse when you are lying down and you have such pain that you have been sleeping in a sitting position for four years. I don't have enough experience to be able to judge the cause and the solution for your situation.

    Wise.





    Quote Originally Posted by AngelaBunn1 View Post
    Hello. Below is the interpretation of my current lumbar spine MRI. I've had low back problems for > 10 years, mainly diagnosed as DDD; pain has progressively worsened, to the point where I've been sleeping upright in a chair for the past 4 years (unable to lay flat on my back due to the pain); even purchased a $2000 mattress specific for back problems, & didn't last a month on it! (it now serves as a very expensive place to keep folded laundry...) I also cannot spend more than 2 minutes standing still because of the pain (ok if walking - I'm able to walk fairly long distances w/ no problems). Had lumbar/facet injections in the past, initial injection gave relief, but none following (if anything they seemed to exacerbate the pain). As such, family doctor was referring me to pain mgt. in the past, but based on current MRI results now being referred to a neuro-surgeon (nurse reiterated that it should be a neurosurgeon & NOT an orthopedic...).

    Can you please tell me based on current MRI results what the usual surgical protocol would be? I just want an idea what to expect, if there is/are procedure(s) commonly performed to repair these disorders, as well as the expected down time related to the surgery, and if it's a difficult healing process? My other concern, the referred surgeon is completely booked & cannot see me for a few months; I'm currently on Cobra (insurance) which will expire soon, so I’d like to know the approx. time frame of related treatment post surgery. Something needs to be done soon, as the pain is getting worse and making normal, routine activities unbearable (and putting me in a depression). Personal info: I'm a 48 y.o. Caucasian woman, with no other real 'major' health problems, but do suffer with chronic fatigue & sleep disorder (CRD) & related muscle pain (possible fibromyalgia); I take Vicoprofen for the back & muscle pain – have been on it long-term so not as effective, but do not want to go on anything stronger with negative side effects (i.e. Lyrica or Oxycontin) or other Rx's with unpleasant side effects such as Cymbalta & SSRI anti-depressants, etc...

    I truly appreciate your professional advice & assistance with this. Thank you!

    Current MRI Results

    Normal appearance of conus medullaris

    Levoscoliosis, mild diffuse facet & ligamentum flavum hypertrophy.

    Adjacent Schmorl’s nodes & moderate reactive change anteriorly along T11/12 endplates and at L5 inferior endplate.

    There is desiccation of T11/12, L4/5 & L5/S1 discs.

    T11/12: there is central disc protrusion indenting thecal sac causing mild canal stenosis.

    T12/L1, L1/2 & L2/3: minimal physiologic bulging, facet & ligamentum flavum hypertrophy & slight flattening of thecal sac without significant canal or foraminal stenosis.

    L3/4: there is shallow disc bulging, left posterolateral annular tear and tiny protrusion, facet and ligamentum flavum hypertrophy. There is flattening of thecal sac with mild canal and foraminal stenosis, greater to the left.

    L4/5: there is annular tear, shallow central protrusion, facet and ligamentum flavum hypertrophy causing mild to moderate central canal stenosis; mild foraminal stenosis.

    L5/S1: there is spondylosis, shallow diffuse bulge, facet and ligamentum flavum hypertrophy with mild canal stenosis. Mild to moderate bilateral foraminal stenosis, greater on the right.

    Compared with prior study of 2006:

    L3/4 & L4/5: new small protrusions

    T11/12: new or increased disc protrusion

    CONCLUSION: Levoscoliosis with degenerative disc and facet disease. Central protrusion at T11/12 without cordimpingement. Small protrusions at L3/4 & L4/5 and diffuse disc/osteophyte complex at L5/S1. Mild canal and foraminal stenosis as above.

  4. #4

    (Reply to Dr. Young)

    Hello Dr. Young,

    Thank you so much for replying to my post so quickly! I should have clarified better, that I do get relief when laying in an upright position, which is why I sleep on a chair (with an attached ottoman, it's more like a chaise-lounger); I can sleep on my side as well, most comfortably while in a 'fetal' position where bending 'forward' takes that pressure off of my back. I cannot lay flat on my back, or flat on my stomach - both of those positions are very uncomfortable, and become quite painful after just a few minutes. It's also quite painful to bend back or 'arch' my back. (I can better tolerate laying flat on my back if there's a cushion/wedge under my knees - such as what they did for me during my MRI...) As I said, I had purchased a new mattress specifically for my back - the previous one was comfortable enough, but quite old, so I thought I'd benefit with a new one. After doing a lot of research & testing them out, I bought a $2000 mattress that was 'specifically designed for people with back problems.' (The mattress store actually does this computerized back scan & then from the results tries to match you up with the best mattress!) My excitement quickly turned into dismay, as I barely lasted 3 months on it - I'd literally wake up each morning like a cripple, it took over an hour just to be able to walk upright, it was excruciating on my back (even when laying on my side). Unfortunately, I could not return the bed; even more depressing was having to make the monthly payments for the next year while having to sleep on the chair!

    I totally understand that without fully examining me or knowing my history, etc. you can't make a complete diagnosis; but with my MRI results, I was curious if any or all of the diagnoses would warrant surgery.

    Since it began 10 years ago, my back pain generated from the same area, center-low back, shooting down into my tail-bone (or what felt like); the initial MRI I had done at that time only showed DDD, and one or two other issues, but not nearly as problematic as the current one. I never had any pain shooting down my legs or numbness in the legs; the pain was always in the same region but progressively worsened as time went on. However, as of recent, I have been getting very sharp pains to the left of that area - I would say a few inches left of my spine. It hasn't occurred often, only a few times (once when I was laying flat on the floor, another while getting out of a chair to stand) and the pain is very sharp. I have no idea what it could be, I'm assuming that it's indicated somewhere on the current MRI(?) But since I'm unable to get an appointment anytime soon with the surgeon referred by my PCP, I'm in the process of searching highly-rated neuro / ortho surgeons specializing in spine disorders, who participate with my insurance, and then hopefully can schedule a consultation as soon as possible, so I can get treated before my health insurance cancels. (If there are any reputable surgeons that you can recommend from PA/NJ/NY area, I'd appreciate it!)

    If I can ask, regarding the partial occlusion of the right L5/S1 foramen, what would be the usual surgical procedure, or types of surgery done to correct that? In your opinion, is that the only condition per my MRI that would warrant surgery? Is there anything that can be done to correct the DDD (even though I know it's arthritis & would probably return) but to have even temporary relief would be a God-send. Like everyone else with back pain, it has greatly affected my life, my job, my routine activities, etc. and it's been horribly miserable! I'm at the point that I'm so used to the chronic pain, that if it were to be corrected, or go away, it would probably feel as if having a brand-new body!

    But thank you again, very much - for taking the time to respond to my inquiry, I truly appreciate it!

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