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Thread: confused reading MRI results.

  1. #1

    confused reading MRI results.

    I had my bone density and MRI done yesterday for the Charcot joint in my spine, I don't go back to the surgeon until the 17th of this month and am confused by the MRI results. (the terminology).

    I would very much appreciate it if Dr. Young could explain them to me in "simple" terms.

    I just have to figure out how to attach the page.

    I am concerned as to whether these results will go against me or in my favour as far as having my spine fused goes.

    MRI of lumbar spine and lower thoracic spine.
    A longstanding spinal fusion in the lower thoracic and upper lumbar spine is present with a Harrington rod on the right side. At the lower margin of the rod, L3, there is complete dissolution of the L2 vertebral body and most of L3 vertabral body. The residual L3 vertabral body appears sclerotic but over 80% of the vertebral body is no longer present. There is a large enhancing fluid filled collection which is replacing the vertebral bodies at the L2 and L3 level with posterior extensions pushing into the erectospinal muscle complexes. The collection measures 9x7. 5x3cm and there is a thick rind of enhancement and debris within the lesion, particularly on the left. There is intense enhancement within the spinal canal at this level which is obliterating the thecal sac at L2 and L3 levels causing severe canal stenosis.
    The L3/4 disc is still present and there is moderate global disc bulge and moderate bilateral facet joint degeneration change. This is resulting in severe central spinal canal stenosis.
    L4/5 Mild disc desiccation is present without annular tear disc bulge or protrution. Marked bilateral facet joint degeneration change is present. Spinal canal dimensions are normal.
    L5/S1: Disc desiccation is present without loss of disc height. Minimal global disc bulge is present. No evidence of nerve root impingement or spinal stenosis. Marked bilateral facet joint degenerative change is present.
    There is artefact from the rods in the thoracic region but there is no obvious spinal stenosis. Assessment of the cord dignal intensity is difficult due to the artefact but no gross abnormality is detected.
    Impression: Fluid necrotic cavity replacing the L2 and the L3 vertebral bodies just below a right sided Harrington rod. This is resulting in marked compression of the thecal sac focally at L2 and L3 with phlegmon as well as a large necrotic fluid filled cavity with extentions posteriorly. The differential diagnosis is between low grade infection and the sequelae of a neuropathic joint.
    There is severe degnerative central spinal canal stenosis at L3/4 and there is marked facet joint degenerative change at L4/5 and L5/S1.
    Aspiration of the collection could be performed to differentiate between these processes if clinically indicated.

  2. #2
    I'm not Dr. Young, but in simple terms, the vertebral bodies (the substantial part of a vertabra that bears weight has dissolved at the level of L2 and L3 (the second and third lumbar vertabrae (just below your rib cage). In their place is a fluid collection (perhaps sinovial fluid since a charcot joint is a "pseudoarthorsis" meaning a false joint). The fluid collection causes a bulge into your spinal canal greatly narrowing the space for the cord to go through and also bulging outward into the muscles of your back. The bottom line is that you have a pretty serious problem with a rather unstable lumbar spine. You should definitely keep your appointment with the surgeon. If I haven't used simple enough language, let me know and I'll try again. Or if there are specific questions about what the terminology in one part of the report or another means, ask them.

    RAB

  3. #3
    Thankyou for your help on this one. I do intend keeping my appointment, I just wanted to know now what it all meant as my appointment is not until the 17th.

    Do you think the findings will go in my favour for a fusion as obviously he (the surgeon) can not say "lets just leave it" now can he?
    On my previous appointment he threw all the negatives of having a fusion at me and said that it didn't matter if I had the sweats and some clunking going on as opposed to having major surgery. Hopefully now he will see the seriousness of it all.

  4. #4
    when a radiologist says "if clinically indicated" GET IT DONE! Long time in diagnostics.....Patti

  5. #5
    Remember, there are more surgeons in the world than just one. If you don't get good service from this one, find another and get a second opinion.

    RAB

  6. #6
    If a fusion is done, I would imagine they will need to go above L2-3 and by the looks of the MRI below S1 due to the degeneration happening. How do you go with Sacral fusions, do they go that low?

    Would the fluid sac need to be drained before surgery, I think there would be too much scar tissue to insert a needle?

    Is there anyone else on this forum who have had a fusion going down as far as the sacral?
    Last edited by Pixie; 02-04-2006 at 05:08 AM. Reason: spelling erroe

  7. #7
    Quote Originally Posted by Pixie
    I had my bone density and MRI done yesterday for the Charcot joint in my spine, I don't go back to the surgeon until the 17th of this month and am confused by the MRI results. (the terminology).

    I would very much appreciate it if Dr. Young could explain them to me in "simple" terms.
    Sorry I did not see this until now. Let me try to explain:

    I just have to figure out how to attach the page.

    I am concerned as to whether these results will go against me or in my favour as far as having my spine fused goes.

    MRI of lumbar spine and lower thoracic spine.
    A longstanding spinal fusion in the lower thoracic and upper lumbar spine is present with a Harrington rod on the right side. At the lower margin of the rod, L3, there is complete dissolution of the L2 vertebral body and most of L3 vertabral body. The residual L3 vertabral body appears sclerotic but over 80% of the vertebral body is no longer present. There is a large enhancing fluid filled collection which is replacing the vertebral bodies at the L2 and L3 level with posterior extensions pushing into the erectospinal muscle complexes. The collection measures 9x7. 5x3cm and there is a thick rind of enhancement and debris within the lesion, particularly on the left. There is intense enhancement within the spinal canal at this level which is obliterating the thecal sac at L2 and L3 levels causing severe canal stenosis.
    • Your L2 and L3 vertebral bodies are severely damaged. The entire L2 and part of L3 vertebral bodies appear to be gone and replaced by a fluid filled cavity (note that on MRI, fluid produces higher signal and that is why the report says that it is "enhancing"). The remaining L3 is scarred (sclerotic). The fluid filled cavity is apparently pushing up against muscle in front of the spine (erectospinal muscle). More important, the loss of the vertebral bodies have resulted in a severe narrowing (stenosis) of your spinal canal. At the L2 and L3 vertebral levels, the spinal canal contains mostly spinal cord roots, the so-called cauda equina. These roots descend and exit the spinal canal at the respective spaces between the vertebral bodies, e.g. the roots of L4 exit between L4 and L5. It is worrisome because the L2 and L3 roots are right in the area where the vertebral bodies have been so severely damaged. The narrowing of your spinal canal at L2 and L3 may also be compressing your spinal roots.

    The L3/4 disc is still present and there is moderate global disc bulge and moderate bilateral facet joint degeneration change. This is resulting in severe central spinal canal stenosis.
    • The L3/4 disc is herniating back into the spinal canal and is pressing into the spinal canal. There is also significant degeneration of the L3/L4 facets (the places where the back of the vertebrae sit on each other). The radiologist believes that this is one of the reasons for the severe narrowing of your spinal canal at this level.

    L4/5 Mild disc desiccation is present without annular tear disc bulge or protrution. Marked bilateral facet joint degeneration change is present. Spinal canal dimensions are normal.
    • There are only mild changes in the L4/5 disc. Again, there is significant degeneration of the L4/5 facet joints. Desiccation means that there is a loss of water in the disc (usually a precursor to disc damage).

    L5/S1: Disc desiccation is present without loss of disc height. Minimal global disc bulge is present. No evidence of nerve root impingement or spinal stenosis. Marked bilateral facet joint degenerative change is present.
    • The L5/S1 vertebral bodies again show degenerative changes.

    There is artefact from the rods in the thoracic region but there is no obvious spinal stenosis. Assessment of the cord dignal intensity is difficult due to the artefact but no gross abnormality is detected.
    • Your thoracic spinal column appears to be okay. The presence of the rod is interfering with the image so that it is difficult to see.

    Impression: Fluid necrotic cavity replacing the L2 and the L3 vertebral bodies just below a right sided Harrington rod. This is resulting in marked compression of the thecal sac focally at L2 and L3 with phlegmon as well as a large necrotic fluid filled cavity with extentions posteriorly. The differential diagnosis is between low grade infection and the sequelae of a neuropathic joint.

    There is severe degnerative central spinal canal stenosis at L3/4 and there is marked facet joint degenerative change at L4/5 and L5/S1.
    Aspiration of the collection could be performed to differentiate between these processes if clinically indicated.
    • In summary, the L2 and L3 vertebral bodies have been severely damaged and is replaced by a fluid cavity that is compressing into the spinal canal at L2/3. The radiologist is not sure but there is the possibility of an infection that may have contributed to the degeneration but it may also have been simply just severe degeneration of the L2/3 vertebral joint. (Note: I have not heard of such severe degeneration of the vertebral bodies before and therefore think that the possibility of infection should be taken seriously.) The radiologist recommends that a needle biopsy be made of the fluid cavity to see if there is an infection.

    I think that this really needs to be fixed. If there is an infection, it needs to be cleaned out with antibiotics right away. If there is no infection, you will need to place prostheses in the place of the destroyed vertebra and probably rods to stabilize the area. This needs to be evaluated by an experienced orthopedic surgeon. Decisions will have to be made concerning how much of the spine to fuse and how to prevent further degeneration of the spine.

    Wise.

  8. #8
    pixie, I am not sure that you saw my response. I am bumping it up. Wise.

  9. #9
    Thankyou Wise,
    Unfortunately no I did not see your response.

    I had the biopsey done and the fluid was clear of any infection so that is good.

    They still don't know what they are going to do though.
    The 6 spinal surgeons that we have in Perth apparently discussed me at one of there meetings. The procedures I mentioned in the PM where some of their suggestions.

    One more question, because my original level is t3 and I have now had all this flacid loss in my lower limbs, stomach etc. is it possible for the fluid pressure to continue to rise up my spinal collumn and cause even more loss, the reason I am asking is because the registrar seemed to think it could do no more damage than it has and because I have good fusion in the thorasic area it can not travel further up?

    Hopefully I will know more on tuesday when I call my consulting spinal Dr. who I also asked about a brace if this is going to continue to be dragged out so that it reduces further damage, where as he replied that was a possibility but suggested my chair and seating needed to be addressed too.

    Cheers
    Last edited by Pixie; 03-05-2006 at 10:26 PM.

  10. #10
    Pixie, that is very good news that there is no active infection. I am glad that the Perth spinal surgeons got together to talk about your case. I think that it is a real challenge and the more brains work on this together, the better. The flaccidity probably result from the compression of your cord. In my opinion, if they can decompress and stabilize the site, that would be the best. Wise.

    Quote Originally Posted by Pixie
    Thankyou Wise,
    Unfortunately no I did not see your response.

    I had the biopsey done and the fluid was clear of any infection so that is good.

    They still don't know what they are going to do though.
    The 6 spinal surgeons that we have in Perth apparently discussed me at one of there meetings. The procedures I mentioned in the PM where some of their suggestions.

    One more question, because my original level is t3 and I have now had all this flacid loss in my lower limbs, stomach etc. is it possible for the fluid pressure to continue to rise up my spinal collumn and cause even more loss, the reason I am asking is because the registrar seemed to think it could do no more damage than it has and because I have good fusion in the thorasic area it can not travel further up?

    Hopefully I will know more on tuesday when I call my consulting spinal Dr. who I also asked about a brace if this is going to continue to be dragged out so that it reduces further damage, where as he replied that was a possibility but suggested my chair and seating needed to be addressed too.

    Cheers

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