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Old 10-29-2012, 09:02 PM   #1
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Looking for info for husband's back injury

Hi all! I have some questions about his mri report and am hoping someone here can shed some light in layman's terms and share any suggestions you may have. I didn't get to attend the appointment where the doctor discussed this with him, and he didn't understand enough to explain it to me.

His mri report shows small disc bulges for L2-3 and L3-4. At L4-5 disc protrusion complex extending into neural foramina with narrowing combined with facet hypertrophy, the AP spinal canal measures just at 10mm. Also showing osteophytes which I believe are bone spurs.
The big problem is L5-S1, with a herniation measuring 9 x 14 mm in AP and transverse dimension containing a very large annular tear. Other words mentioned are flattening and concavity upon anterior thecal sac and AP spinal canal diameter narrowing.

I have read that as we age we all will have some changes in our spine. So we are not sure what to focus on of course rather than the L5-S1 that the doctors are focusing on. Are small disc bulges normal for a 45 year old? Can you tell me what the annular tear means? What about flattening and concavity of the thecal sac? At this point he is on several medications, which when at home all he does is want to sleep. His pain is in lower back, down left leg more than right, even into the feet. He is to meet with a pain management doctor to schedule an ESI. Does it seem we are headed in the right direction? He doesn't want to stay on medication for long and wants to avoid any surgery as well. It's hard to see a man who was pretty healthy and active become a man who can't stand to walk or even move to much.

Thanks to anyone who made it this far!

 
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Old 10-29-2012, 09:12 PM   #2
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Re: Looking for info for husbands back injury

If I were you or your husband, I would at the very least make an appointment with a board certified spine surgeon- either or better both, a neuro spine surgeon and an orthopedic board certified spine surgeon. Given that there is some compression of the spinal nerves in the central canal ( where the spinal nerves come down the spinal canal), and the neuroforamina ( where the nerve roots exit), he really needs to consider that surgery is most likely his best option, rather than dealing with simply pain management.
Once there is compression of either the central canal or the nerve roots, the damage can become permanent and effect everything from his hips down to his feet, depending on what nerves or nerve roots are being compromised, including his bladder and bowel. He also has a large herniation , which is contributing to his compression in the central canal, so unless he is willing to risk permanent damage, having the injection may offer some temporary relief, but I do think that a consult with a surgeon is his best option.

 
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Old 10-29-2012, 10:04 PM   #3
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Re: Looking for info for husbands back injury

[QUOTE=backhurtz;5080847]If I were you or your husband, I would at the very least make an appointment with a board certified spine surgeon- either or better both, a neuro spine surgeon and an orthopedic board certified spine surgeon. Given that there is some compression of the spinal nerves in the central canal ( where the spinal nerves come down the spinal canal), and the neuroforamina ( where the nerve roots exit), he really needs to consider that surgery is most likely his best option, rather than dealing with simply pain management.
Once there is compression of either the central canal or the nerve roots, the damage can become permanent and effect everything from his hips down to his feet, depending on what nerves or nerve roots are being compromised, including his bladder and bowel. He also has a large herniation , which is contributing to his compression in the central canal, so unless he is willing to risk permanent damage, having the injection may offer some temporary relief, but I do think that a consult with a surgeon is his best option.[/QUOTE]

Thank you for your quick reply and explanation. He was hurt on the job, and it stinks to follow all the protocol that goes with it. He did see a orthopedic surgeon but I doubt he was a spine specialist. I definitely think we should consider a second opinion from one of the doctors you mentioned on our private insurance. We didn't understand why his feet have hurt worse over the last few weeks and had no clue it was truly back related.

 
Old 10-30-2012, 01:19 AM   #4
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Re: Looking for info for husbands back injury

Hi & welcome to the board.
I think you will find a lot of information from this board.
I personally have been thru 7 spine surgeries. I have had surgery to both the cervical/neck area and the lumbar/low back area.

All of my issues were degnerative in nature in that I was NOT involved in any car accident or fall.
Yes, as we age we will all have some changes with in our spines. I've heard that you can take the normal adult and even if he/she isn't having any symptoms the MRI will show degenerative changes.

The discs which are located thru out the spine are like grapes. They are watery and act as cushions. Well over time they lose some of that watery substance and will lose its height. they can then tend to bulge out and can eventually get worse and become herniated. There is a difference between bulges and herniations.
Thats what happened to me when my back first gave me problems. I had bulges which required me to be in traction for 2 weeks. Within a few years those same bulges became herniated and thus my first sugery.

You mentioned "Neural Foramena." That is one of the issues that I had in my neck and required surgery. Think of your spine as being like a straw. Down the center of the straw/spine run all your nerves. But there are exit points at various levels of your spine as well. Like there will be an exit area in the neck area where the nerves run out from the center of the spine and the nerves will be the shoulders or arms or hands. Same with the lower back there are nerves that exit the spine specifically for the legs; feet etc.

That is what neural formanina is the exit spots from in your husbands case. They are exiting the spine in the low back area.

You asked if 45 years old is normal to have changes in the spine. Yes it is normal. My problems started in 1988 & I was 35 at the time. I am now 59 and still having major issues.

All the surgeries that I had helped the specific problem. But everytime I turned around a new problem developed. And because of the ongoing issues I am now on permanent disability for almost 10 years. I have severe nerve damage as a result of years of problems. Severe arthritis and peripheral neuropathy. Peripheral Neuropathy is where you have issues with your arms and legs. In my case I have severe numbness in both legs. Weakness in both my arms. They are afraid to do surgery on me again wondering if at this point if there will be any benefit from surgery but I also have other health issues that are affecting the decision to do more surgery.

You asked about ESI. It is difficult to say whether your husband will benefit or not from the injections.
In my case I have been thru them several times. I was told that they usually limit the injections to 3 injections within a certain time frame. I would go thru the 1st one and have some relief for several days. Then I would go thru a 2nd one and it had no effect whatsoever. So since there was limited and no benefit that lasted any length of time it was decided for me at least that the 3rd ESI would be of no value.

I've know people that did benefit from it.

I would suggest the following:
- be sure you are treating with an orthopedist or neursosurgeon that is specifically train in spines and treats patients with spine issues.
- I usually prefer seeing someone at a major teaching hospital. The reason for me at least was that since my case is extremely complicated, I feel the larger hospitals they are exposed to the more complicated cases.
- as to treatment I recommend conservative treatment first if possible. That would include physical therapy, medications to see if that is of any benefit.
- if not, and only after all other options have been exhaused would I recommend surgery. Surgery to the spine is difficult and risky and should not be taken lightly.
- if surgery is recommended I suggest that 2nd or 3rd opinions be obtained.

I have had 2 or 3 opinions and was faced once where 2 doctors said surgery should be done and 1 said no. So I had to make a decision. I knew that going thru the surgery was the right answer and have no regrets about doing it.

Please keep us posted on how your husband is doing. This is a great board for suggestions based on our past experiences and a place for support. Sometimes you need to vent and can always address your concerns here. Good luck............

 
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Old 10-30-2012, 08:48 AM   #5
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Re: Looking for info for husbands back injury

All I can say is he needs to be real careful on going thru a surgery, I wish I could have known more before I went thru it for I would have opted out of any surgery. I had a 3 level lower lumbar fusion with all the rods ,screws, and bolts. And I am and will be on meds forever to help with the pain, and I do mean PAIN.Two of my disc were torn and 3 bulging. L1toL5. I would like to see your husband go to some real good theripist and anything eles there is to prevent surgery. He thinks he is in pain now ,well he will really know PAIN if he has the surgery. This is based on my experence and maybe he would be better off but i urge you guys to really research all offers out there and you can call the tec. that wrote the findings on his MRI and they will go over it with you at least mine have and they can do it over the phone. They cannot give any advice but they can read it to your understanding. So much Luck to you both, and please keep in touch. If he has a discogram that will tell how much pressure those disc can hold and which ones are torn, much good luck to you both, and please let us know how things are going. I wish I could have said more positive words but I really have none. I live in constant pain. GOOD LUCK

 
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Old 10-30-2012, 09:37 AM   #6
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Re: Looking for info for husbands back injury

Would you mind copying the report for the...L4-L5 and L5-S1 findings and include the "Impressions" section of the report? You may have left out a word that had no meaning to you, but that would be important to an accurate diagnosis for your husband...(not that we are "diagnosing" anything...but it might provide a bit more valuable clues).

While the issues at L5-S1 appear to be causing pain, there is a lot going on at the level above as well that may make it a pain generator, too.

The MRI is just one piece of the diagnostic puzzle. It is correlated with results from the physical exam, a basic neurologic exam and the patient's description of symptoms and how they impact his life.

As you noted, it is common to see a bulging disc on a MRI, and in many cases it is asymptomatic. Almost everyone has signs of bulging discs by middle age. While it may seem that your husband's age is young for degenerative changes, in reality our backs begin the aging process in our 20s. The difference is that for many people, these changes do not cause symptoms.

The issues your husband has at L4-L5 are resulting in a "stenosis." This means there is narrowing in a passageway that needs to be open as the nerves pass out of the spine to the limbs. These openings called neuroforamen are sometimes shortened to foramen (plural for "foramina").

The reason this is a problem is because as the foramen clog up with tissue or inflammation that does not belong there, the nerves get squished. This causes nerve compression which leads to the pain the patient can feel anywhere along the path of the nerve.

Each spinal nerve innervates a particular part of the body -- this path of innervation is called a "dermatome." You can look online to find a "dermatome map" which will show you specifically what the L4 nerve controls...and for all the other spinal nerves as well.

There are two main places where stenosis occurs. One is in the central canal (which your husband has at L5-S1) and the other is in the foramina (which he has at L4-L5). Anything that impinges into these spaces such as a disc bulge, facet joint enlargement,inflammation of tissue, etc. can cause "stenosis."

[B]At L4-5 disc protrusion complex extending into neural foramina with narrowing combined with facet hypertrophy, the AP spinal canal measures just at 10mm. Also showing osteophytes which I believe are bone spurs.[/B]

So, at the L4-L5 segment there is a disc that is bulging out of its space, which is pushing into the foramina and causing that space to be narrowed. In addition the facet joint is showing signs of arthritic change, including joint enlargement. When these two issues are combined, the result is that the diameter of the central canal is being affected....This can also cause neural compression as the nerves bundle together in the central canal and run down through the sacrum where the nerves branch into two and form the sciatic nerves in each leg. Any pushing into this central canal space can result in nerve pain...and if it is severe enough, the nerve will not be able to function which can lead to permanent nerve damage.

 
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Old 10-30-2012, 04:36 PM   #7
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Re: Looking for info for husband's back injury

Thank you all for your kindness. I appreciate everyone sharing their knowledge and experiences with me. Teteri66, this is word for word the findings and impression sections for L3-4 to L5-S1.

The findings section states: There is a large broad based disc herniation at L5-S1 flattening the thecal sac. Lateralizing disc bulges are seen from L2 to L5. The verterbral body height and disc spaces are maintained. There are mild endplate degenerative changes at L5-S1. There is no acute vertebral body compression injury. The distal cord and conus are normal, and the sagittal images of T11 through L-1 are normal, as well as retroperitoneal structures.

I am including the impression for for L3-4 as well. It states there is a 2.5mm lateralizing disc buldge, most accentuated into the neural foramina, and there is minimal neural foramina narrowing, left greater than right, when combined with facet hypertrophy and no central spinal canal stenosis.

L4-5, there are posterolateral osteophytes and a 2.5 to 3mm lateralizing disc protrusion complex extending into the neural foramina with mild to moderate neural foramina narrowing when combined with facet hypertrophy. The AP spinal canal measures just at 10mm.

At L5-S1, there is a large broad based disc herniation measuring at least 9 x 14mm in AP and transverse dimension, containing a very large annular tear. There is flattening and concavity upon the anterior thecal sac, and the AP spinal canal diameter is narrowed at 6mm. Lateralization of the disc into the neural foramina results in mild to moderate neural foraminal narrowing bilaterally, probably slightly greater on the right, when combined with facet hypertrophy.

 
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