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  • MRI report, please help - back surgeries, resulting in RSD

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    Old 06-29-2013, 04:18 AM   #1
    ArizonaJeff
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    MRI report, please help - back surgeries, resulting in RSD

    Hello,
    I'll try to keep my comments short and sweet.
    Have had 3 low back surgeries - fusions without and with hardware;

    Have chronic, constant pain, it is a lot worse now than before first surgery which after it failed, I think is when the real problems started. Some days worse than others but it never ends even with pain meds. After the last surgery I had so many different injection treatments/therapies, nothing has really helped. Pain is in low back and in legs, both but left is worse than right.

    I was injured in 1996, low back L3 - L5
    P.T. didn't do much, steroid injections, tried something called VAX D (traction type contraption), etc.

    3 surgeries

    1) July 1997 - bone fusion, bone taken from hip - failed

    2) July 1998 - laminectomy (?), hardware and bone fusion combo, again bone taken from hip - failed, one rod bent and a couple screws sheered off at head

    3) July 1999 - removed old hardware, reinstalled new, removed discs and another bone fusion with some of my bone and some cadaver. Complications during surgery, nerve damage and they had a hard time getting old hardware out.

    When I woke up from last surgery my legs were swollen 2 + times normal, red/purple and extremely hyper sensitive. Surgery took several hours longer than they planned.
    They have labeled that as RSD or now I guess CRPS. I’ve always had a hard time with that diagnosis because they kind of know what caused it whereas from what I understand, the cause of RSD is unknown. After about a week of the swelling not going down and the pain increasing the Dr’s said there ‘may’ have been damage done to the Sympathetic nerves during the surgery.

    The ‘RSD’ has gotten a little better over the years but is still there. The swelling isn’t as prevalent and the hyper-sensitivity is better but still there, left leg is worse than right. Still have redness, excessive sweating and burning in both legs. What hasn’t gone away and has gotten worse is hard to explain, but my legs feel ‘tired’ like I walked 20 miles or am treading water all the time. I have been on Gabapentin 400 mg, 4 times daily for about 6 months. In the past I didn’t like this stuff but it is helping burning and redness.

    OK.
    A few weeks ago I fell pretty hard and my back has been worse. The pain Doc wanted me to get an MRI just make sure nothing was broken or out of whack.

    I was sent a copy of the report, it is compared to a previous MRI but unless it is important, I’d rather not have to add both of them. I will include the REPORT note from the first MRI.

    The thing is, just reading this 2nd report I would think I should feel pretty dang good. Lots of ‘slight’, ‘no significant’ and ‘mild’ in the report. And, if I’m not mistaken, the report says there is ‘slight’ bulging in the discs seen between L4 –L5……..where unless someone lied to me, there should be NO DISC (sorry for the yelling but, I’m actually yelling – there isn’t a disc there!?!) Unless I just don’t understand, which is why I’m here asking what this report is saying, because my not understanding is very possible. Discs don’t grow back and they packed bone in place of the discs even if they did.


    First REPORT: There is a 2.0 mm anterolisthesis of L4 on L5. This is present in spite of the fact that there is a posterior spinal fixation apparatus in place. There are horizontally oriented pedicle screws and vertically oriented fixation rods spanning L3 through L5 vertebrae at the site of a posterior spinal fusion. There are intervertebral disc space fusion devices noted at the L3-4 and L4-5 levels. Mild disc space narrowing is seen at the L5-S1 level. End-plate hypertrophic degenerative changes are noted along the anterior margins of the T12-L1 through L5-S1 levels. The tip of the conus is at the T11-12 interspace level.

    Here is the 2nd report, I’ll type it as it is.

    MRI OF THE LUMBAR SPINE WITHOUT CONTRAST WITH FLEXION AND EXTENSION

    CLINICAL INFORMATION: Lower back pain and radicular symptoms.

    COMPARISION: The exam is compared to a prior MRI of the lumbar spine…

    TECHNIQUE: Routine noncontrast MRI images. Scan performed with patient in the upright sitting position.

    FINDINGS: There is a mild degenerative anterolisthesis of L4 on L5. There are intervertebral disk space fusion devices present at the L3-L4 and L4-L5 levels. Note is also made of an extensive posterior spinal fixation apparatus extending from L3 to L5. There are transversely oriented pedicle screws and vertically oriented fixation rods in place. The tip of the conus is at the midbody of T12.

    L5-S1 LEVEL: Slight circumferential disk bulging is seen. No spinal canal stenosis, nerve root impingement or neural exit foraminal encroachment seen. Prominent bilateral facet joint degenerative changes are seen. There is a wide posterior laminectomy defect present.

    L4-L5 LEVEL: Slight circumferential disk bulging is seen. No spinal canal stenosis, nerve root impingement or neural exit foraminal encroachment seen. There is a wide posterior laminectomy defect present.

    L3-L4 LEVEL: No significant intervertebral disk, spinal canal, neural foramina, or nerve root abnormality is seen.

    L2-L3 LEVEL: Mild circumferential disk bulging is seen. No spinal canal stenosis is identified. The bulging annulus and endplate bony ridging contribution to mild right-sided neural exit foraminal encroachment. Mild bilateral facet joint degenerative changes are seen.

    L1-L2 LEVEL: Mild circumferential disk bulging is seen. No spinal canal stenosis is identified. The bulging annulus and endplate bony ridging contribute to slight bilateral neural exit foraminal encroachment.

    No significant abnormality is seen at the T12-L1 level

    There is a relatively normal range of motion at flexion and extension. There is no change in alignment or position of the vertebral bodies or posterior elements.

    IMPRESSION:

    1. There is at least a mild bilateral neural exit foraminal encroachment at the L2-L3 level.
    2. There are intervertebral disk space fusion devices present at the L3-L4 and L4-L5 levels
    3. There is an extensive posterior spinal fixation apparatus present extending from L3 through L5, all of which appear intact and are unchanged.
    4. There is a mild degenerative anterolisthesis of L4 and L5 level.
    5. There is relatively normal range of motion at flexion and extension.
    6. There has been no significant interval change as compared to the ##/##/## exam.


    So, does that say there are discs?
    Does this read like the MRI of someone in constant pain?
    When I read the report I was thinking it seems like I should have 'mild' pain, maybe 'slight' discomfort. For some reason, it has been bugging me.

    Any comments are welcome and appreciated.

    Thanks.

     
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    Old 06-29-2013, 08:11 AM   #2
    teteri66
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    Re: MRI report, please help - back surgeries, resulting in RSD

    Was the first MRI done with you in a sitting position?

    Please describe in more detail your pain symptoms...where specifically, what positions make pain worse or better, etc.

    Last edited by teteri66; 06-29-2013 at 08:22 AM.

     
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    Old 06-30-2013, 04:22 AM   #3
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    Re: MRI report, please help - back surgeries, resulting in RSD

    Quote:
    Originally Posted by teteri66 View Post
    Was the first MRI done with you in a sitting position?

    Please describe in more detail your pain symptoms...where specifically, what positions make pain worse or better, etc.
    Hi teteri66,
    Well I've had several MRI's over the years, I have all my records but usually my wife just files this stuff in the boxes, yes boxes of records we've gathered over the years. We moved from the state where I had the surgeries and the last surgeon made sure we had everything before we left. I would imagine most if not all the MRI results are in there, I never really looked at the reports because most of them were before we actually had everything in hand, afterwards it's kind of overwhelming and there's nothing that can be done now with the old stuff, plus it's kind of depressing so....

    Anyway, all of the MRI's in the past were the standard lay down in a tiny, narrow horizontal tube. The last two were sit-down in a tiny, narrow vertical open faced contraption. Actually, it is alot better than the lay down style, at least you can watch tv while they do it.

    I'm having a bad night, so I'm going to have to type this in shifts, don't have a laptop - so hopefully I don't leave anything out or repeat things.

    As far as pain in my back, it is pretty much constant sharp pain in the L4-L5 area and it does radiate down into my butt and down legs (separate from the 'RSD' pain). It is hard for me to say that it is a sharp pain because it has been there so long that it does radiate out if that makes any sense. I know things are holding together down there but I feel broken, if that makes any sense. It just (pardon my language) sucks - constant is the best word for it. Sitting in vehicle makes things worse on back, I have yet to sit in a vehicle that didn't.

    I switch between standing and sitting - kind of rotate every 20-30 min of each because if I don't it (back pain) gets worse. When I sit too long the sharp pain gets worse but oddly if I stand too long the sharpness doesn't get worse but the muscles get really tight.
    Ever since the 2nd surgery, my spine in fusion area feels like it is curved too much in the extension (?) - like I'm bending backwards all the time, so when I do bend backwards it hurts bad, but I can do it.
    Standing too long gets the legs to become more painful (the rsd stuff) and start to swell up and get red. When the redness hits a certain shade that hyper-sensitivity starts really starts kicking in. It is better than the years right after the last surgery when all that was constant no matter what I did or didn't do. The Gabapentin does help a little, mostly with the heavy leg (really tired, treading water feeling) and keeps the other symptoms from extreme breakout.

    Bending forward for too long (measured in minutes - say 3-5 minutes) really hurts, if I do, I can not straighten for several minutes, the pain gets so bad it takes my breath away until I can straighten up. Its close to blackout pain.

    Laying down doesn't help really, I never sleep more than a few hours at a time at the most even with generic Ambien. Sometimes I just can not sleep and stay awake for a couple days until I pretty much pass out, even then I wake up constantly. I can sleep in a recliner, same as bed though, only for short periods.

    Walking does relieve back pain but the leg thing gets worse. If I go for too long of a walk the whole 'rsd' stuff I mentioned when I stand too long kicks in, so I'm trading temporary relief of one pain for making the other worse.

    Overall, I think the back is the lessor of the two evils. But I don't know - just wore out from it all.

    If I wasn't wondering about the 'Slight circumferential disk bulging is seen.' were there is no disc, I probably wouldn't be telling all this - I know it could be worse, I've read some of the post here and other places. I've seen people with that rsd in their heads and quite frankly my heart breaks for them, I can't imagine how they deal with it.
    I try not to be a whiner about it all, and I'm not saying others are whining so I hope no one who reads this thinks I'm saying that - I just feel like that when I complain or have to go into details.

    Thanks for your help.

     
    Old 06-30-2013, 07:08 AM   #4
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    Re: MRI report, please help - back surgeries, resulting in RSD

    Your not whining Hun your venting! It has to come out eventually, and here people totally get what your feeling! So vent away! I hope you get some relief soon!
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    Old 06-30-2013, 09:34 AM   #5
    teteri66
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    Re: MRI report, please help - back surgeries, resulting in RSD

    It sounds like your "story" could be used for the example when some surgeons tell their patients, after the first failed fusion, that any further surgery might make things worse.

    I understand you had the new MRI because you fell and just wanted to be sure that there were no new problems caused by the fall, right? I can't say why that was written about the disc. I had the same thing happen, also at L4-L5 where I had a PEEK cage...I asked my surgeon about it, and he could find no reason why the report said it was bulging -- just a mistake.

    You are correct in that the MRI report doesn't show anything that would point to a cause for your pain. My guess is that the pain you are dealing with is a result of the damaged nerves caused by the earlier surgeries. Perhaps the impact of the fall shook things up a bit and caused enough inflammation that it made the nerve pain worse -- but it doesn't look like anything new has occurred. It does refer to slight disc bulging where you had the fusion.

    L5-S1 LEVEL: Slight circumferential disk bulging is seen and it says the same thing at L4-L5, L3-L4, L2-L3 and L1-L2. I would agree that you should not have discs at the levels that were fused, assuming both had cages or some sort of disc spacer. (I am fused from L3 to S1 and I have discs at all levels except for L4-L5 where I have the PEEK cage. The other levels were added on and the discs were left in place because they were not the problem.)

    I think the reason you have the issue when bending is due to the arthrolisthesis you have at L4-L5. This means that the L4 vertebra is slipping forward over the L5 vertebra by 2mm. Since this is stabilized by the fusion, it might affect the extent to which you can bend forward or back. (If you want to look up photos, look for spondylolisthesis.)

    I find it interesting that your MRI was done without contrast. It makes it more difficult to see as the hardware throws off what is called "artifact." Usually when there is hardware, the MRI is done with contrast. It is possible they didn't want to risk it with your RSD.

    Obviously I am not a doctor nor do I have any medical training. I have learned a lot about nerve pain, however, when my first fusion (PLIF at L4-L5) was successful, medically speaking, but did not resolve my sciatic pain. I spent several years going from one specialist to another looking for a solution.
    Initially it was thought that the pain was a result of permanent damage to the spinal nerves at L5 and S1, but ultimately that turned out to not be the case. However, during that period, I learned quite a lot about nerve damage.

    It is a frustrating topic because it is still an area of medicine that is mystifying in many ways. The whole issue of the nervous system and pain is one area of medicine that is still not well-understood. There is lots of promising research going on, but that doesn't help you.

    You probably had nerve damage going into that last surgery, and then due to whatever happened during surgery, it further intensified the problems. I think what your MRI shows is not affecting how you feel. Nerve damage doesn't really show up on MRI except for showing there is nerve compression and/or nerve clumping. Neither of these issues are mentioned in the report, so I am guessing that there are other types of nerve damage that do not show up on this type of testing.

    I would imagine that the best you can do at this point is to find someone in pain management who is a specialist in Complex Regional Pain Syndrome.

    You provided so much detail that I had trouble absorbing it all at one time. I apologize that my response is rather disjointed. I'm going to reread your posts tonight to see if I can come up with any helpful suggestions. I'm really sorry you find yourself in this position. More later....

     
    Old 06-30-2013, 10:29 AM   #6
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    Re: MRI report, please help - back surgeries, resulting in RSD

    Hi jeff, I do have nerve clumping, arachnoiditis & it causes similar neuropathy issues as RSD like burning, erythromelelgia, temperature in extremities feel cold or on fire, painful to light touch etc & im so sorry for the suffering, i understand because i had pain & other symptoms for years before i was finally told my diagnosis. Its hard to differentiate which is which in my case as far as central nervous system or autonomic nervous system symptoms or damage, EMG & nerve conduction studies help diagnose damage to CNS & there are tests that check for damage to sympathetic nervous system as well but i cant remember the name! I had a lot of difficulty finding a dr after my diagnosis & i saw 3 spine neurosurgeons, a pain mgmt NS, a PM dr & finally see a physiatrist but it was a peripheral vascular dr who administered these tests as well as doppler studies. Lyrica makes the neuropathy symptoms so
    much better for me & i take a beta blocker for the sympathetic
    nervous system symptoms. I really hope that you find the right specialist & a working treatment plan can be implemented & hope that you find help & relief soon!

    Last edited by gmak; 06-30-2013 at 10:33 AM.

     
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