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Pls help me read my CT Myelogram


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Old 08-27-2018, 12:19 PM   #1
SophSam
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Unhappy Pls help me read my CT Myelogram

Hello I could really use some help. I’ve been suffering from chronic neck pain for about 15 yrs and back pain for about 5 yrs. I had a fusion at C5-7 in 2011 with no relief of pain. I’ve ran the gamut of specialists from chiro, massage, PT, Pysio, trigger point injections, nuerotomy, multiple ESI’s and even a spinal cord stimulator to no avail, the pain is still there and still an achy, burning, constant pain. Then about 5 yrs ago it started in my low back and has progressively gotten worse. I had a spinal cord stimulator placed about 4 yrs ago by my pain specialist to help the pain. This helped for about 6 months, they have not been able to get it to program correctly to cover my pain. My pain is in my low back to where it constantly feels like someone has their fist digging into my back. I also have right side pain at the hip/buttock area that is sharp and constant and is starting to cause aching type pain in both legs. I finally had enough and had my pain specialist refer me to a neurosurgeon to see about maybe replacing the stimulator to see if I could possibly get coverage in my area of pain. He of course wanted recent imaging done before he would even agree to see me. As I can’t have an MRI right now because of the stimulator I had a CT myelogram. He didn’t know of my neck problems at the time of the ordering of the scan so it was done only at the thoracic (so he could see the placement of the stimulator leads) and the lumbar. I had a visit with him 2 weeks ago. He said since I’ve had so much stuff already done and am still in pain I was a bit of a challenge case for him. I explained that 15 yrs of neck pain and 7 yrs post fusion and still in chronic pain from that as well. He then wanted me to have a nuclear medicine bone scan so he could look at the bones of my spine. I had that done on Friday (8/24) and do not have results of that yet. He did say however that based on the results on my CT myelogram of my back that he could do a fusion and that would take away all of my back pain and I wouldn’t need the stimulator and that he could take that out at the same time. He however didn’t really go over the results of the scan, just that he wanted me to do the bone scan and come back for a follow up visit. I see him again on September 17th - here are the results of my CT Myelogram and my flexion/extension X-ray if anyone could help me. Is it bad enough to need a fusion? Is there a way to be rid of my pain without one? I live alone and fear the recovery time of the fusion however I just really want to be out of pain. I am getting ready to turn 50 in a few days. I would just like to not only do normal daily activities without pain, but I want to be able to pick up my 5 month old grandson or get on the floor and play with my 4 yr old granddaughter.

CT Myelogram:
L4/5 level demonstrates diffuse degenerative disc bulge resulting in mild narrowing of both neural foramina
L5/S1 level demonstrates significant disc space narrowing, vacuum space phenomenon, endplate sclerosis and osteophyt formations. Spinal canal is patent, there is moderate bilateral neural foraminal stenosis

Flexion/extension X-ray: pronounced L5/S1 disc space narrowing with endplate sclerosis and lower lumbar facet arthropathy. Impression: moderate to severe L5/S1 degenerative disc disease and lower lumbar facet arthropathy

Any help would be gratefully appreciated. Is this bad enough to warrant a fusion with 5 yrs of back pain with all conservative treatment tried? I am on heavy pain meds and some days it barely touches the pain. I just want off this roller coaster and I want to enjoy my life. Thank you

Joy

Last edited by SophSam; 08-27-2018 at 12:24 PM.

 
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Old 08-28-2018, 05:22 AM   #2
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Re: Pls help me read my CT Myelogram

Welcome to the board. I am sorry you have been suffering with pain caused by spinal issues for years.

As you know, a CT scan does not provide the depth of information that a MRI can...but it is enough to see there are problems in the lumbar spine that correlate to the lower back and leg pain you are experiencing...specifically at L4-5 and L5-S1.

Degenerative disc disease refers to the wear and tear on spinal discs that causes neck and/or back pain. It often goes hand in hand with spinal arthritis...which is what is going on from L4-S1.

At L4-5 there is a disc bulge that is spilling out of the disc space and pushing into the neuro foramina, which are the openings located at each vertebrae that allow the spinal nerve to exit the spine and go out to innervate a particular area of the body. (Look online for a dermatome map to see which dermatome covers which area of the body...keeping in mind our individual bodies do not have quite so clear demarcations as shown on the chart!).

When a foraminal has something pushing into it or it becomes clogged up, the spinal nerve cannot function normally. This results in pain, tingling, numbness, etc. That can be felt either at the specific site in the back/neck or anywhere along the path the nerve travels....thus a C6 nerve compression can cause numbness in the thumb...or a L4 compression can cause the big toe to become numb...etc.

At L5-S1 it looks like there is more degeneration of the joint. The disc space is narrowed, meaning the disc is collapsing or dying out, there are bone spurs that have formed and there are other degenerative processes going on as well. There is no narrowing of the central canal but again, the foramina are showing signs of moderate stenosis (on a "scale of: minimal, mild, moderate and severe).

The X-ray reinforces these findings, showing moderate to severe arthritis and degenerative disc disease at L5-S1.

Now, as to your other questions...given your cervical issues, it would be difficult to guess to what extent these lumbar findings are responsible for your current pain. Hopefully the bone scan will provide some information that will be useful to the neurosurgeon.

To what extent has the SCS been helping with your pain?

Do you know if the surgeon is thinking a one or two level fusion is needed?

My guess is that given your prior cervical spine history, the surgeon is thinking a smaller procedure would simply be a temporary solution. The primary reasons for doing a fusion are instability and nerve compression. You do not seem to have any instability...at least no spondylolisthesis is noted. No specific nerve compression is noted either but with the foraminal stenosis you are bound to have some.

It might be possible to go in and clean out the stenosis by means of a smaller procedure like a laminectomy, but my guess is that with the amount of degenerative disc disease, the surgeon thinks the fusion is necessary to provide more long term benefit.

 
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Old 08-28-2018, 05:05 PM   #3
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Re: Pls help me read my CT Myelogram

Thank you so so so much for your reply. My surgeon hasnít yet said what exactly his plan is. He got a complete history from me from every different kind of doctor or physical therapist or chiropractic or naturopathic or psyiotherpist out there. Iíve tried everything 2 different pain management centers have tried to get the pain to stop. My neck first and then my back. He said that he could replace the stimulator to a more advanced one and place the leads closer to where I need them, or he could do a fusion and he said he could take away all my pain and I wouldnít need the stimulator so he would remove it. The stimulator only covers my sides really and kind of wraps around to my stomach. Iíve had it programmed so many times, and once one of the main Boston Scientific programers flew out to my PM clinic to personally see me to try and get it programmed and even he couldnít do it. The stimulator was first placed by my PM doc but the leads skipped so I had to go to a neurosurgeon for another surgery for him to go in there and do a stronger placement in my thoracic area. I believe that was done as a lami. Recent X-rays however show that either my spine moved or he didnít place the leads correctly. They never came right out and told me he did a crappy job of placing the leads thus the reason it canít be programmed but it was alluded to be the case. My CT myelogram also showed some mild degeneration and bone spurs throughout the thoracic but thatís mild for now. For the first few months it covered my main area of pain at the time which was at the mid low back area, like right in the small of the back. Constantly aches and just feels like someone has their fist jammed up in there. Then about 6 months ago I got a sharp pain on the right side kidney area. I thought at the time it might be kidney pain but then just figured it was probably a pulled muscle. It came and went for awhile and now that pain seems to be an everyday part of me too. As well as sore and achy legs. I try to walk as much as I can. I have 2 dogs and we usually take small walks of 10 mins throughout the day because thatís all that I can do. I wake up and my first movement creates that sharp pain in that low right side.

What is your opinion on what could still be going on with my neck? No doctor has been able to figure it out. They just keep calling it cervicalgia. My C/5-7 fusion was done because I was told I had DDD and torn discs also. A NCS showed nerve root compression at C/5-7 also. We tried conservative measures to get the annular tears to heal on their own but the kind of work I was doing and my work area was not ergonomically correct and so the same repetitive motion all day didnít help. I also tried a Medtronic stimulator and it never really helped much either, that was eventually removed. I tried 2 L&I claims, was denied of course so filed for disability. My neck always feels sore and achy and goes down into the shoulder blades and upper back. It also burns straight down the back of the neck. Just about the only relief I can get from that pain is if I can get it to pop, I know I shouldnít be doing it but it feels so much better, even if itís just for 5 minutes itís a relief. Iíve had this for 15 years now. I had to quit work at age 45 and go on disability because of my pain. Oh and I also had a rheumatologist diagnose me with fibro.

What part of arthritis do you believe comes from our genes? I started getting it at age 35. Is there something I should or could have done at that age to prevent this? I was raising 3 kids and working a full time job at the time.

Anyway thank you so much for taking your time to help me, itís really very appreciated.

I see my neurosurgeon on the 17th

 
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Old 08-28-2018, 06:29 PM   #4
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Re: Pls help me read my CT Myelogram

I would guess your spinal condition is a combination of genetics, occupation, daily wear and tear, what you eat, how you go about your day....obviously some of us are more likely to develop arthritis than others...some of our bodies just seem to manufacture more bony overgrowths, joint enlargement, etc. Some of us are born with a central canal that is a tad narrow...thus prone to stenosis as we age.

I trust you know that none of us on the board have formal medical training. We are just fellow spineys who share information and experiences. I've been on the board since the beginnings of my spine problems back in 2005 and have picked up many useful tips during that time. But I had to do a great deal of research on my own after my first fusion when my pain was not impacted at all and the surgeon couldn't figure out why not. Pain management and surgeon immediately suggested a spinal word stimulator. I said no thank you...and began a journey to find a doctor who would look beyond the most obvious.

I should probably tell you that I am not a fan of neurostimulators...I think they are just another "procedure" that makes money for the doctor implanting it...I think they are recommended too soon and too often...which was not the case a decade ago. Then they were considered as a last resort...when the patient had tried every other option without result and there was nothing left to do but try to treat the symptoms. In your case I would be concerned that there is now a lot of scar tissue from the various neurostimulators that have been implanted in your spine.

I'm not clear on whether the neurosurgeon who recommends a fusion now is the same surgeon who implanted the SCS? Do not believe any surgeon who tells you the fusion will take care of all the pain. He does not have a crystal ball...and with a spine with your past history, it would seem to me that you probably have some residual nerve scarring and damage. It may take away some of the lumbar issue but it will do nothing for anything above the level of the fusion!

 
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Old 08-31-2018, 05:28 AM   #5
SophSam
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Re: Pls help me read my CT Myelogram

Hello again. Thank you so much for helping me out. The neurosurgeon I am seeing now is not the same one that put in my stimulator. It was first put in by my PM doc and then when the leads started slipping he sent me to a neurologist that did a lami and supposedly fixed it so they wouldnít slip again, the lead implant is done at the thoracic level - this was all done 4 yrs ago. Fast forward to now - after yrs of trying to get me programmed correctly they sent me to a different neurologist to see if he can revise it. This is the doctor Iím seeing now. Iíve done yrs and yrs of research and felt like a guinea pig in my own body. When I was able to work I worked in a hospital as an admission specialist, registering all pts and doing all insurance work up, I was also for awhile a referral coordinator in an internal medicine clinic. I am however always eager to learn more and to hear others experience with their own spine issues and how and what has made them feel better. I received the results of the bone scan through my online chart and they donít seem too bad at all.

Impression: mild increase in focal uptake is noted along the spine slightly more prominent in the mid cervical, mid to lower thoracic and lower lumbar spine regions indicating mild degenerative changes. Very mild degenerative changes are also noted within multiple articulate joints. No other significant focal adnormality is identified within the axial or proximal appendicular skeleton to indicate an injury or other etiology

Comments: increased focal activity is noted within the mid cervical spine again involves C4-6 indicating some mild degenerative changes just above and include the upper portion of the C5-7 fused levels. Degenerative changes are identified in the lower lumbar spine involving L5-S1 level. No signifant facet athropathy is identified within the spine.

Hoping to learn more about what the game plan is when I see him on the 17th

 
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Old 08-31-2018, 07:41 AM   #6
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Re: Pls help me read my CT Myelogram

To me, the most significant finding in the bone scan report is: "No significant facet athropathy is identified within the spine."

This is very good news but also rather startling to me as the symptoms you describe could so easily be blamed on facet arthropathy! So, back to the drawing board...

I'm sure the 17th seems like a really long ways away!!

Last edited by teteri66; 08-31-2018 at 01:20 PM.

 
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Old 08-31-2018, 08:48 AM   #7
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Re: Pls help me read my CT Myelogram

The no facet athropathy I found kind of strange because in my CT myelogram it say there is facet athropathy in L5 I believe is what is said, so very very strange. Also I had all of my imaging done at the same facility with same radiologist reading them.

Oh well Iíll pop back in after my appt on the 17th and let you know what the neurosurgeon has to say - thanks a bunches

 
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Old 08-31-2018, 01:23 PM   #8
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Re: Pls help me read my CT Myelogram

The flexion/extension X-ray also showed facet arthropathy at the lower lumbar segments. This is why you rely on the spine surgeon to review the imaging not a radiologist!

 
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