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    Old 11-12-2009, 07:16 PM   #1
    abbeyg
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    Could someone explain this??

    I am 15 months out from a multi level fusion at T10 - L2. I recently had a bone scan done and cannot understand the results. The doctor only noted that the test came back abnormal.

    Posterior fixation is noted at T10/T11 as well as L1 and L2. There is horizontal activity at T12 in area of known benign fracture. There is focal activity within the right facet at L3 which is not radiograhically apparent. There is some loss of height involving the superior endplate of L5 without significant radiotracer activity. There is mild dextroscoliosis.

    Impression:
    1. Activity within the collapsed T12 vertebra. It is possible that this is within the inferior endplate of T11 fien the location. Note that ther has been a stable compression fracture at T12 since the 2008 exam.

    2. Unilateral right facet activity at L3. This is not radiographically apparent and may be due to mechanical forces secondary to the patient's mild dextroscoliosis.

    I had a burst fracture at T12 and a compression fracture at L2 in Aug. 08 and another compression fracture at L5 in Dec. 08. I am in continued pain, does any of this explain my pain??

    Thanks!

     
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    Old 11-13-2009, 01:24 PM   #2
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    Re: Could someone explain this??

    Abbeyg - could you describe your pain and symptoms and location? L5 is way outside your fusion and doesnot look to be called out on the report - so it probably healed. What originally happened to make you have surgery? So we can try to use just a process of elimination to see where your symptoms might be pointing and then when they explain it to you, you will understand it better. Besides pain are you having any urinary problems?

    You have some activity within your fusion at the T11 or T12 level. The reason they are not sure, over time you fused, and they cannot clearly determine if it is the T12 vertebrae or the T11 endplate. Enplates are the horizontal surface of the vertebrae. When they fuse you the endplates the bone graft all grow together. So for instance T11 vertebrae endplate would fuse with graft and T12 endplate when the disc is removed in this surgery.

    They call it collapse, I guess us patients could call it disintegration Again they are not positive it is the T12 vertebrae or the T11 endplate. The reason I asked what drove you to this surgery is sometimes in a fusion if the bones are not strong enough there can be future collapse. Since you have the hardware fixation - you having some strong support, but with that instability in there it might be able to cause symptoms.

    THe level adjacent to your fusion - L3 looks to be having unilaterial (one sided) problem in the facet joint. They say they couldn't see it on Xray but could see it on MRI. The facets are between the vertebrae. The facet joints are located on the back of the spinal column. There are two facet joints between each pair of vertebrae, one on each side of the spine. A facet joint is made of small, what they call knobs that line up along the back of the spine. Where these knobs meet, they form a joint that connects the two vertebrae. The alignment of the facet joints allows for bending forward and backward. The surfaces of the facet joints are covered by cartilage. A smooth, rubbery material that covers the ends of most joints. What they said is that this problem in your facets may be to your slight curve to the right (dextroscoloios) and that minor curve could be putting pressure there.

    FYI - people can get a lot of pain from the facets. When that cartilage gets damaged it can even wear away allowing bone/bone contact. Ouch!

    If you tell us what your symptoms are - maybe it will help answer some of your questions.

    Last edited by PNo; 11-13-2009 at 01:27 PM. Reason: spelling

     
    Old 11-13-2009, 06:42 PM   #3
    abbeyg
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    Re: Could someone explain this??

    Thank you for your reply. I will provide a little background.

    In July of 2008 I had a baby, I had a very uneventful pregnancy and very easy labor, well I didn't think so at the time ;-)

    In August of 2008 I was walking down the stairs at my home with my baby, he was 5 weeks old, and my foot slipped off the step and we fell. I did not tumble down the stairs rather fell directly onto the step that I had been standing on. I knew that I could not stand up and crawled to a phone to call for help. After 8 hours in the ER they did a CT scan and it showed that I had a burst fracture at T12 and a compression fracture at L2. The wanted to know if I had ever been in a major car crash, which I had not. I required emergency surgery and was fused from T10 through L2 with two rods, two hooks, two cages, and eight screws the next day. I went home a week later. Well not my home but the home of a relative that could help with me and the baby so that my husband could work.

    In November of 2008, I had a dexa scan and was told that I have osteoporosis in the spine and hip, I was told that my hip is much worse than my spine and I should have broken my hip when I fell.

    In December of 2008, I got sick right after Christmas, and while in the bathroom heaving I felt a pop in my back and down I went. I did not fall rather my legs just got so weak that I went down to the floor. I was told at the ER that I sprained my SI joint. I did not find out until the MRI in February of 2009 that I had a compression fracture at L5.

    My pain is everyday, somedays are not so bad, but other days I feel like I am 80 years old, and I am only 29.

    My pain is mostly on my left side, my mid back about my bra line, my rib cage, and my hip bother me the most. I also have lower back pain. It is not a constant pain, but I know if I try to do to much that I will pay for it. As the day progresses so does the pain. It is like a horrible cycle.

    My back has a bump that you can feel and see at my fusion that causes pain. I rotate with an ice pack and a heating pad so that I only take a minimum of pain meds. I am incredibly stiff first thing in the morning and the colder it gets the longer it lasts into the day. My hip also makes this loud popping sound that I had not heard before the surgery that is painful at times.

    Thank you again for your reply.

     
    Old 11-17-2009, 11:40 PM   #4
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    Re: Could someone explain this??

    Oh my abbeyg that sounds like a scary fall (congratulations on the baby). Thanks for giving more background. Sorry it took a few days - I have been bad for a week and trying to stay off computer.

    Thankfully you did not break your hip - it's bad enough with the back. Too scary to think you were throwing up and fractured! I broke a rib once coughing. Have you had a recent dexa scan on that hip?

    Well I am surprised based on the pain in your mid back and bra line that they didn't call out anything in the upper T's - when you talk to your doctor, ask if there are any bulges or anything there that didn't get notated. It could be muscular type pain - with the pressure being on your spine. With that mild curve you have perhaps you are having trouble there with alignment problems. Sometimes when we have problems in a part of our spine we can irritate and put pressure on other parts.

    Is your osteoporsis making progress with the treatment - that can cause pain too. I also hope you are not carrying/lifting your child(ren)

    If it were me I would suspect the pain at that bump to conitnue. Many of us who have had a fusion have some pain and tenderness at the fusion areas. However, you have that T12 area that is collapsing so maybe this is causing more pain than normal. I think that facet would be causing more lower back pain symptoms, but maybe what you think is hip is being caused by that facet?

    You are very young to have these problems - make sure to keep a good routine up with your doctor to be watching your spine on a yearly basis if you can against that osteoporsis!

    When do you go back?

     
    Old 11-25-2009, 04:24 PM   #5
    abbeyg
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    Re: Could someone explain this??

    Thank you again for the wonderful reply, you seem to be more knowledgeable than my dr.!

    Yes, I do lift my little guy...sometimes there is no way around it. He is very heavy at 32 pounds, but when I am by myself with him I have no choice.

    When you say collapsing do you mean that this is happening now as in after the surgery. If you could go into any further detail I would be appreciate it.

    I have not had another dexa scan yet....they wanted to wait until the spring to rescan and see if my calcium and vitamin d therapy are helping any. We finally got my vitamin d levels up at my last visit to the endo.

    I do not have another appointment with the ortho. I am thinking of getting a referral to another doctor. What little info I found out about my bone scan came from the endo. but the ortho. was the one who ordered it. I am also thinking about going to a rheumatologist. My endo. stated that it looked like I had arthritis starting my low back. So maybe a rheumy could help with that and the osteoporosis.

    Thanks again for your insite!

    ~abbeyg

     
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