Can you help me wrap my head around things...

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10sox

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I met with my dr today for the results of my myelogram. He was shocked to see something that wasn't on my MRI's. I don't know how to explain this, but I will try. I guess when the dye is injected it flows into the disc area. Well all was good in my problem disc (L5) but the dye was not flowing in the L4 area like it should. He thinks I could have possible stenosis and maybe a bone spur that is causing my leg pain. He said this could explain the myelogram results. In order to know for sure, he is sending me for a Nerve Root Block. I will be injected with a temporary nurabing agent and if my pain goes away, then his assumptions will be correct.

He was very intrigued by my test results and did spend quite a bit of time reviewing the scans. Unfortunately, he was running late and we had to rush out to pick up my daughter from preschool. I am having a hard time understaning what is going on with my back. My history is DDD, with two large disc herniations at L5-S1. If the nerve block does work, then what are the usual next steps for a bone spur?

Thanks!
 
10,
The dye in a myelogram flows around the spinal fluid and the nerves and in your case nerve roots. The dye stopped or slowed in the flow pattern around the L4 level. That is called is stenosis, which is a narrowing of the flow of the spinal fluid and a pinching of the nerve roots. The usual "cure" for that is a laminectomy or laminotomy.
He may be doing the nerve root block to see if the spinal nerve rootlet is effected at that level.
Myelograms have nothing to do with the discs themselves, other than to see if the disc herniations are blocking off the flow of the dye/contrast.
The bone spurs usually occur because of the thinning of the disc causes the bone of the vertebrae to grow to try to compensate....
Hope this helps explain it......
Backhurtz
 
Backhurtz-
Thanks you soooo much! Your explanation was exactly what I needed and now it totally makes sense.

So, if this Root Injection does take my pain away, then what are the usual steps to correct stenosis and a bone spur. I have already had 2 back surgeries and really don't want a third. The dr. wants me to get 2 more opinions from other surgeons as well. He doesn't think this is causing all of my issues, but could very well be causing a good amount of my pain.

Thanks again!
10sox
 
I think your doctor is right on the money in asking you to see two other surgeons for their opinions.
If the nerve root injection works, he may recommend steroid injections to see if that calms the inflammation.
If not , the surgeons may recommend a foraminotomy to open the nerve root sleeve, but with the central canal stenosis, you may be looking at a fusion. I am not a doctor, but that's what was recommended for me when I had similar problems.
I hope that it doesn't come to that for you. What types of surgery have you had already?
Back
 
Back-
Thank you again for your response. I have had 2 microdiscectomies on my L5-S1. The second herniation was the largest my surgeon had ever seen in his career (according to him).

My last surgery was one year ago (Oct 07). Since that time, my pain has increased down my leg and buttocks. During the past year I have had 3 epidural steroid injections. They help with the pain tremendously, but only last for about 2 months.

So, if the bone spur is pressing on my nerves and causing my pain, I am not sure what else to do besides remove it?

Thanks again!
10sox
 
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