Doctor doubletalk

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datedwards94

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I went to see a bone and joint surgeon about back pain and left leg pain I have been getting. On February 27th. He mentions Point tenderness over the LS junction. mild restriction of forward felxion and extension. IMPRESSION: Significant Degeneration. X-Rays - Mild degenerative changes at L4-5, 5-1 and sclerosis of the facet joints. There is some minimal straightening. IMPRESSION: Significant degenerative changes.
He then sent me for an MRI. The report FINDINGS: Scattered partially visualized bilateral renal cysts are present. At L1-L2: No significant spondylosis or stenosis. Subcentimeter subchondral cyst present at the anterolateral margins of the bilateral facets. At L2-L3: No significant degenerative changes or stenosis. At L3-L4: Mild diffuse disc bulge is present with mild bilateral neural foraminal stenosis. Minimal central canal stenosis is present. At L4-L5: Mild diffuse disc bulge present with mild to moderate bilateral neural foraminal stenosis. No significant central canal stenosis. Minimal degenerative facet disease is present. At L5-S1: Moderate degenerative facet disease is present with advanced left and moderate right neural foraminal stenosis present. No significant spondylosis or central canal stenosis. IMPRESSION: Lower Lurabar Degenerative disc and facet disease with central canal and neural foraminal stenosis most pronounced at the lurabosacral junction.
On March 21st the doctor stated in his notes - Recent MRI was discussed with him showing some degree of degenerative disk disease with some degree of foraminal stenosis at the LS junction. Discussed possible epidural steroid injection. Suggested changing from Mobic to Lodine.

I don't get this parts say significant then some degree. This guy is trying to put me on Arthritis medicine. I previously saw a chiropractor after a car accident and she stated I have bone spurs all up and down my spine and over time my back will bend to where it looks like I am hunched over and looking down. I have some sort of straightening of my back.

I am trying to figure out what is going on with my back and how to correct it, if possible. Can anyone help me understand all this terminology and why it sound like doubletalk and like the doctor is trying to avoid something?
 
Hi. Well you sort of do have arthritis in your spine. It's at your facets, aka degeneratvie facet disease. An anti-inflammatory should help you reduce your pain in these areas some or alot.

I would not heavily rely on the chiros diagnosis to be honest. And on this particular board, they are not well received here by most. They do have merit, but not with any serious spine issues going on, and without a spine doctor's recommendation to be seeing one. Was the Chiro actually able to order an MRI or CT Scan and see the spurs he/she mentioned you had? How was it concluded you had spurs all over?

Your MRI report you showed here does not show or mention spurs.

I can't speak to the renal cysts though I know what they are.
As to your MRI - you have a few things going on in your lurabar spine. Your facets are aging and are somewhat arthritic as best easily described. You have two bulging discs at L3/L4 and L4/L5 (which means the discs outer shell is sticking out into the spine canal) and can press on the nerves (spinal cord). You have foraminal stenosis at both these levels and one of those levels also having central canal stenosis. The foramen is the canal that the spinal cord runs through in the spine. Foraminal stenosis can only be relieved one way that I know of, which is surgery. There are a few different stenosis' but foramen stenosis is generally caused by a bony/calcification around each opening which narrows the canal down and can either cause pinching or irritation to the spinal cord that runs through it. If it becomes significant enough, surgery can be done to "hone out" the opening and allow the spinal cord to run freely through.

The purpose of the injections is two-fold. To reduce inflammation and reduce pain. They are often done in a series and since you also have facet issues, there also injections that can be done at the facet joints as well.

What you have is not an easy fix and the stenosis is not something that can be prevented anymore than the aging of your spine can. You can try and stay as healthy as possible in hopes of less risk of injury and further degeneration of the spine, but it simply can not be prevented. Being healthy and fit is not even a guarantee. I was young and very fit when my back issues began.

I encourage you to make sure you are seeing a spine surgeon, preferably who only does spines with what you have going on. And if surgery is brought up, I encourage you to seek another spine surgeon's opinion before committing to surgery and all other non-surgical methoRAB have proven futile. Surgery should always be a last resort.

Please keep us posted.
 
Hey Dated,

I'm 39 too with similar issues and share your frustration. I echo what everyone else says about seeing a doc who specializes in the spine. As for arthritis meRAB, give it a try. I have bone spurs and both facet and SI joint problems and recently started on a patch called Flector, which is a non-steroidal anti-inflammatory drug that I put on my back twice a day. It doesn't solve all my problems, but it does help with the arthritis and I noticed a difference after only a few days.

As for steroid injections, most of us have gone that route. They're a temporary fix, but if they help you can get relief for a period of time and reduce swelling. Physical therapy can also really help you build a foundation of exercises to do and teach you correct posture and positioning of your body to help allay future problems. Would definitely recommend doing PT over seeing a chiro for your issues.

What you really need to do, as the others say, is find an orthopedic surgeon or neurosurgeon who specializes in the spine who can interpret your MRI for you (bring the films!) and advise you on treatment options. As Justoneofus says, you may need to see more than one.

Good luck to you!

Schragie-girl
 
i would listen to justoneofus on this question
im 36 and suffered cervical spondylosis for 7 years now, if you can cope or control the pain, then avoid surgery, chiros ok but your better of with spinal expert that deals with spines 24/7,
with me the damage is high up so even riskyer to oporate on,
iv had facet joint injections, not the most pleasent day out but i kid you not
48 hours i was a different man!! could of kissed the sky
how ever they are not garunteed to work for every body,
but i would recomend it to anyone whos offered them.
they didnt last very long on me i must admit, but with others iv spoken to they have lasted for years and iv met some one who claims he has been free of pain ever since he had them many years ago.
give em a try you never know, you could be one of the luck ones
good luck
 
Just had an MRI performed on the cervical part of my spine. the MRI report reaRAB: TECHNIQUE: Multiplanar noncontrast T1 and T2-weighted imaging of the cervical spine. FINDINGS: No intrinsic pathology identified in the cervical spinal cord or partially visualized brain stem. C2-C3: No significant degenerative changes or stenosis. C3-4: Within ormal limits. C4-5: Within normal limits. C5-6: Diffuse disc bulge is present with moderate central canal stenosis. No neural foraminal compromise. C6-7: Diffuse disc bulge inluding right paracentral disc protrusion is present with moderate to advanced central canal stenosis. Mild to moderate bilateral neural foraminal stenosis present. C7-T1: Within normal limits. The previous MRI I had done of my lurabar spine reaRAB: The MRI report reaRAB: TECHNIQUE: multiplanar T1 and T2 weighted imaging. FINDINGS: Normal signal and morphology present in the distal spinal cord. Scattered partially visualized bilateral renal cysts are present. At L1-L2: No significant spondylosis, or stenosis. Subcentimeter subchondral cyst present at the anterolateral margins of the bilateral facets. At L2-L3: No significant degenrative changes or stenosis. At L3-L4: Mild diffuse disc bulge is present with mild bilateral neural foraminal stenosis. Minimal central canal stenosis is present. At L4-L5: Mild diffuse disc bulge present with mild to moderate bilateral foraminal stenosis. No significant central canal stenosis. Minimal degenrative facet disease is present. At L5-S1: Moderate degenrative facet disease present with advanced left and moderate right neural foraminal stenosis present. No significant spondylosis, or central canal stenosis. IMPRESSION: 1. LOWER LUrabAR DEGENERATIVE DISC AND FACET DISEASE WITH CENTRAL CANAL AND NEURAL FORAMINAL STENOSIS MOST PRONOUNCED AT THE LrabOSACRAL JUNCTION. IMPRESSION: LOWER CERVICAL SPONDYLOSIS WITH MODERATE TO ADVANCED CENTRAL CANAL STENOSIS AS DESCRIBED ABOVE.
 
I saw the chiro probably seven years ago. All she took were x-rays. I have since given those x-rays to my cousin who is a practicing chiro since the one I was seeing joined her practice with another and closed her office. The MRI was ordered by a bone and joint surgeon that I saw after a trip to the ER. They only did the MRI of the cervical and lurabar area. He also took x-rays and does not seem to want to discuss anything but surgery or the steroid injections. He lacks a personality. So I am looking for someone else. I am only 39 years of age an everyone that goes to him are in their 60 and older. I was referred to him by the ER and have dealth with him one time in the past and was not too impressed. I was stabbed in the hand during an attempted robbery and saw him for three weeks before he reeferred me to a hand surgeon who told me two minutes into the appointment I had a lacerated tendon going to my thurab and if he had stitched it it would have healed but now required surgery.
 
Having had so many spine MRI's that I could cover the walls of an entire room, I'll try to decipher for you. BTW, I always get copies of either the films or a CD and a copy of the report.

Cervical: between C2 and C5 your spinal canal and disks looked normal. At C5-C6 you have a disk that has ruptured but it is a rupture that is wide and flat and not pressing on anything like your spinal cord. The bones of your vertebrae are showing some narrowing(stenosis) on the spinal cord but not touching it. The nerves exiting the vertebrae on either side are normal and show nothing pressing on them. At C6-7 You have another bulging disk that is bulging more in the central area toward your spinal cord. this along with more advanced narrowing of the bones of the vertebrae means it's getting pretty tight in there. And there is a similar snugness where the nerves exit the sides of your vertebrae. C7-T1 is normal. Interpretation...you are developing a real tight area at C6-7 where you will need to be monitored for the disks starting to press on your spinal cord and you may be feeling pain down your arms from the narrowing of the exiting nerves.

Lurabar:L1-2 No narrowing of the canal or arthritis(spondylosis). There is a small fluid filled cyst near one of the facet joints. The facet joints are on the back of the vertebrae and far away from your spinal canal. Many joints, small and large, with arthritis, develop little cysts that are like waste baskets for the bone and cartilage that is wearing away. they are harmless unless they get really large and press on a nerve. L-23....fine. L3-4 again have another wide disk bulge and some narrowing of the outlet where the nerves leave the vertebrae. Your spinal canal has a little bit of narrowing(stenosis)but nothing is touching your spinal cord. L4-5 is about the same but has less narrowing of the spinal canal as you have above it. Your facet joints on the back of the vertebrae have a minimal amount of arthritis. L:5-S1 shows more moderate arthritis in the facet joints on the back of the vertebra but here is your big problem. You have advanced narrowing of the area where the nerve exits the vertebra on the left side and moderate narrowing of the area where the nerve exits on the right side. So I would suspect you have some pretty bad pain going down your left leg and possibly your right as well.

Interpretation of the Impression.....You have arthritis in the lower part of your cervical spine with that is causing some moderate to advanced narrowing of the spinal canal. In the lurabar spine, you have arthritis in the facet joints on the back of the vertebrae, the disks are starting to slowly degenerate and form bulges, some narrowing of the spinal canal and advanced narrowing of the areas where the nerves exit the vertebrae to your lower lirabs.

I am not a radiologist or in the medical profession but I've had the same results in my MRI's and have asked for detailed explanations of what each term means. I also have educated myself as best I can. ***REMOVED***.

But take heart in one thing. You may have the nerves coming out of the vertebrae that are being "squished" but your spinal cord is not involved. That is good news.

Any other questions, I'll try to help.

gentle hugs............Jenny
 
You need to take your MRI to a spinal specialist. This could be either a neurosurgeon or an orthopedic surgeon who has specialized training and only works on issues of the spine. A general orthopedic surgeon has some training on issues of the spine, but not to the extent of a doctor who only works on spines.

Often physical therapy is the first treatment that is tried, followed by the epidural injections. Doctors usually want you to try everything possible before commiting to surgery.

Surgery is primarily done for pain relief. If you can live with the amount of pain you have, you can avoid surgery. It sounRAB like you have some pinching of the sciatic nerve and this is causing you the leg pain you refer to.
 
Hi Dated, how far away are you from Philly? I only ask because i used an orthopedic spine specialist based in Philly for my surgery. I did have to fax them all my MRI reports (I also faxed my phyiscal therapy reports) and wait a few days, but they did call me back and tell me the surgeon I had requested would definitely see me for a consulatation. The group is pretty well known an renowned....
 
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