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Cervical And Lumbar Fusions, Decompressions, Disc Protrusions, Cord Deformation. Cause Of Lower Back Pain ?
Question: I'm 57, weigh 185 lbs., 6'1" tall. Have history of multiple cervical and lumbar fusions and decompressions. Previous lumbar surgeries did not resolve lower back pain issues. Condition so painful I'm taking 10 mg. oxycodone/325 apap to control pain six times per day. I just completed thoracic mri today. radiologist's summary states multilevel significant disk protrusions with resultant multilevel severe axillary recess narrowing with levels of cord deformation. Could this area be the source of my lower back pain and can this be surgically treated?
Hello XXXXXXX
Thanks for the query.
The MRI report provided indicates that multiple levels of the spine have been affected. Hence they definitely could be the cause of your persistent backpain.
Let me explain the findings of the MRI.
Behind discs and vertebral column lies the spinal canal and spinal cord. Only posterior margin of disc is in contact with spinal canal and two neural foramina on either side. This posterior disc margin can be divided into central portion and paracentral portions on either side. Immediately behind this margin lies anterior cerebrospinal fluid space containing CSF. Axillary recess are lateral CSF spaces on either side of spinal cord. This space is between disc and spinal cord and prevents any compression of nerve roots and spinal canal. These spaces are narrowed in your case.
Compression of the cord and the nerve roots due to the vertebral disc protrusion and narrowing of the axillary recess are likely the cause of your symptoms.
Some measures that are indicated in treatment of your condition include :-
Exercise. Improving back strength and flexibility with simple exercises may lessen discomfort.
Nonsteroidal anti-inflammatory medications (NSAIDs). Drugs like aspirin and ibuprofen can reduce swelling and painful symptoms.
Epidural steroid injections. Cortisone is a powerful anti-inflammatory. Cortisone injections in the "epidural space" can decrease swelling as well as pain.
Surgery might help you since you seem to have severe or disabling pain. It will help to prevent worsening of the condition and development of neurological complications. But Since multiple areas of involvement would mean that you might need a procedure like laminectomy or laminoplasty, which will probably be more helpful.
You might consult a orthopedic doctor, specialized in spinal surgery who can examine the MRI and then treat you accordingly.
I hope this helps. Please feel free to contact me , if you have additional doubts or questions.
Regards
Thanks for the query.
The MRI report provided indicates that multiple levels of the spine have been affected. Hence they definitely could be the cause of your persistent backpain.
Let me explain the findings of the MRI.
Behind discs and vertebral column lies the spinal canal and spinal cord. Only posterior margin of disc is in contact with spinal canal and two neural foramina on either side. This posterior disc margin can be divided into central portion and paracentral portions on either side. Immediately behind this margin lies anterior cerebrospinal fluid space containing CSF. Axillary recess are lateral CSF spaces on either side of spinal cord. This space is between disc and spinal cord and prevents any compression of nerve roots and spinal canal. These spaces are narrowed in your case.
Compression of the cord and the nerve roots due to the vertebral disc protrusion and narrowing of the axillary recess are likely the cause of your symptoms.
Some measures that are indicated in treatment of your condition include :-
Exercise. Improving back strength and flexibility with simple exercises may lessen discomfort.
Nonsteroidal anti-inflammatory medications (NSAIDs). Drugs like aspirin and ibuprofen can reduce swelling and painful symptoms.
Epidural steroid injections. Cortisone is a powerful anti-inflammatory. Cortisone injections in the "epidural space" can decrease swelling as well as pain.
Surgery might help you since you seem to have severe or disabling pain. It will help to prevent worsening of the condition and development of neurological complications. But Since multiple areas of involvement would mean that you might need a procedure like laminectomy or laminoplasty, which will probably be more helpful.
You might consult a orthopedic doctor, specialized in spinal surgery who can examine the MRI and then treat you accordingly.
I hope this helps. Please feel free to contact me , if you have additional doubts or questions.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
more complete discussion of findings:multiple Schmorl's nodes indent endplates within mid to lower thoracic spine.(no evidence for bone marrow edema around these nodes) At T5-6,disc protrusion with mild to moderate right axillary recess narrowing;at T6-7,focal left paracentral disk protrusion which contacts and deforms the left anterior aspect of the spinal cord;at T7-8,disk protrusion with mild left axillary recess narrowing;at T8-9, left paracentral disk protrusion with moderate left axillary recess narrowing;at T9-10, prominent rightg paracentral disk protrusion with severe right axillary recess narrowing;at T10-11, right paracentral disk protrusion with moderate right axillary recess narrowing;at T11-12, focal right paracentral disk protrusion with severe right axillary recess narrowing. at each of these levels radiologist ends with noting no evidence for central canal stenosis and no evidence for neural foramenal stenosis. How does this additional information affect your previous comments on my condition? Thanks for your help!
Hello XXXXXXX
Thanks for the follow up.
From the additional information given, it indicates that the T 6-7 disc protrusion is mostly the cause of your pain. Other sites that are severely affected include the T9-10 and T 11-12 levels.
The management (medical or surgical) strategy and treatment measures remain the same as mentioned above.
Since multiple levels are affected, laminectomy or laminoplasty would be the best surgical option to prevent progression of your symptoms.
I hope this helps to clear your doubts.
Regards.
Thanks for the follow up.
From the additional information given, it indicates that the T 6-7 disc protrusion is mostly the cause of your pain. Other sites that are severely affected include the T9-10 and T 11-12 levels.
The management (medical or surgical) strategy and treatment measures remain the same as mentioned above.
Since multiple levels are affected, laminectomy or laminoplasty would be the best surgical option to prevent progression of your symptoms.
I hope this helps to clear your doubts.
Regards.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Shanthi.E
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