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Oy, finally got my CAT and MRI

happyHBmomhhappyHBmom Posts: 2,068
edited 06/11/2012 - 8:47 AM in Lower Back Pain
Of course, no interpretations from the peanut gallery. But the CAT scan tells me why I've been feeling so much more pain- I have a retrolisthesis at L4/L5 AND facet hypertrophy at L5/S1 now. A lot of this stuff is new, although the actual fracture hasn't moved much, the parts below it are failing fast. (I OCRed this from a fax, if you find odd typos).

There is a severe burst compression fracture of the L2 vertebral body. No other compression fracture is noted.

The T12-LI disc space is mildly decreased in height. The neural foramina are widely patent. There is no spinal stenosis.

At the L1I-L2 level, there is narrowing of the disc space height. There is posterior encroachment on the spinal canal by the posterosuperior aspect of L2. It encroaches by 7.4 mm. It causes a moderate spinal stenosis. The residual AP diameter of the spinal canal is 9.7 mm. The neural foramina are widely patent.

At the L2•L3 level, there is decreased height of the disc space, There is mild spinal stenosis at this level caused by the posteroinferior aspect of L2. The L2-L3 facet joints are partially subluxed. The neural foramina are widely patent.

The L3-L4 disc space appears within normal limits. The neural foramina are widely patent. There is no significant spinal stenosis. There is degenerative facet hypertrophy, greater on the right side than the left.

At the L4-L5 level, there is 2.0-mm retrolisthesis. There is a diffuse 5.0 mm disc bulge. This has
moderate mass effect on the thecal sac. The neural foramina are widely patent.

At the L5-S1Ievel, there is narrowing of the disc space height. There is vacuum disc phenomenon.
There is a 3.0 mm disc bulge, which has mild mass effect on the thecal sac. There is mild encroachment on the right neural foramen due to facet hypertrophy. The left neural foramen appears widely patent.

IMPRESSION:
Page 1 of 2
l. SEVERE BURST COMPRESSION FRACTURE OF THE L2 VERTEBRAL BODY.
POSTEROSUPERIOR ASPECT OF L2 CAUSES MODERATE SPINAL STENOSIS WITH THE
RESIDUAL AP DIAMETER OF THE SPINAL CANAL MEASURING 9.7 MM.
2. MILD SPINAL STENOSIS, L2•L3 LEVEL.
3. 2.0-MM RETROLISTHESIS AND 5.0 MM DISC BULGE, L4-L5 LEVEL WITH MODERATE
MASS EFFECT ON THE THECAL SAC.
4. MILD 3.0 MM DISC BULGE, L5-S1 LEVEL WITH MILD MASS EFFECT ON THE THECAL
SAC
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Comments

  • And here is my MRI. I didn't understand most of it, which is fine- I see my doctor next week. They focused mostly on the actual fracture, while I'm more interested in knowing whether my lower back is deteriorating, but I can ask more questions next Wednesday so it's all good.

    HISTORY: The patient is a 43-year.old female with previous lumbar compression fracture following afall from a horse. She continues with low back pain. Previous MRI of the lumbosacral spine (July 7,
    2009) revealed marked compression fracture of L2 vertebral body, with retropulsion of the posterior
    vertebral fragments, effacing the thecal sac and causing spinal stenosis.

    PERTlNENT FINDINIGS: In the sagittal images, midline views reveal severe wedge-shaped anterior
    compression fracture at L2 vertebral body, with posterior displacement of the posterior aspect of the entire L2 vertebral body into the spinal canal (offset approximately 5.0 mm to 6.0 mm at both superior and inferior plates of L2). Severe degenerative and traumatic disc changes are noted in both the L1-L2 and L2-L3 interspaces; there is displacement of the anterior vertebral margin anteriorly and superiorly along the anterior border of the L1 vertebral body. L2 pedicles appear to be intact bilaterally. At least moderate central canal spinal stenosis is evident throughout the rostral•caudal extent of the posterior aspect of L2 vertebral body. Fat suppression imaging shows increased signal in the anterior aspect of the L1-L2 disc space and in the central portion of the L2-L3 disc space, suggesting edematous or sclerotic change. Lateral views reveal adequate foraminal parameters throughout sagittal imaging rostral-caudal field of view (T 11-T12 through L5-S 1 ).

    Axial images confrrm the presence of severe compression deformity at L2, as previously noted. There is central bony spicule projection into the thecal sac, in near contiguity with the cauda equina and possibly terminal conus medullaris (spinal cord ends at or around the superior portion of the L2 vertebral body, cauda equina extending there below). Moderate central canal narrowing pertains throughout the rostral-caudal extent of the posterior aspect of the L2 vertebral body. Lesser similar central posterior disc protrusions are also identified at L4-L5 and L5-S1, with minor contouring of the anterior central thecal sac as a result at both levels.

    Comminuted severe compression fracture defomlity at L2 vertebral body, as described; there is posterior fragment protrusion of virtually the entire posterior margin of the L2 vertebral body into the spinal canal, effecting longitudinal moderate central canal spinal stenosis over the rostral-cauclal extent of the posterior aspect of L2. Angulated vertebral fragment is noted centrally in the canal at the mid point of rostral-caudal L2 extent, causing contouring of anterior thecal sac; this portion of the comminuted vertebral compression fracture appears to be caudal to the conus, with posterior displacement of the individual cauda equine elements noted.

    Comparison is made with the patient's previous study (July 7, 2009); allowing for slight differences in
    technique and technology, the present study appears basically similar to previous.

    OVERALL INTERPRETATION:
    SEVERE COMMINUTED COMPRESSION FRACTURE DEFORMITY AT L2 VERTEBRAL BODY, WITH ASSOCIATED MODERATE CENTRAL CANAL SPINAL STENOSIS, AS DESCRIBED.
    TRAUMATIC DISC CHANGES ARE NOTED IN THE Ll-L2 AND L2-L3 INTERSPACES,
    ASSOCIATED WITH THE L2 COMPRESSION DEFORMITY.
    BONY SPICULE FRAGMENT PROTRUSION ANTERIORLY AND SUPERIORLY ALONG THE ANTERIOR MARGIN OF THE L1 VERTEBRAL BODY.
    MINOR CENTRAL POSTERIOR DISC PROTRUSIONS AT L4•L5 AND L5-S , WITH MINOR
    CONTOURING OF ANTERIOR THECAL SAC.
    CT SCAN OF THE LUMBOSACRAL SPINE MAY BE ADDITIONALLY HELPFUL FOR FURTHER
    BONY DETAIL, IF CLINICALLY INDICATED.
  • Wow you're a mess - lol. At least you have an answer for the pain. Now you can ask the doc next week if he has the technology to fix this.

    You do realize that your fall makes me want to keep my daughter away from horses. Every time she rides I am scared. She has already had a few falls and a broken arm. OMG what mothers have to deal with !!!
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  • It appears that your back took very good pictures, which is always a positive. It's really difficult to remain still on those hard surfaces during scans and I always feel sore and miserable afterwards.

    These films most certainly will give your surgeon a good idea of what needs to be done.

    As many other members will also be telling you, I will be anxious to hear how your visit goes next week.

    Keep taking it easy and NO MORE FALLS. I do hope your ankle is healing well.

    Off to get a big glass of water,

    Tammy ;)

  • Well, off course it was a good picture, they used fat suppression! (sorry, had to LOL about that!).
  • Hope all the kings horses can put you back together again.
    Horses are beautiful & fun to ride, but the fall is devastating.
    My 21yo daughter fell from hers last year & got a concussion(sp) & sprained both ankles. Could have been so much worse, but that fact didn't make me feel much better.
    Can't wait to hear what your doc says, Juva
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  • Nothing surprising there. We *knew* you were a mess! (G) jk! Lots going on. When is the final consult prior to surgery? Fingers crossed...:)

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Next Wednesday. At least I hope there wasn't anything found that would throw a wrench in the works!
  • I fully agree! I hurt more just looking at your avatar woman! (G) Surgery bites, but at least so far, from what they are telling you, you might have a chance of reducing much of the grief you have now. That is a win-win in my book! Fingers crossed for ya, and of course, positive energy heading your way!! :)

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
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