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Should I see Neuro or Ortho? Thanks

Lumbar spine x-rays April 26, 2007

L-spine complete 5 views

Procedure: lumbar spine 5 views

Technique: lumbar spine radiographs, including AP, lateral, oblique, and Lumbosacral spot views.

History:  back pain..   trauma

Comparison:  none


Findings

Alignment: normal

Vertebral body heights/disk spaces:  disk space narrowing L5 - S1...

Fractures: none

Facets: hypertrophied facets at L3 through S1.. pars defects L5.

Bone mineralization: normal

Radiologist impression:
1.  Spondylolysis at L5 without spondylolisthesis

2.  Extensive spondylosis at L4 through S1

3. Disc disease L5 -- S1. No fracture

4.  Further evaluation with magnetic resonance imaging is recommended
if symptoms persist and are unexplained.

=================================================================
Cervical spine C-SPINE  4 views April 26, 2007


Procedure: cervical spine 5 views

Technique: cervical spine radiographs, minimum of four views, including AP, lateral, both oblique, and open-mouth odontoid projections.

History: trampled...  neck pain

Findings:

Alignment: straightening of the cervical curvature is a nonspecific finding that may indicate the presence of neck pain and/or spasm..

Vertebral body heights/disk spaces: normal

Impression: no fracture
=================================================================

Day of exam:  8/13/03

Procedure: MRI spine cervical without contrast

Technique: magnetic resonance imaging of the cervical spine was performed using standard pulse sequences without contrast material.

Findings: the cervicomedullary junction is visualized and the spinal cord appears normal.  The vertebral bodies are normally aligned without evidence of fracture or marrow abnormalities.  Prevertebral soft tissues and posterior elements or normal.

C1- 2, C2 -3 : within normal limits

C3- 4: Mild DDD and diffuse disc bulge which slightly indents the thecal sac without significant stenosis.  There is mild right-sided facet hypertrophy and foraminal stenosis.

C4-5: Minimal to mild diffuse disc bulge which slightly indents the thecal sac without significant stenosis.  There is mild right-sided facet and uncovertebral  arthrosis and foraminal stenosis.

C5- 6: Mild DDD and diffuse disc bulge which mild to moderately indents the thecal sac and results in Mild central canal stenosis and cord compression with AP thecal sac diameter 9 mm.
there is mild bilateral facet and uncovertebral  arthrosis, greater towards the right with associated foraminal stenosis.  No definite HNP.

C6-7, C7-T1:  within normal limits

Impressions:

1. C3-4 and C4- 5 Mild spondylosis, greater towards the right with mild associated foraminal stenosis.  No evidence of central stenosis or HNP.

2.  C5- 6 Mild spondylosis with mid-central canal stenosis and cord compression, and bilateral foraminal stenosis, slightly greater towards the right.  No definite HNP.

X-rays cervical spine 2003

Date of exam: 08/13/03

Procedure: spine cervical, 5 views

Technique: cervical spine radiographs, minimum of four views, including AP, lateral, both oblique, and open-mouth odontoid projections.

Findings: lateral masses of C1 are normally aligned on C2, and the dens is intact.  Vertebral bodies of C1 through the C6 are well delineated in the lateral projection.  The vertebral bodies demonstrate normal height.  There is loss of a normal lordosis.  There is grossly normal alignment of C7 on T1.  The intervertebral disk spaces are fairly well preserved.
Facets to demonstrate normal relationship in oblique projections.
Precervical soft tissues within normal limits.

Impression:
there is loss of normal cervical Lordosis, which may be positional in nature.

=================================================================


Date of exam 09/30/03

History: back pain

Procedure: MRI spine Thoracic without contrast

Technique: magnetic resonance imaging of the thoracic spine was performed using standard pulse sequences without contrast material.

Findings: normal marrow signal intensity is noted a side from a minimal vertebral hemangioma of T11 vertebral body.  There is normal cord signal intensity and the cord morphologically appears normal.

There is a minimal central disc protrusion at T7-T8 with the effacement of the ventral thecal sac and borderline compression of the midline cord.
The canal is patent as are the foramina.

Impression:
there is a minimal disc protrusion T7-T8.

=================================================================

Date of exam: 9/19/03

History: low back and leg pain

Procedure: MRI spine lumbar without contrast

Technique: magnetic resonance imaging of the lumbar spine was performed using standard pulse sequences without contrast material.

Findings: normal marrow signal intensity.  The Conus terminates at L1-2.
L1-2 appears normal.
L2-3 appears normal.
L3-4 appears normal.

L4-5 shows minimal ligamentum flavum hypertrophy and early facet arthropathy.
Be canal and foramina are patent.

At L5-S1, there is mild disc desiccation and a minimal intraforaminal disc bulge bilaterally.
The canal and foramina, however, are patent.

Impression:
there is a minimal spondylosis as above a



Spinal problems run in my family my mother has plates and  screws on her back, my maternal grandmother has had cervical surgery as well.  My father has arthritis and as a child had rheumatic fever and brights disease.
I am married 30 year old mother of two.  I have not had health insurance in the last two years but recently my husband and I have gained access to insurance through his employer.  
Before I was insuranced through the state.  
The MRI tests that I had done were done in 2003, and the doctors I had at that time wanted me to have surgery.  One of them had had cervical surgery herself.  She told me that my neck was a lot worse than what hers was when she had her surgery.  I had a wait around six months to get into a neurosurgeon.  I saw him and he did not have a lot to say, he would not answer any of my questions, such as should I have a breast reduction before having surgery.
He sent his nurse in after doing some tests and said he wanted me to have another three-part MRI done.  My regular doctors then scheduled a three-part MRI.  The day before I was to have the test done, the hospital called and said my insurance have been canceled.
My doctor continue to treat me with 120 Lortab 10 a month, 120 Soma a month, 60 Ativan a month.  After about six months he closed the office and left, due to personal reasons with his private life.
Ever since then I have had to deal with horrible pain and spasms daily.  It feels as though my upper back is ripping open in it feels like my left shoulder blade is jammed in my spine.
My hands and especially my right two fingers and my toes have the feeling of numbness, but not all the way gone.  Like a vibrating asleep sensation.  I have also had this feeling on the right side of my face and scalp.
Since Tuesday I have had a huge muscle knot on the right side of my neck, but it hurts to turn my neck to the left, down, or back.  I have spasms constantly on the opposite side of my breast in my back, I even have muscle knots in my ribs.
But even then lifting my left arm a little above my chest is standing what feels like a wave of hot electricity burning from my neck through my own arm and down my left shoulder blade, and pain radiates across my back. And I feel like something is sticking me way deep inside of my throat...
  My lower back shoots down my left butt cheek, then the back of my leg then my calf and into my toes.  My right side is not as bad.  The last couple of months I have had a lot of problems in the morning and at night feeling like I have rods sticking out of the bottom of my heels.
Every morning I have to pull my right shoulder into place, and I can't sleep more than 4 hours, w/o waking up miserable, so I just get up.
I do not know what to do or who to go to, do I need to see a neurosurgeon or an orthopedic doctor or someone else.  I do not know how to deal with the pain I am in anymore.  It makes me miserable to feel this way, as I have always been very active before and after having children.  Now it is such a task to go to the store, to clean, to do anything really.  But I do it a little at a time as I can.  My mother had plates and screws placed in her back after three failed back surgeries and is now wheelchair-bound and that is one reason I think I have delayed in getting or being more vocal about the treatment I received several years ago. And just living with the miserable pain.
I made an appointment with a doctor's office Thursday and was told to come in Friday morning.  I saw the nurse practitioner, which of course they had none of my medical records. When he asked what was wrong I tell him a brief history of my problems with my neck and back and that I was use to hurting, but not being able to turn my neck since Tuesday was scaring me, and that it was killing me.  He then told me that women with large breast often have neck pain.  I tell him I understood that and that I was all for having a breast reduction, especially since I've had kids...lol  I told him some of what my MRI report stated and suggested looking into going to physical therapy for now, I then tell him I had previously seen one of the physical therapist at this hospital and after she saw MRI report, she would not see me again.  He then asked me what was the most recent x-rays or MRI that I had done stated, I only knew what the doctor in the ER told me, and that was that not only was my neck straight and stacked it was completely reversed and that was on April 26, 2007 after my daughter, her friend and myself were injured at a concert I had taken them.  The ER doctor started telling me exactly how I hurt, and I cried knowing someone understood and knew.  He then told me to take some sample Celebrex he had, and I told him I had taken it before, but due to the issues with it, my other Dr. had took me off of it, saying the risks to someone my age, were not worth the benefits of the drug.  I just took it, and he told me to see the nurse out front to make an appt. with a neurosurgeon, I saw her, and she said since I had open access insurance, I could make the appt. myself and just let them know what happens.  
So I called them, they were dumb founded, saying they didn't order a new MRI or anything, I told her no, and that he gave me celebrex and they referred me to them.  She didn't think I should be taken celebrex either.  She then told me to call them, have them set up a new mri, I know that is going to cost us a fourtune, as well as these copays to the drs.  What or who should I go to and is it very serious what is wrong with me?
Thank you...




5 Responses
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172715 tn?1285494490
ortho-I think.  Either one would be fine but you seem to have more disc degeneration than nerve impingement.  Good luck & feel better. I'm not a doctor just a long time patient.
Helpful - 0
Avatar universal
i would listen to mike1105 and go to the website www.drbookspan.com. i have a messed up spine from top to bottom. i do the neck exercises dr. bookspan has listed there. nothing has reduced the tightness or the spasms in my neck like these exercises. they do not take long to do and you can do them as many times a day as you like. i do them every two to two and one half hours.  good luck, rlharwick
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Avatar universal
Thank you so much for your kind reply, I am in the Northern Middle TN area.  Only about 20 min. north of Nashville.   I am sorry for the delay in getting back to this site, life has been so hectic.  Thank you so much!  
Any help or advice is always appreciated.
Helpful - 0
Avatar universal
MRI results are not that bad---this may be why breast reduction was suggested and why no one was willing to jump in and do surgery. I think you may have Myofascial pain syndrome. some thngs to ask yourself:

Are you overweight? How is your posture? are you fit? do you hunch over the computer alot? is it difficult to stand up straight??

muscle spasm, tightness, lumps in muscles are usually not signs of a pinched nerve or of any other neurological conditions or spinal problems that require plates or screws or surgery. these problems are usually brought on by our own poor and self-abusive habits and postural/fuctional issues. this also means they can be fixed. a PT may be able to guide you, but you will need to do it yourself. read a website by Jolie Bookspan and maybe even buy one of her books.
Helpful - 0
Avatar universal
I'm not sure that a new MRI is absolutely necessary at this point.  I would seek out a qualified orthopedic spine specialist or neurologist affiliated with the most respected hospital in your area - most have private practices as well.

What area are you in?  Perhaps I could point you in the right direction.

Sincerely,
      Chris
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