My daughter is a 34 year old woman who has a history of lumber spinal fracture, herniated discs. She has been suffering with debilitating pain for the past several years. She has 3 children ages 6, 2, and 3 months. These problems have significantly effected her quality of life and that of her family. Sometimes she is barely able to get out of bed. Her MRI on 5-10-13 showed hypoplastic 12th rib, L5 to be transitional, L3-4 degeneration with loss of height, L3-4 Schmorl's node is present. There is no know cause for the fracture. L4-5 herniation of the thecal sac with a 5mm facet effusion, and L5-S1 facet hypertrophy. The impression of the rediologist's is transitional L5 vertebrae, hypoplastic 12th rib, L3-4 degeneration with mild facet hypertrophy, L4-5 central severe stenosis. She has had multiple episodes of physical therapy without any relief. Before this MRI, her neurosurgeon told her that pain injections were her only option, as insurance probably would not cover any type of surgery. I realize this is a very complicated case, but would appreciate your opinion as to options available for resolution of her condition.
Thank you, in advance, for your review. Carol
Well, without knowing the relevant clinical details or a detailed clinical evaluation it would be difficult to comment specifically on the situation. Schmorl's nodes are intervertebral cartilage indentations into the vertebral body and are associated with inflammation and necrosis. It is not yet known if these are the cause or the result of inflammation/ necrosis. Here is no specific treatment for schmorl's nodes and management is mainly symptomatic aimed at limiting inflammation/ degeneration. The MRI describes degenerative changes along the lower spine with narrowing of the spinal canal. Ideally a surgery would be recommended in severe causes or in cases where there is neural compression; while in moderate cases rest, followed by physiotherapy and anti-inflammatory/ pain medications would be advised. I would suggest discussing the situation and the suggested management plan in detail with her treating orthopedician.
Hope this is helpful.
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