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Avatar universal

My MRI and CT

Just wondering if anyone sees anything that they would be particularly concerned about- I am going to see my NS regarding vertebrectomy and fusion (I guess that's what it is called, I'll know more later) and really am not sure what questions to ask.  This fracture is 3 years old, by the way.

CT scan:

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-S1 level, 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.
6 Responses
Avatar universal

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 confirm 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 deformity 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-caudal 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.
Avatar universal
Sorry so long, as you can see my back is a mess.  
Avatar universal
yeah it sounds like it is a bit of a mess alright! However, as your spinal cord ends at or around the superior portion of the L2 vertebral body, this is positive as your problems exist BELOW this level. Any discomfort that you feel should ease when you bend forward or sit down, as this will have the effect of reducing the spinal stenosis. Other than that there seems to be lots of arthritic changes (often present in symptom-free patients!). You should talk to your doc about doing stability exercises such as Pilates to provide some support for your back.
Avatar universal
Unfortunately the L2 pushes forward right into the cauda equina, so that's always been a concern, but it has never materialized.  Now he will be taking it out so I don't have to worry about it anymore.  They don't discuss it in the reports, but the fracture also causes kyphosis, which sets the entire lumbar spine pretty out of whack and is responsible for the deterioration below L2 being so bad.  I'm hoping that by straightening everything out, I will be able to slow down the degeneration.

I actually can't sit.  Not sure why, but I get burning and numbness along the side of my back within a few minutes and now my left foot goes numb as well.  I have some weakness in my left foot, but not severe.  I did pretty well with physio until I had a fall and aggrivated the L4/L5/S1 so badly.  I'm a sad puppy now :(
Avatar universal
oh you are really suffering alright!! when you say that you get "burning" and "numbness" and "weakness" you are describing two separate things: (1) the numbness and weakness are both "negative" symptoms which show a compression of a nerve... (2) the burning feeling is a "positive" effect and would show an overly sensitive nerve.... that reacts badly to stretch etc...

When you suffer with both it is hard to get a comfortable position... try maybe sitting with your hips and knees fully bent and your feet on the seat...??
Avatar universal
LOL, I often sit with my left leg bent under me on the seat, but then I started getting a lot of pain in that ankle from sitting on it all the time.  Amazing how much this stuff just is a chain reaction.

Mostly I try not to sit too much.  It's really just very uncomfortable, even if I shift around a lot.  I suspect the discomfort is coming from multiple sources.
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