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MRI and CT results?

  Could anyone please tell me what it means when a CT scan says, "at L5-S1
  there is a vacuum disc?" I have never heard of it.
  I would appreciate any insight anyone can give me on the rest of the recent CT report and the
  comparisons to the  CT done recently, a CT done a year ago and a MRI done last Spring.
  Recent CT
  " At L2-L3 there is a mild residual right posterior and posterolateral disc herniation. This causes a mild
  indentation of the anterior aspect of the thecal sac around the orgin of the right L3 nerve root.
  At L3-L4 there is a moderate circumferential bulge of the disc, causing a mild indentation of the anterior
  aspect of the thecal sac, without lateralizing features.
  At L4-L5 there is again a mild to moderate circumferential bulge of the disc, in contact with the anterior
  aspect of the thecal sac, but without significant displacement"
  At L5-S1 there is a vacuum disc"
  A CT a year ago said, "combination of degenerative changes are causing mild spinal stenosis at L3-L4.
  Small central disc herniation at L5-S1 does not impinge upon the neural elements. At L2-L3 there is a
  decreased amount of fat in the anterior and right lateral aspect of the epidural space. This is not a disc
  herniation and likely represents scar tissue from the previous operation in February 1997."
  And an MRI last February said, " At L2-L3 most of the herniated disc has been removed. There is still a
  small residual disc herniation on the right posterolaterally which is mildly indenting the dural sac but not
  producing any compression of the nerve roots of the cauda equina within the dural sac. The neural
  foramina remain patent.
  At L2-L3, L3-L4, L5-S1 ther is a loss of disc signal. At none of these three levels is there any disc
  heniation therefore there is no compromise of the spinal canal. The lateral recesses and the neural
  foramina are patent at these three levels.
  The nerve roots of the cauda equina show a mild anterior deviation at the L2-L3 suggesting that there
  are some subarachnoid adhesions present. The nerve roots at the other levels are normal. No clumping
  of the nerve roots, no other abnormality."
  My husband had surgery(micro discectomy?) almost 2 years ago for a "large sequestered central disc herniation at L2/L3 occupying 2/3 of the spinal
  canal and compressing the nerve roots of the cauda equina by 50%".
  He still suffers with the same symptoms as before surgery(but to a lessor extent),
  numbness and weakness
  in the fronts of his legs, and pain in his back, hips and legs.
  He presently takes(daily) 600mg of codeine contine, 800mg neurontin, 400-1200mg ibuprofen as needed, 40 mg prozac,
  10-30mg of flexeril as needed, and 30mg of prevacid.   I am concerned about the
  amount of medications he must take just to cope with the pain, and he still
  at age 38 is not able to half of the things he could do before.
  The neurologist and neurosurgeon said there is nothing more they can do for
  him and the pain management doc agrees.
  What do these tests results mean?  The neurologist and pain doc said he may get
  worse over time.  Is this not a lot of medication to be taking?
  Also, some of these reports seem to conflict with each other and I was hoping someone could help interpret
  the results. Sorry for the lengthy post.
  Thanks, Joady
Dear Joady,
To summarize the described reports, your husband has mild-to-moderate degenerative disease in the lumbar spine in general.  There seems to be little residual disc at the level where surgery was done two years ago.  The rest of the levels described do not have major compression on the spinal cord or nerve roots.
A 'vacuum disc' is a product of degeneration of a disc over time from daily wear and tear.  It is not uncommon in the population, especially as a patient ages.  It can be seen on MRI as a change from the normal signal quality of the disc.  
The cause of your husband's pain is not clear from what is described.  At times a patient may have pain after such surgeries due to instability of the spine.  Some of the patients that have this instability may benefit from a fusion.  
Speak to your husband's physician about the results of the studies and what further recommendations he may have.  If you are not confident in the information you are getting, a second opinion to a spine surgeon may be warranted.
Good luck.


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