Need advice based on my MRI to go for surgery or not

[manish897]

Dear Dr.

Need your advice on whether i should go for surgery or conservative treatment.

I fell down from a 12 feet ht and fracture my L1.I was brought to local hospital and doctor took the MRI-Scan and X-rays.Doctor said that I dont rquire surgery as my spinal chord was not damaged by sudden burst and after 1-2 months rest , you can resume daily activities. But when i went to another doctor, he saw my MRI and told that surgery is needed as bony fragment of vertebral causing the canal compromise upto 40-45% and need to remove that fragment.

Its been a 2 weeks now and I dont have much pain in my back .However, my left leg has some weakness and pain.After the accident,there was pain the in left leg butit is keep on decreasing gradually day by day.

I have written below the MRI test report.Could you pls suggest me what should i do .I m in deep trouble.
pls help me

MRI TEST REPORT:
----------------

MBO  LUMBO SACRAL SPINE
FINDING
There is multisegment fracture L1 vertebral body  with compression of superior end plate. Stir hyperintensity signal noted in the vertebra  consistent  with edema.
A posteriorly displaced fragment seen posterosuperiorly-causing anterior indentation of thecal  sac. Posterior element of L1 vertebral  body is seen normally. Rest of lumber vertebrae are normal in height and signal intensity. A lipohaemangioma noted in body of s3 segment.
Left  neural  foramina appear minimally compressed by fracture fragment at  D12-L1 level. Rest of neural foramina and exiting nerve roots are seen normally.

Canal compromise seen at D12-L1 level with canal dia as follows
Level                   ap(cm)
L1                      0.73
L1-L2 1.49
L2 1.39
L2-L3 1.36
L3 1.28.
L4 1.34
L5 1.37
Cord ends at upper border of L2 with normal conus and cauda equine.
Bilateral facet joints are seen normally
Paraspinal soft tissues are seen normal.
IMPRESSION
Subacute fracture L1 vertebral body with compressed superior end plate.
A fracture fragment in posterosuperior  aspect is indenting anterior thcal sac and causing canal compromise . however underlying cord do not show edema .
Left  neural foramen at D12-L1 appears compressed by fracture fragment   and need clinical correlation.


Should i go for surgery or not as doctor is saying that i may have problem in future  and also will have pain while bending or lifting or may affect my spinal chord.

[manish897]

Dear Kaul,
Thank you for giving the valuable suggestion, but unfortunately it was too late for me.I had under gone to the surgery :(
Its been almost a month.I dont know whether it was good or bad decision.Just wanted to know will surgery affect my normal life.Till now i dont have any pain due to surgery and i am recovering quite well.But just heard that success rate of spine surgery is very less and may create future problem.Doctor removed the bone and they put titanium rod .

As of now I dont have any kind of pain or problem till now but just wanted to know what precaution should i take to avoid problem in coming future .
Is really success rate of spine surgery is very low?

Again thank you very much .

[S. Kaul, MD]

Hi there!

Well, though there is 40% narrowing, the bony segment is just described indenting the covering of the spinal cord without any actual compression and one could decide either way. A surgery may be avoided if rest and physiotherapy seem to help. However a surgery would be suggested if the weakness does not seem to improve or you develop other neurological issues. A repeat MRI may be suggested in 6 months to note the amount of healing and compression if there is any to decide the further course of management.
Hope this is helpful.

Take care!