injured lumbosacral spine

[ggreg]

My low back X-ray looks very peculiar.  Lumbosacral area has been giving me sharp pain that does not radiate.  The pain is so bad I cannot stand for very long, can't do hardly anything standing up.  The only drug that has numbed it is Lyrica.  I take opiates for bad legs.  I spend nearly all day laying down.  I posted this over at the back forum, but this is also an orthopedic issue.

My first question is, on a plane black and white X-ray of the vertebral bodies, does a fracture show up as a white line?  On my X-ray, the last lumbar bone has a white irregular line in it, that goes from back to front about halfway across the bone.  I didn't know if this is just some blood vessel or what.

Also, I have a question about the relationship of the sacral spine to the lumbar spine.  A lateral X-ray was taken of my low back with my legs bent, and the sacral part is perpendicular to the lumbar part.  Should the sacral spine be like that if the knees are bent?  If anything, that angle shouldn't ever be the 90 degrees, and in fact should be even less if legs aren't straight?  All the disk spaces are where they are supposed to be.  Please enlighten me.

My history and pictures show the thoracic spine with compression fractures from a falling accident many years ago, on X-ray the bones appear crumbled on the edges, disks vapororized, the bodies misaligned, tilting diff ways, and the whole works curves to one side.  At the time, the pain was sharp, natural fusion took place over time, now the pain is just deep aching muscle pain from being permanently wrenched out of place.  

Now, the lumbosacral spine that is the subject of this post, the discomfort there began several years ago, I thought it was just an aging processs, maybe the disks were fading or arthritis or something.  Recently the pain became quite sharp, so I had an X-ray, and all the disks are in place.  I was declared normal in the lower back.  But how come the pain?  

I look at the X-ray, frontal view of the whole spine, and the lower spine leans in the opposite direction of the original thoracic injury's curvature.  The orthopedist did suggest the old injury may be affecting the low back somehow.  He says I should do therapy, lose weight (it hurt before I gained some weight recently from IBS).  My family physician then advised me no therapy, instead upped my antidepressant.  *Sigh*

I say I've got a broken bone because that's how it feels.  I also think I've got a whole spine that is about to fall off itself.  Second opinion is expensive, so that's why I'm here.  Also, I am afraid sudden or strenuous movement might hurt me, even afraid the Lyrica might mask any worsening of the situation.  Any replies at all would be appreciated.

[JainMD]

Hi,
I understand that you are unable to make the orthopedist understand your concern. I am not sure whether the sports medicine doctor would be able to guide you or not, but I am sure if you get imaging study done in form of MR study then definitely you would be able to point out some diagnosis.
I hope the best things come your way.
Keep me posted if you have any queries.
Bye.

[ggreg]

Thank you so much, Dr. Jain.  Yes, I first came to MedHelp a year or two ago, I've had snowballing medical problems for five years.  Just when I come to terms with one thing, something else goofs up!  I have indeed researched my own disorders and syndromes, a couple family members have serious health issues, and so I share, altho I try to vary details of me whilst on the internet.  Also went thru a nursing program a while back and have been interested in nutrition for years.  

I don't want to be fearful over my back or whine, but I never complain about my accident, and when I finally do, the orthopedist was not exactly thorough, he missed reporting a different but still orthopedic anomaly, a limp that all other doctors have seen, even tho I automatically reacted when he squeezed my foot by jumping straight up off the exam table.  My mind is in such a fog from discomfort that I didn't push him around like I maybe should have.  So I shall consider following your advice about an MRI and another specialist, gosh it's costly, and I'll bring it up with my gerontologist guy when I see him in a couple weeks, or maybe even consult a sports injury doctor separately, I had a good experience with one.  GG

[JainMD]

Hi,
I have seen you posting in all other forum quiet frequently. Your posts are interesting and suggest your own experience.
Plain radiography has been the primary musculoskeletal imaging technique for >100 years.
White line on x-ray suggests that either there is green stick fracture or that an old fracture is healing.
For suspected fractures, dislocations, congenital bone abnormalities, joints should be imaged in 3 projections (frontal, lateral, and oblique).
The sacrum should not be exactly perpendicular to the lumbar spine, though there could be variation.
I feel x-ray would not show nerve compression or spinal disc pathology.
You need a MR study for further evaluation.
I think a different opinion from another orthopaedician with MR study should clinch the diagnosis.
Keep me posted.
Bye.