QuestionI injured my back in 08 unloading a semi, I had partial laminectomy surgery on L5-S1. This did help the severe pain running down my right leg, I was left with permanet numbness in a small strip going down my right leg and little toe. I continued to have severe pain in my lower back and tingling down both legs. They kept treating me with narcotics and about 7 other medicines and countless injections. I hate narcotics, so I chose to have the stimulator placed. This device truely works for me, it has little issues like the battery flipped and it required surgery to fix, but for the past year I have had a pain free life! A few weeks ago I started coughing and found I had pneumonia, the coughs were deep and after coughing in my kitchen I had a sharp pain, that has not went away, its horrible pain!!! I had a cat scan, cant get MRI due to the stimulator.
Can you please help me understand the results? and is there anything that can be fixed?
Transitional vertebral body at lumbosacral junction.Compatible with lumbarized s1 vertebra on right. Moderate degenerative change brtween broad-based transverse process on left at s1 and left superior sacrum.
At L3-L4 a minimal diffuse disc bulge is identified, which flattens the ventral aspect of the thecal sac.
L4-L5, left foraminal discogenic changes, moderate narrowing of the inferior aspect of the left L4 neural foramen without nerve compression at this time. Mild bilateral hypertrophic facet arthropathy and ligamentum flavum hypertrophy are indentified at L4-L5.
At L5-S1 post partial laminectomy on right. There is loss of disc height at L5-S1 compatible with degenerative disc at this level. A vacuum phenomenon is identified at L5-S1. Mild diffuse discogenic changes at L5-S1, appear focally prominent in left foraminal location. moderate bilateral hypertrophic facet arthropathy at L5-S1. There is subsequent bilateral narrowing of the L5 neural foramina, which is moderate on left and mild to moderate on right, without definite evidence of L5 nerve compression in their neural foramina.
Thank you so much!
Answer
Hanna Somatic Educatio
Hi, Tiffiney,
Well, sounds like you've "been through the mill". (Sigh) There is a way that is so much easier. If you were my client, I expect it would be something like one or two weeks to be mostly or completely out of pain.
I'll say more at the end, including what you can do to treat your own back pain (which takes somewhat longer).
As to your results, let's get to them item by item.
Then, I'll summarize at the end.
So:
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Transitional vertebral body at lumbosacral junction. Compatible with lumbarized s1 vertebra on right.
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A "transitional" vertebra is one more vertebra than are usually found in a person. For lumbar vertebra, the usual is five (5) -- "L1 - L5". A transitional vertebra in that location is "L6".
I don't know what this physician means by "compatible with". Perhaps he means, "comparable to" -- S1 -- by location. "Lumbarized" means that it has become functionally part of the lumbar spine, and therefore flexible, rather than (as usual) part of the sacrum, and therefore essentially inflexible (the flexibility occurring in most people at the sacro-iliac joints).
** This shouldn't be a problem. If it is, it has to do with something else than the existence of this vertebrae. We'll get to that.
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Moderate degenerative change between broad-based transverse process on left at s1 and left superior sacrum.
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The essential question, here, is, What caused the degenerative change *at that location*? Vertebrae don't just decide to degenerate, one day, and the location of degeneration is an important and suggestive clue.
Yes, what caused it ... we'll get to that. But a clue: compression and movement: friction
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At L3-L4 a minimal diffuse disc bulge is identified, which flattens the ventral aspect of the thecal sac.
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Aha! the tell-tale disc bulge! and minimal!
What causes discs to bulge? Well, what causes the tires on your car to bulge at the bottom? Pressure.
What causes pressure on the discs in the spinal column? The spinal muscles! In this case, the lower back (lumbar) spinal muscles, by pulling the spine short, by pulling vertebrae closer together.
What this item tells us is that you have tight back muscles, enough to cause a bulge but not enough to press on nerves. This sounds suspiciously like tight muscles are the source of the pain. Doesn't it.
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L4-L5, left foraminal discogenic changes, moderate narrowing of the inferior aspect of the left L4 neural foramen without nerve compression at this time. Mild bilateral hypertrophic facet arthropathy and ligamentum flavum hypertrophy are indentified at L4-L5.
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He must have meant, "discogenic left foraminal changes" -- changes in the openings in vertebrae where nerves come out of the spinal column on the left side. But "without nerve compression". In other words, inconsequential.
HOWEVER, the "hypertrophic facet arthropathy" means that the contact surfaces between neighboring vertebrae, "facet joints" are irritated. Again, the likely culprit: tight back muscles compressing vertebrae. Ordinarily, space exists between facet joints (for flexibility), but when tight back muscles pull vertebrae together, their facet joints rub. Too much rubbing, they get irritated and sore.
I don't thing the ligamentum flavum (the strip of ligament that runs along the front surface of the spine) is hypertrophic. I think it is somewhat shortened and thickened by vertebrae being pulled together.
"I think I see a pattern, here."
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At L5-S1 post partial laminectomy on right. There is loss of disc height at L5-S1 compatible with degenerative disc at this level.
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Let me tell you a secret -- a secret everyone already knows: When we experience injury or pain, we tighten up around the painful place.
Pretty obvious, huh?
Well, you had surgery. You tightened up in what we call, "trauma reflex". Where did you tighten up? Well, that's a bit unclear. You have a transitional vertebra, which would be "L6", and the laminectomy would be at "L6-S1". But this report says, "L5-S1". Makes me wonder.
In any case, you tightened up exactly at the place where a "broad-based transverse process on left at s1 [rubs against the] left superior sacrum."
Hmmm, the same culprit. I think I see a pattern, here.
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A vacuum phenomenon is identified at L5-S1. Mild diffuse discogenic changes at L5-S1, appear focally prominent in left foraminal location. moderate bilateral hypertrophic facet arthropathy at L5-S1. There is subsequent bilateral narrowing of the L5 neural foramina, which is moderate on left and mild to moderate on right, without definite evidence of L5 nerve compression in their neural foramina.
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The vacuum phenomenon, despite its science-fiction sounding name, is a quaint observation made by radiologists. There is no "vacuum", but gas in the disc space radiates light when irradiated, as in during the scan. There is no real "vacuum"; it's a reference to how vacuum tubes emanate light. You know -- radiologists' sense of humor. What's interesting is why gas would collect in the disc space.
We've already covered the rest in that section.
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So, I've laid it out, but I'll summarize: Whatever made it necessary for you to have a laminectomy was still at work after the laminectomy. Moreover, whatever the laminectomy, itself, did, it prompted further reflexive contraction of the muscles nearest the laminectomy and for some distance, away from it.
You were already very contracted (and close to spasm) in your low back when were unloading the semi; you were even tighter when you had pneumonia and coughing fits.
What happens in a coughing fit? We contract, repeatedly and may stay contracted. Coughing was enough to send you into spasm in your tightest place.
I suspect that the tingling down your legs comes from very tight muscles in your buttocks compressing your sciatic nerves.
So, how to address all those muscular contractions?
You've tried so much. You need something categorically different.
Therefore, I'm sending you to a page that outlines what I think you need.
http://somatics.com/back_pain.htm
You'll notice that it links into a number of other pages. Follow links only after you've read all the way through, and start with the first one that interests you.
and a page of access to practitioners
http://somatics.com/practitioners.htm
and an interesting page on "herniated disc impinging on the thecal sac"
http://www.herniated-disc-pain.org/herniated-disc-impinging-on-the-thecal-sac.ht...
regard,
Lawrence Gold
