Question
Hi Doc,

My mother has had two previous surgeries on her neck, the first wad done in 1997 and the second in 2003. Both surgeries don in the USA. Since these surgeries she has gone from not having sensation of the arms (unable to feel heat and getting burnt) to being unable to move her hands.  In addition, she has pain in the arms.

In the recent past she has been complaining of pain in her legs originating from her hips.  She receives a little relief depending on the position she sits or lies in.  We have received the results of her MRI could you explain it to me.  It reads as follows:

Clinical History: Bilateral L5 and S1 polyradiculopathy
Technique:  Sagittal and axial T1 and T2
Findings: There is Grade 1 retrolisthesis at L3/4.  Vertebral heights and marrow signal are unremarkable. The conus medullaris ends normally at L1/2.  The L1/2 disc is unremarkable.  The other discs are desiccated.  At L2/3 a diffuse annular bulge and mild facet joint OA (what does OA stand for?)are associated with mild central and foraminal stenosis.  At L3/4 and L4/5 diffuse disc bulges are more severe facet joint and posterior ligament hypertrophy are associated with moderate central and foraminal stenosis.  At L5/S1 the disc is unremarkable.  there is moderate facet joint OA without significant central or foraminal stenosis.  The S1 root appears to be normal.  No para-spinal abnormality seen.

Could you break this down for me?  I am the primary care giver here in the Caribbean for my mother and my sister who lives in the USA was the one involved with the previous surgeries.  My Mum is relying on my better judgement to assister her in making a decision about surgery which was her neurologist's recommendation.  She is 66 and scared that her legs end up like her hands.

By the way,  my Dad, her ex-husband and life-long friend of over 50 years recently died from a blood clot after successful similar surgery at C3-5 and was having pretty good recovery(2 months ago.  Surgery was done locally.

Please help me understand this report.  And is surgery her best or only option at this point.  

Answer
Hi Lisa-Ann, I would be glad to.

1)Clinical History: Bilateral L5 and S1 polyradiculopathy

This means your mother told the ordering physician that she had pain shooting down into both legs involving more than one dermatome(area of nerve innervation).

2) Technique:  Sagittal and axial T1 and T2

This is standard technical jargon that means the films will have both a positive and negative image. Something like when you get film developed and you receive the negatives as well. It also describes how the slices will be printed on the film.

3) Her 3rd Lumbar vertebrae is slightly malpositioned (slid backwards) on top of her 4th Lumbar vertebrae. Many things can contribute to this, overall it is no big deal. Most likely it is degenerative in nature but it can also be caused by a pars defect ( a part of the vertebrae that holds it in place has been compromised by trauma or a birth defect. Usually by itself is not clinically significant.

4) Vertebral heights and marrow signal are unremarkable

This is significant because it tells me that the bone itself is not diseased such as cancer or osteoporosis.

5)  The conus medullaris ends normally at L1/2.  The L1/2 disc is unremarkable.

This is the end of the spinal cord where it turns into a bundle of separate nerves, it looks like spaghetti branching out to there respective exit sites lower down the spine. Her 1st Lumbar disc is healthy.

6) The other discs are desiccated.

This means that the rest of the lumbar vertebrae show signs of dehydration or lack of fluid in them, this can be treated with flexion/distraction therapy. It creates negative pressure in the disc forcing the interstitial fluid back in. It is a painless procedure something like traction with a flexion component.

6) At L2/3 a diffuse annular bulge and mild facet joint OA (what does OA stand for?)are associated with mild central and foraminal stenosis.

OA stands for Osteoarthritis, this in combination with the "slipped disc" (really a misnomer) is causing the diameter of the hole that the spinal nerves travel through to get narrower. Stenosis simply means narrowing and foramina means opening. Essentially her disc is bulging into the space the spinal nerves need to occupy and the facet arthrosis is causing a narrowing of another opening needed for the nerve to exit the spinal canal and go to the legs.

This is another thing that can be effectively treated without surgery using flexion/distraction (F/D).

7) At L3/4 and L4/5 diffuse disc bulges are more severe facet joint and posterior ligament hypertrophy are associated with moderate central and foraminal stenosis.

Again, more crowding into the space needed for the nerves by the discs. Also treatable.

Posterior ligament hypertrophy is the ligamentum flavum (which runs down the inside of the spinal canal in the lumbar region only) is getting thick and taking up too much space causing a "choking" effect on the spinal nerves.

Also something that is readily repaired with F/D.

8) At L5/S1 the disc is unremarkable.

This is very good since this is the most common and highly stressed area to undergo pathological change. If she has a healthy L5/S1 disc, it makes the prognosis much better.

9) There is moderate facet joint OA without significant central or foraminal stenosis.

This is treated with ultrasound and glucosamine sulfate with MSM. A common and readily available treatment and OTC supplement proven to stop and sometimes reverse OA.

10) The S1 root appears to be normal.  No para-spinal abnormality seen.

More good news, her last nerve in her spinal cord isn't being compressed and the soft tissues around her low back are normal.

Doing surgery on this women borders on criminal assault, she has several proven, safer and more effective options. Low back and neck surgery never has a good outcome, there will always be scar tissue proliferation following surgery along with countless other negative physician induced problems that could potentially kill her. Do not put this women through this again, find a good D.C. in your area and find out if he does F/D. This procedure usually takes 6-8 weeks of 3x/week visits lasting 20 minutes. This includes the manipulation, ultrasound and F/D.

They, the AHA (American Hospital Association), have essentially banned these surgeries in my state because they are unecessary, rarely successful and potentially deadly. Due to the overwhelming amount of justified lawsuits, the AHA finally decided it's time to put the brakes on these medieval procedures unless absolutely necessary, such as Cauda equina syndrome (loss of bowel and bladder control secondary to spinal canal stenosis).

Here is what F/D does.............

Flexion-Distraction Therapy - What is it?


Flexion-Distraction, (F/D) is a gentle, chiropractic treatment procedure utilized for back and neck pain. Flexion-Distraction is a safe alternative to back surgery for those 95% of patients whose conditions do not demand surgical intervention. The doctor is in control of the treatment movements at all times.

Flexion-Distraction is utilized for many conditions such as:

Failed Back surgical Syndromes
Disc Herniation/Ruptured Disc / Bulging Disc / Herniated Disc
Sciatica / Leg pain
"Whiplash" injuries
Stenosis
Arm Pain
Neck Pain
Failed course of Steroid Injections
Chemical Radiculitis
Spondylolisthesis
Headache
Transitional segment
Many more conditions?
How does Flexion-Distraction Work?

For Disc related conditions:

Increases the intervertebral disc height to remove annular tension on the annular fibers and nerve by making more room and improving circulation.
Allows the nucleus pulposus, the center of the disc, to assume its central position within the annular fibers and relieves irritation of the spinal nerve.
Restores vertebral joints to their physiological relationships of motion.
Improves posture and locomotion while relieving pain, improving body functions, and creating a state of well-being.
For Non-Disc related conditions:

Patients with other conditions causing back pain (facet syndrome, spondylolisthesis, sprain/strain, scoliosis, transitional vertebra, sacroiliac restrictions and misalignment, certain types of spinal stenosis), Flexion/Distraction provides all of the above benefits plus the ability to place the spinal joints into normal, painless movements so as to restore spinal motion without pain:

The posterior disc space increases in height.
F/D decreases disc protrusion and reduces stenosis.
Flexion stretches the ligamentum flavum to reduce stenosis.
Flexion opens the vertebral canal by 2 mm (16%) or 3.5 to 6mm more than extension.
Flexion increases metabolite transport into the disc.
Flexion opens the apophyseal joints and reduces posterior disc stress
The nucleus pulposus does not move on flexion. Intradiscal pressure drops under distraction to below 100mm Hg. On extension the nucleus or annulus is seen to protrude posterior into the vertebral canal.
Intervertebral foraminal openings enlarge giving patency to the nerve.

Reference: Cox JM, Feller JA, Cox-Cid JA: Topics in clinical Chiropractic 1996; 3(3):45-59

Your mother is tailor made for this procedure, find a D.C. ASAP and get her an appointment. Soon I hope to see the day when they throw these doctors in jail for greed and negligence, no way she needs surgery.

If I can be of further assistance, don't hesitate to ask,

Dr. Timothy Durnin
drs.chiroweb.com