2 1/2 years post op - Charite ADR L5/S1

[Poncho]

Hi Blair,

Bulging discs - it may be a benign problem at this point. Many people live with bulging discs every day and have absolutely no idea they have them because they present with no symptoms. Then, there are other people out there that have a slight bulge of the disc and are in horrible pain. This is one of the reasons that it is soooo hard to diagnose spine problem(s). AND this is why finding what the cause of your pain is.....

This bulging disc at L4-5 could be nothing.... and I hope that it is nothing....

What dermatome path is the pain following? It sounds like the PM doc has things narrowed down to the facets - considering that you received some relief with the left sided rhizo.... This also makes sense because it corresponds to the arthropathy or enlargement of the facet joints.

Mild sclerotic in this case appears to mean a mild narrowing. Think of the heart when they talk about arteriosclerosis which is a "hardening of the arteries" - basically this type of sclerosis is caused by a plaque narrowing a heart artery - Same concept applies to the spinal canal they are saying that there is some mild narrowing there.... Keep in mind that narrowing and inpingement are two different things.

Now - they are saying that the spinal canal is widely "patent" meaning that there is nothing obstructing the spinal canal - my impression is that they are saying that even though the spine has some areas of "narrowing" there is no obstruction or impingement of the neural structures.

Hope this helps..

Poncho

[Blairsara]

Poncho
Thank you so much for responding, I appreciate it. I'm guessing the reason why my doctor didnt mention that I had a bulging disc was b/c that it's not related to my symptoms, and he believes that my pain is directly related to my facet joints. This makes sense to me because all of my symptoms point to my facet joints and the rhizo significantly helped the pain on my left side, since I don't feel it anymore. I'm guessing that when a bulging disc is a problem is when its hitting the sciatic nerve and then causes pain. My mom suffered from a bulging disc, but didnt have surgery and now she's fine.
I think youre right that the bulging disc is nothing at this point considering my symptoms, but I wonder if it's directly related to the Charite because I didnt have a bulging disc before my ADR.
Again thanks for the info on those terms I tried googling it but was having problems. Hope you're doing well.
I'm going in for a facet block next week so hopefully that will help with the pain.
Thanks.

Blair

[mmglobal]

With more advanced DDD, the doctors describe 'modic' changes to the vertebral bodies. These refer to changes in the bone and are representative of how far you are down the degenerative cascase. After we've had DDD for a while, the endplates start to look like they were dusted with powdered sugar. As you progress down the degerative cascade, these changes become more pronounced. These are sclerotic endplates:



I'm not used to seeing facets described as sclerotic... but Blair's description was talking about osteophytes... are they from the facets or from the vertebral body?

Mark

[annapurna]

Blair,

Thanks for posting your test results so that we can all learn. From what I've understood, the descriptor "sclerotic" when applied to a joint surface refers to densification or hardening of the subchonral bone. This hardening typically occurs in response to a mechanical overload such as would occur in the case of articular cartilage loss (arthritis), or a change in joint biomechanics. Since you've said that your Charite permitted excessive extension to the point of permitting subluxation of the facets, this could be the source of the overload.

The presence of osteophytes on the facet joints would go hand-in-hand with the sclerotic bone as another response to overstress. Osteophytes are typically a joint's crazy way of trying to stabilize itself or increase it's contact surface area in order to reduce stress (load per unit area).

The term "patent" applied to nerve openings typically means "wide open".

If I were drawing conclusions from this description, I'd say that your facets are taking a beating as shown by the sclerotic bone and osteophyte growth. On the other hand, the osteophytes have not yet gotten large enough to even start to close down the foraminal or central canal nerve openings. I'd be interested in seeing the thickness of your remaining articular cartilage on the facet surfaces and whether or not there way any sign of effusion or synovitis in the facet capsules. If you've still got articular cartilage left, then it's likely that the facets would calm down once you corrected the improper loading coming from your ADR. If you have little or no articular cartilage left, you might want to think about doing something else down the road.

Forgive me if I yack too much, but, your CT report reads almost like my MRI reports. I feel like I've found someone else in the same situation as me.

Best,
Laura

[mmglobal]

From http://www.asnr.org/spine_nomenclature/glossary.shtml

discogenic vertebral sclerosis: Increased bone density and calcification adjacent to the end-plates of the vertebrae...