Misery and Mirth

My Spine & Scan(gallbladder)

Monday I had my consult with Dr. Begum, my neurologist about the MRI of my spine the NCV & EMG. The NCV & EMG were inconclusive, oh yeah, great I spent over an hour being shock tortured for “inconclusive” results. The MRI was even better news *sarcasm* it showed I have chronic spondylolysis and minor to moderate facet osteoarthropathy.

Spondylolysis refers to a fracture defect in one of the vertebra in the lower back, usually the last vertebra of the lumbar spine. The area of the vertebra called the pedicle is affected. The pedicle is part of the bony ring of each vertebra that protects the spinal nerves. This can cause pain across the small of the back and into the buttocks
The compressive symptoms (pain down the leg to the foot, numbness in the foot, possibly weakness in trying to raise the foot, etc.) can arise because the nerves at the segment involved are pinched. There is usually a lump of tissue in the area of the spondylolysis - probably where a fracture tried to heal itself. This lump of tissue may press on the nerve roots as they leave the spine. The forward slip of the vertebra also makes the spinal canal smaller, leaving less room for the nerve roots. So in lay man’s terms that’s a damaged vertebra causing a pinched nerve.
Treatment for spondylolysis is not much different than for other causes of mechanical and/or compressive back pain. In most cases, surgery will not be necessary. Strengthening the back muscles can reduce the mechanical symptoms resulting from the segmental instability. Medications may be used for short periods to: control pain, ease muscle spasms, and help regain a normal sleep pattern (if you are having trouble sleeping). Short periods of bed rest may help with acute painful episodes. A back brace or corset, may reduce pain.

Facet osteoarthropathy / osteoarthritis is the degeneration of the bone/cartilage of the facet joints of the spine. The facet joints or joints with “small faces” are found at every spinal level (except at the top level) and provide about 20% of the torsional (twisting) stability in the neck and low back.
Facet joints are in almost constant motion with the spine and quite commonly simply wear out or become degenerated in many patients. When facet joints become worn or torn the cartilage may become thin or disappear and there may be a reaction of the bone of the joint underneath producing overgrowth of bone spurs and an enlargement of the joints. The joint is then said to have arthritic (literally, joint inflammation-degeneration) changes, or osteoarthritis, that can produce considerable back pain on motion.
Facet joint disorders are some of the most common of all the recurrent, disabling low back and neck problems, and can cause serious symptoms and disability for patients
Recurrent painful episodes can be frequent and quite unpredictable in both timing and extent. Patients are often left with the notion that this is a psychosomatic problem, and it may even be implied that “it’s all in your head.”
In the lumbar case, standing may be somewhat limited but sitting and riding in a car is the worst. So-called “limited duty” (sitting) assignments for patients with low back pain are paradoxically bad. When at its height of pain and disability, the muscle spasm is so continuous that the fatigued muscles begin to hurt themselves and a vicious cycle begins.

Treatment is similar to that of spondylolysis.

For more on:
Spondylolysis: http://www.spineuniversity.com/public/spinesub.asp?id=39
Facet Osteoarthritis: http://www.spinehealth.com/topics/cd/facetjoint/facetjoint01.html

Today Tuesday was my hepatobiliary (HIDA) scan at St. Joseph hospital, Ann Arbor. Dad & I checked in a little after 12:30pm and didn’t leave until almost 4pm over 2 hours of that time I was on a gurney under a scanner with an IV in my arm, forced to listen to country music and not allowed to move much. I was happy that the technician was skilled with the needle because she got my IV in with the first try and it didn’t hurt too badly. The scanning wouldn’t have been bad at all if I didn’t have joint and back problems but laying on that hard gurney so long made my back and legs really sore and lock up. It was hard to resist the urge to shift weight off my back and my right leg kept twitching. When it was over I was so stiff and painful I could barely swing myself around and off the gurney. So I fell getting down but I caught the side of the gurney and the technician grabbed my other arm so I didn’t hit the floor.