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QAs a result of a fall on the stairs at my house, I have a wedge compression fracture of T5 and have been braced. I am 33 years old. It has been four days since the accident and the pain is almost gone (just some "pulling sensation in certain positions"). I never lost any sensations anywhere in my body.

I have some basic questions that I have had conflicting answers to: can I sleep in the side position (without a brace on) or should I try to be on my back as much as possible when in bed? Also, what is the percentage rate of sucessful outcomes following bracing in this type of injury? I am really scared of the surgery. Right now they say it is stable.
AThoracic compression fractures which are stable are most often treated with a Cash Orthosis or similar "extension" brace. The purpose of bracing is to support the fracture until it is healed and limit the amount of angulation at the fracture site (called kyphosis).

In my opinion, the brace should be worn for AT LEAST six (6) weeks to allow time for boney/ligament healing. The most ideal position for sleep is supine (on your back) and the brace should be worn full time and removed for bathing only.

In stable fractures, surgery is rarely necessary. As always, close follow-up by your caregiver, with apropiate radiographs (x-rays), are necessary to ensure the best outcome.

Answered by Andrew Boughal, DO, Orthopedic Surgery, , (5/8/2005)

QI had an MRI done of my back in 2003 because of low back pain, tingling in both legs, pain radiating down my left leg. The report findings:

The lumbar vertebral bodies are normal in height and alighnment. The bone marrow signal is homogeneous. There is disc desiccation at L5-S1. The conus extends to t12-L1 and appears normal. The L3-L4 and L4-5 discs appear normal. There is a small annular tear at L5-S1 with a very small central disc herniation at that level. There is no lateralization. The neural foramina are widely patent. There is no evidence of spinal stenosis. IMPRESSION: Degerated disc L5-S1 with annular tear and very small central HNP.

What does all this mean? Since then I have continued to have severe back pains and in the last four weeks I have had three episodes where I have bent down, or twisted to move, and I have gotten stuck so that I can't straighten back up or move my legs.
AIf you think of your disc as a jelly filled doughnut, the annulus is the dough and the nucleous pulposus is the jelly. IF you have a tear in the annulus, some of the jelly can bulge backwards toward the spinal canal where the nerve roots live. People who experience radiating pain, numbness or weakness down one leg have may have a bulge more to one side, "lateralization", instead of your "central" herniation. This central bulge may cause your symptoms to be a little more subtle. I am assuming if you had this test in 2003, whoever was interpreting it and examining you did not feel that you had any loss of nerve function and that the symptoms could be managed with exercise. If that has not been successful or if you are having different symptoms than in 2003, you should consider a follow-up evaluation.

Answered by Tom Hasbach, MD, Orthopedic Surgery, Springfield, Thomas Hasbach MD (4/28/2005)

QI am 17 years old and about three years ago I hurt my back lifting weights. I couldnt even bend over to put on my shoes. I went to a doctor and got x-rays and an MRI and they said something about L4 and L5 -- I can't really remember and all my papers got lost.

I went to physical therapy for about a month and it got better. It still hurt, but the doctor said the only cure was surgery and that I was way too young for that. It got to where I could stand it, but two weeks ago the pain started again -- bad, but not as bad as before. I am wondering what I should do and I would greatly appreciate it if someone will advise me?
AIf you have injured a disc in your low back (and you probably have) and it keeps hurting after 4-6 weeks, you should ask for an evaluation by a spine specialist. There are a few reasons for this. You need an accurate diagnosis of the cause of the pain after 6-8 weeks without resolution of the pain. From this diagnosis it can be determined whether spine injections are indicated for relief of pain. The specialist can determine the best rehab program for you to prevent further injury/pain. Also, your activities should probably be adjusted to prevent reoccurance.

Answered by Michael Karasek, MD, Pain Management, , (4/13/2005)

QI injured my back in October, 2004 and have been receiving physical therapy ever since. I had some improvement, but after taking my vacation the pain feels like I'm back where I started.

I had an MRI done and I recived a report as follows:

At the L1-2 level, the intervertebral disk is normal. There is a mild bilateral facet hypertrophy, without stenosis or impingement. At L3-4 level there is a broadbased left paracentral disc protrusion which mildly effaces the dural tube anterolaterally impinge on the traversing roots. There is mild bilateral facet and ligament flavum hypertrophy, without significant stenosis. At L4-5 level there is an annular tear and small left paracentral disc protrusion.Moderate bilateral facet and ligamentum flavum hypertrophy is present. No definite neural impingement is identified

Could you explain what this means in English, and will the tear heal itself?
AThe "English version" requires an understanding of disc structure. The lumbar disc consists of a gel center, surrounded by a think, ligamentous wall. Trauma may tear the wall, or it may weaken with age. When the wall tears, the gel bulges into the fissure and the disc may bulge or protrude into the spinal canal.

Your MRI shows this type of abnormality in two of the lower three discs. 4-6 months of physical therapy is more than enough. Ask your doctor for other options, like spinal injection or referral to a spine specialist.

Answered by Michael Karasek, MD, Pain Management, , (3/9/2005)

QWhat are hemangiomas in the vertebral bodies T9 and T11? What is a hemangioma? The MRI showed these.
AThese are usually small vascular malformations, or clumps of blood vessels in the vertebrae. They are usually of no clinical significance. You should discuss this with the doctor who ordered the MRI. Hemangioma is not a likely cause of your back problem unless they are very large.

Answered by Michael Karasek, MD, Pain Management, , (2/3/2005)

QI have just been told that I have an L4 disc herniation. I don't really understand that. Would you be able to tell me anything about that type of herniation?
AUsually, discs are numbered by the vertebrae that they are between. For example the vertebrae in the low back are numbered L1 through L5. Usually the disc between the 3rd and 4th would be called the L3-L4 disc. and the next one down would be L4-L5. Probably your doctor is indicating the one between L4 and L5, which is just below the belt line in your back. It doesn't say anything about the size or side of the herniation or whether the herniation is affecting a nerve or not. More information would be needed to completely characterize the herniation for you.

Answered by Ray Englander, M.D., Neurology, Springfield, Oregon Neurology Associates (2/3/2005)

QCan you educate me on who can perform kyphoplasty? Can Pain specialists, who are also Anesthesiologists, perform them, or do you have to go to an interventional radiologist?
AThe kyphoplasty procedure is performed by pain specialists, interventional radiologists, and some spine surgeons. The key is to ask about the doctor's training and experience. How many have they done? How did they train -- a weekend course?

Answered by Michael Karasek, MD, Pain Management, , (12/30/2004)

QMy husband had a lumbar epidural steriod injection. The doctor said this injection does not deteriorate bone tissue or the disk. A chiropractor said it does. I believe the doctor. Who is correct?
AThe doctor. There have been studies of tissue in humans after many epidural steroid injections. No significant damage from the steroids has been found. Your chiropractor may be thinking of tissue changes with long term oral steroid use, which may be substantial.

Answered by Michael Karasek, MD, Pain Management, , (12/5/2004)

QI have 3 compressed and/or fractured vertabrae after a fall from a horse. My Doctor mentioned the possibility of repairing the one in my upper back by "glueing". Could you possibily explain the procedure, and the pros/cons?
AFor the pain of vertebral compression fractures, vertebroplasty and kyphoplasty are often effective surgical options. These procedures essentially 'splint' a fracture from within by using a bone cement that hardens within the fracture.

To undergo these procedures, a patient would have:

1. continued intractable pain that interferes with the activities of daily living due to vertebral compression fracture. Therapy with analgesics and bracing is the first and often effective step at pain control

2. Images (either a bone scan confirming a recent fracture and a CT scan to be certain that there is no spinal narrowing or a MRI with STIR sequence to evaluate for the fracture and narrowing)

3. Absence of active infection or bleeding disorder

Vertebroplasty does not regain vertebral body height, but is effective for pain control in over 80 % of patients, and requires only local anesthesia with sedation. This outpatient procedure requires 15-20 minutes, and is done by Pain Mangement Physicians and Radiologists here in Eugene.

Kyphoplasty involves first inflating a balloon in the broken vertebral body, and then injecting the same cement as in vertebroplasty. The ability of this procedure to control pain is simular to vertebroplasty. The balloon inflation may help regain vertebral body height. Kyphoplasty requires general anesthesia, and is done by neurosurgeons here in Eugene. Drs Kokkino, Miller and McGirr.

You can read about these procedures on at Kyphoplasty, Vertebroplasty .

Answered by Christa Danielson, MD, Geriatric Medicine, Eugene, PeaceHealth Medical Group - Oregon (7/30/2003)

QMy daughter was diagnosed with scoliosis. It is at a 65 degree angle, and the doctor suggested surgery. It is "S' shape. She is 15. She has a deep dimple on the left and her side bothers her when she walks a lot.
AYour daughter apparently has an advanced idiopathic scoliosis curve. Conservative treatment (exercise, bracing) will not improve the deformity and may NOT prevent continued progression of the curve. Evaluation and treatment by a pediatric spine surgeon is mandatory to prevent long term cosmetic and functional disability. To learn more about this condition try reading Scoliosis at the American Association of Orthopaedic Surgeons web site.

Answered by Andrew Boughal, DO, Orthopedic Surgery, , (5/10/2002)

QMay I please have some basic, general information on degenerative disc disease?
AThe term "degenerative disc disease" refers to deterioration of the disc space between vertebra as a result of aging. Arthritic changes are also usually seen involving the posterior facet joints of the spine. Degenerative dics disease usually occurs in the lumbar spine. Your doctor may prescribe an anti-inflamatory agent for the arthritis. Exercises for toning and stretching are also useful. For general information see the short articles on Degenerative Disk Diseases at MedlinePlus/Herniated Disk

Answered by Andrew Boughal, DO, Orthopedic Surgery, , (3/28/2002)

QWhat are spinal stenosis, central canal stenosis, and degenerative disk desease?
ASpinal stenosis is a condition where the spinal canal becomes narrowed and squeezes the spinal nerves. When the canal becomes significantly narrowed it can cause symptoms of back and leg pain which are worse with walking or standing, and usually relieved by sitting or stooping forward (leaning on the grocery cart while shopping). The symptoms are often improved with epidural steroid injections. I perform these routinely with very favorable results. Surgery is also successful in alleviating the condition. To read about these conditions try
Spinal Stenosis
at MedlinePlus.

Answered by Andres Betts, MD, Anesthesiology, , (2/27/2001)

QI get kidney pain at night, which slowly abates during the day. Any suggestions?
AFrequently pain in the joints and the muscles of the low back is interpreted by people as kidney pain. The kidneys are tucked up inside next to the spine right below where the lowest rib attaches to the spine. The pattern of nighttime pain that gets better once you are up and moving about suggests that this may be the case for you. Here is some more information on low back pain from the National Library of Medicine's consumer web site: MEDLINEplus/Back Pain

The only way to be certain that the pain is not coming from kidney or from some other cause is to be checked by your health care provider.

Answered by Tom Ewing, MD, Family Practice, Eugene, Planned Parenthood of Southwest Oregon (2/9/2000)

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