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Thread: Do CT Myelogram Results Nullify MRI Results?

  1. #1
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    Do CT Myelogram Results Nullify MRI Results?

    My MRI said I had stenosis, but then a neurologist suggested I take a CT Myelogram to clarify the potential source of suspected nerve impingement. The CT myelogram did not show stenosis just degenerative changes, listhesis and bulging of every lumbar disc and some spurring, but not enough to point to nerve impingement in the eyes of the doctor who administered the CT myelogram ( not a doctor knowledeable about scoliosis).

    Yet, I have stenosis-like symptoms that come on and get progressively worse with activity and get a little better after rest.

    I am hung up about the stenosis as it would give a clear explanation for my symptoms and the need for surgery and I am obviously still struggling to make up my mind about surgery.

    A final question, if you believe the CT myelogram does nullify the MRI's indication of stenosis then: Can scoliosis cause issues with standing and walking even without stenosis?

    Thanks to all for their continued help and support
    Lisa

    Pre-surgery: Thorocolumbar curve starting at T12 of 60 degrees and a compensatory curve of 30 degrees

  2. #2
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    From what I've heard, it depends on who did your CT myelogram. When mine was done, my surgeon insisted on my having it done at his hospital, by his expert. He did not want me doing it anywhere else. I think it's kind of like the time everybody thought I had a muscle cancer, and when I got to the sarcoma specialists finally, they weren't interested in seeing anyone's MRIs, only the ones they did at their hospital, that were read by specialists in sarcomas.

    Generally, the CT myelogram should be far more accurate than the MRI for revealing the nature of nerve impingement. The impingement I have was visible on both types of images. The doctor who did my CT myelogram showed the the picture on the monitor, and it was obviously clearer than the MRI for showing the nerves...was your MRI with or without contrast? That could make a difference, too.

    You can have a narrowing of the space the individual nerves pass out of, without having stenosis, which as I understand it is the narrowing of the spinal canal where the spinal cord itself travels. But if the guy doing your myelogram said he didn't see anything that would cause nerve impingement, he certainly ought to have seen it if it was there. Unless it takes an eye practiced in reading myelograms of scoliosis patients, and maybe it does.
    Stephanie, age 53
    Diagnosed age 8
    Milwaukee brace 9 years, no further treatment, symptom free and clueless until my 40s that curves could progress.
    Thoracolumbar curve 39 degrees at age 17
    X-rays in Dec. 2010 and January 2011 at 58 degrees thoracic, 70 degrees thoracolumbar
    Expect eventually to need long fusion to Pelvis.
    Surgeon Dr. Michael S. O'Brien, Baylor's Southwest Scoliosis Center, Dallas TX
    Bilateral laminectomies at L3 to L4, L4 to L5 and L5 to S1 on April 4, 2012

  3. #3
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    Thanks Stephanie.

    The guy who did the CT myelogram is an expert. It was done at Pennsylvania Hospital, which is associated with University of Pennsylvania

    The MRI was done without contrast at a center connected with Thomas Jefferson University Hospital, another big hospital in the Philadelphia area. However, it was an open MRI.

    Is it important for the person reading the CT myelogram to understand scoliosis or does it not matter?

    Lisa
    Pre-surgery: 60 degree thorolumbar curve starting at T12
    30 degree compensating curve
    18 degree rotation

  4. #4
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    I agree with Stephanie. MRIs typically aren't used to diagnose stenosis.

    Stenosis isn't the only reason people with scoliosis can have pain. You might have pain from degenerated or herniated discs, arthritis, etc.

    I would assume that the radiologist who read the CT myelogram knows at least a minimal amount about scoliosis. I don't know about your case, but at UC, the surgeons don't even look at the radiologist's reports unless they see something about which they're uncertain.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  5. #5
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    Quote Originally Posted by LindaRacine View Post
    I don't know about your case, but at UC, the surgeons don't even look at the radiologist's reports unless they see something about which they're uncertain.
    I am guessing our surgeon never looked at the radiologist's reports on my daughters. During treatment, I only ever knew about the surgeon's readings because I saw the radiographs and he told me. When I finally got the radiologist reports at the end of the treatment, they didn't resemble at all what the surgeon was saying about the curve measurements and progression/stability at certain time points. The take home for me was that it is VERY important not to mix readings from two different people in this game. You could easily get the wrong idea by bouncing back and forth. In the end both said there was progression to surgical range and both agreed on the general incessant progression in the one kid so it's probably moot.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  6. #6
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    Question to Linda

    "Stenosis isn't the only reason people with scoliosis can have pain. You might have pain from degenerated or herniated discs, arthritis, etc."
    Linda Racine

    Thanks Linda and Pooka.

    I don't have herniated discs. I do have arthritis and bulging discs, but would that cause muscle tightening after activity?

    And my back does have its problems, but nothing really bad that would explain the symptoms. The guy doing the test said I did not need surgery, but I don't think he knows anything about scoliosis surgery and he didn't think my scoliosis was bad. He just meant looking at my back it is not bad enough for regular back surgery.

    It seems like I have nerve impingement, but wouldn't that show on the CT myelogram?

    One of the surgeons seemed to say that the problem may not show because it occurs when the spine isn't flat (loading of the spine in scoliosis), but I don't want to proceed with surgery and still have a problem. I know there are no guarantees, but my motivation would be to walk and stand unlimited. Again, I can walk and stand, but the more I do the worse I feel so I am am discouraged from a full range of normal activity though I have been trying to build to it. And I feel good and pain-free on a day where I don't walk or stand a lot.

    I feel like my problem is muscular from my body being pushed together opposite my curve. I used to stretch with yoga daily, but lately got so messed up that the stretching doesn't help and can hurt so I only do a little bit--all gentle and that's not enough to really stretch me out.

    I realize I keep asking variations of the same question, but feel this is what I need to focus on to understand and confirm my path to surgery.

    Thanks for your patience and help.

    Lisa
    60 degree thorocolumbar curve (starting at T12) and a compensating 30 degree curve underneath it
    18 degree rotation (kyphoscoliosis)

  7. #7
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    Hi Lisa...

    Have you tried injections?

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  8. #8
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    Quote Originally Posted by LindaRacine View Post
    Hi Lisa...

    Have you tried injections?

    --Linda
    Sounds like you think that makes more sense.

    Errico and Lonner didn't really feel it would help though Lonner did suggest initially just because that is what he tells everyone. Also, the doctor who gave me the CT myelogram didn't think epidurals would be helpful, but the doctor who gave me my first epidural thought I should try more.

    I tried one and didn't think it worked. Made me feel worse at first. About three to four weeks later I did start to get better. Could it take that long to work?Also, could it help someone like me who doesn't have problems till activity?

    And the question is what level? I realize that is a question for everyone and you just need the best guess.

    One doctor suggested T12/L1 and when I told that to Errico, he said you never do epidurals there.Did you ever hear of epidurals for that level?

    The one I did get was supposed to be for L4/L5, but the doctor inserted it at one level above.

    I rejected as didn't think it would help and I found it made me feel worse, but I will think about again. Thanks Linda!

  9. #9
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    Hi Lisa...

    I can't recall ever hearing any of our docs tell someone that injections wouldn't work for a patient, but it's entirely possible that that's true. The one thing I know for sure about injections is that you need to go to a physiatrist who knows what they're doing. And, even then, injections only help some people. There seem to be dozens of possible reactions to injections. They don't work for some. They work for some, but they can work immediately, or it can be delayed. The benefit can last minutes, hours, days, weeks, months, or even years.

    The reason I inquired about whether you'd had injections is that they can be diagnostic. If you have an injection at the level(s) that are causing the pain, and it works, it can be totally diagnostic. Unfortunately, the opposite is definitely not the case (that is, if the injection doesn't work, it's still entirely possible that surgery will reduce or eliminate pain).

    Obviously, I don't have a clue what level your injections should be done at. I've never heard that injections can't be done at T12/L1, but if Errico said that's the case, I would believe him.

    I would stop thinking about what the doctor who did the CT-myelogram told you. You're seeing two surgeons who have great reputations in terms of scoliosis care. If I were you, I'd put my trust in one of them, and let him guide my treatment.

    Regards,
    Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  10. #10
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    Quote Originally Posted by LindaRacine View Post
    Hi Lisa...

    I would stop thinking about what the doctor who did the CT-myelogram told you. You're seeing two surgeons who have great reputations in terms of scoliosis care. If I were you, I'd put my trust in one of them, and let him guide my treatment.
    Thanks for your good advice. It was Clements who suggested the T12/L1 and suggested epidurals first. He thought they might save me from surgery.

    Earlier in my interactions with Lonner, he suggested epidurals, but when I questioned him about it he didn't really think they would help.

    Both Lonner and Errico think I need surgery within the next year or two (I believe they are thinking that more progression is inevitable) and I have lost a lot of function.

    I appreciate your thoughtful responses.
    Regards,
    Lisa

  11. #11
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    Lisa, what exactly are your symptoms?
    Stephanie, age 53
    Diagnosed age 8
    Milwaukee brace 9 years, no further treatment, symptom free and clueless until my 40s that curves could progress.
    Thoracolumbar curve 39 degrees at age 17
    X-rays in Dec. 2010 and January 2011 at 58 degrees thoracic, 70 degrees thoracolumbar
    Expect eventually to need long fusion to Pelvis.
    Surgeon Dr. Michael S. O'Brien, Baylor's Southwest Scoliosis Center, Dallas TX
    Bilateral laminectomies at L3 to L4, L4 to L5 and L5 to S1 on April 4, 2012

  12. #12
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    Hi Stephanie,
    The symptoms keep changing a little, but I have problems mostly with my right leg opposite the curve. Pretty soon after I stand it feels like I have a compromised base that is weak on the right side from the leg to the foot, and if I stand too long I get a lot of very uncomfortable tightness in my leg after (somewhat relieved by rest) and more tightness later that evening that can make sitting very uncomfortable. I can walk a number of blocks, but again on my foot under the big toe it starts to feel a little sore and then it translates into my butt hurting and my leg getting uncomfortably tight and sometimes the area right above my butt.

    At night, my leg pulses ( in response to how much activity I have done) and I feel the tightness in a sciatic pattern under my leg though my whole leg can bother me. I also can feel some binding/soreness in my feet (top and bottom) and in parts of my leg and in response don't like anything tight on my legs or feet.

    I am currently on Lyrica 450mg and I take tizanidine at night.

    At different points in the year I have been in pain, but right now if I don't walk or stand I feel okay, but the more I do the worse I feel, which discourages a lot of activity. I live in the city and I can't walk (or wait for a bus) to where i want to go, can't exercise (though do tai chi and some very basic yoga poses) and haven't been shopping or going to museums, and at parties I always look for a chair. I also do household and personal care activities sitting down because standing becomes uncomfortable so quickly.

    It seems like my right leg needs release, but past attempts at more vigorous yoga and PT have reversed any progress I have made and put me in pain so I am cautious as in the past the pain didn't resolve. I am working to slowly build up my activity level again, but it is slow. My discomfort/pain is resolving more now, but I am unsure how much progress I can make. I am trying to add a little bit daily.

    I looked up an old thread and read Boachie Adjei's presentation on scoliosis and he said pain from scoliosis can be mechanical, radicular or stenotic. Mine seems mechnical and radicular though the pinched nerve is not clearly identified. He also had an example of someone who had leg pain only. And third he mentioned that something like dynamic (multi-position) CT myelograms are sometimes needed to show stenosis.

    This all started with years of leg spasms at night, several acute bouts of sciatica and some neuropathy that remained in my feet. Once I got sciatica six years ago it never completely went away, but I still was always very active and a walker and hiker until this year. And before things deteriorated i just did lots of yoga and did stretches to release my leg throughout the day.

    The symptoms were a lot worse before I stopped taking B6, and also I was recently laid off (unrelated to my physical issues) and less sitting has helped, but the symptoms are still very disruptive and a little puzzling to me since they seem so different than everyone else (though seem like stenosis) though Errico and Lonner for the most part didn't find them puzzling.

    I remember you have terrrible pain. Right now thankfully I don't and that's one of the reasons I hesitate yet I've been struggling for six years. I didn't have progression of my curve this year, but clearly had progression over the last six years or decade. I just know that my back didn't used to look like this, but I'm not sure when the change happened.

    Thanks for asking. It's good you made your decision.
    Lisa
    60 degree thorocolumbar cuve beginning at T12 and a compensating 30 degree curve beneath
    18 degree rotation

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