Results from MRI

[nell]

Hey, I just joined this forum a couple of months ago and have been looking through all of the advice and information posted here=) I never wrote anything up until now because I was diagnosed with scoliosis at the age of 15 and was told it was not severe enough to do anything for it, at the time i was pain free.

I'm now 27 and have had sciatic pain for the past 6 or 7 years. I never really complained about it until recently though, and was given anti-inflammatory, muscle relaxants and percocet to deal with the pain when it comes. I went to an osteopath as well as a orthopedic doctor to get insoles.

Finally my doctor decided to get an MRI done and I now know a bit more about what is going on with my spine. Although i don't really understand some of the medical terms that well:

my L2/L3 has very mild diffuse circumferential bulge of the disc, facet O.A. no spinal or foraminal stenosis

My L4/L5 mild diffuse circumferential bulge of the disc with some flattening of the sac. Mild central spinal stenosis. Severe foraminal stenosis. Right foramen is normal, facet O.A.

and finally my L5/S1 posteromedical tear in the annulus fibrosis. Broadbase diffuse posterior disc bulge centered posteomedially coming in contact with the sac without causing mass effect. No mass effect on the nerve roots. Facet O.A. Mild central spinal stenosis. Severe bilaterial foraminal stenosis, more prominent on the left. Scoliosis convex to the left.

My Doctor is trying to push me ahead of the waiting lists to see a Neuro Surgeon for a consultation. Just wondering what you guys think....

I know my scoliosis is not half as bad as the majority of people here, but I was wondering if anyone has the same type of problems as me with their spines and Facets and who have gone the non-surgical route?

[Pooka1]

Hey great post. I hope you get some responses.

I was curious as to what your Cobb angle was at 15 when your curve was too small to treat and what it is now. It seems like folks with sub-surgical curves sometimes go on to need treatment as young adults either for progression or pain which is not the paradigm you hear from surgeons.

[nell]

it was so long ago.. I think it was around 20 degrees or 21 or something. They said it was too small for surgery and that I had already stopped growing so a brace would do no help. I personally lay blame on my pediatrician who never checked my spine to begin with. It was only once I got my own GP and she did x-rays of my lungs because of Bronchitis that she saw the scoliosis.

At the moment I have no idea what the curvature is. The MRI technicians didn't calculate it and they didn't give my Doctor the images, just their report. I will be finding out soon enough though since I need to get a copy of the images for the neuro surgeons. It's true you know, no one ever did a follow up. They never tell you that this is something that can worsen horribly as you age.

[Pooka1]

I think your case is illustrative of the need for surgeons to continue observation of people even with small curves such as 20*. Though you still may be sub-surgical, it is possible some conservative treatments could have helped you and maybe have avoided your getting to the point of having damage to your lower spine. I don't know.

I'm just saying this paradigm of making it to maturity at a subsurgical angle so as to avoid surgery in the future is looking more and more suspect. The reason it matters is my one kid was given a brace in the 30* to try to keep her below 50* and thereby avoid surgery in her life for scoliosis. I have no confidence she would have avoided surgery for some reason even if the brace held her in the mid 30*s. In other words, the brace was a complete waste of time in my opinion.

Good luck.

[Confusedmom]

Pooka1,

I know you have probably heard this story from many people, but it addresses your question. I wore a Boston brace for two years in 8th & 9th grade. My curve went down to 8 degrees. They took it off and it just gradually crept back up to now 67 degrees at age 38.

I had gone to a doc just before graduating college who said at 33 degrees I would never need surgery nor future appts. Unfortunately now I am looking at surgery. I do view the brace as sort of a waste of time and wonder if I hadn't worn it if maybe I just would have gotten the surgery over with in high school. On the other hand the technology is much better now. Hope your daughter never needs surgery!

Evelyn

[Pooka1]

Pooka1,

I know you have probably heard this story from many people, but it addresses your question. I wore a Boston brace for two years in 8th & 9th grade. My curve went down to 8 degrees. They took it off and it just gradually crept back up to now 67 degrees at age 38.

I had gone to a doc just before graduating college who said at 33 degrees I would never need surgery nor future appts. Unfortunately now I am looking at surgery. I do view the brace as sort of a waste of time and wonder if I hadn't worn it if maybe I just would have gotten the surgery over with in high school. On the other hand the technology is much better now. Hope your daughter never needs surgery!

Evelyn

Wow thanks for posting that testimonial.

You went from 33* at he end of college to a 67* at 38. That might be a record for progression after skeletal maturity from a clearly subsurgical curve. Of course you are correct that the instrumentation now is better than 16 years ago so that's in your great favor.

There are about 8 now that I can recall of people who were clearly sub-surgical and in some cases very sub-surgical at maturity who nevertheless progressed to surgery territory as young adults. I realize this is not a good cross-section and people come on here who are having further trouble. Maybe the vast majority of folks in the 30* range at maturity in fact never need spinal fusion for progression. But I question how many need it for ancillary damage at far younger ages than the general population. Who knows. I just find the situation curious.

As for my kids, they are both fused. They have some connective tissue disorder which makes the brace for the one kid even more questionable as far as I can tell. That was a failed experiment if ever there was one in my opinion.

Good luck.

[Pooka1]

Pooka1,

I know you have probably heard this story from many people, but it addresses your question. I wore a Boston brace for two years in 8th & 9th grade. My curve went down to 8 degrees. They took it off and it just gradually crept back up to now 67 degrees at age 38.

I had gone to a doc just before graduating college who said at 33 degrees I would never need surgery nor future appts. Unfortunately now I am looking at surgery.

Evelyn

Can I just ask you if your surgeon now is absolutely dumbfounded over your 34* progression from a very subsurgical curve at maturity in only 16 years? What did he say?

We have another case where the surgeon didn't seem to think that it at all odd. I can tell you this is not what surgeons are telling kids as far as I can tell. We were told if the curve could be held to a sub-surgical level at maturity they she would not need fusion. Of course that was looking less and less likely as these testimonials pile up.

Amazing. I don't understand why bracing is ever done.

[LindaRacine]

Sharon...

I doubt I need to remind you that scoliosis patients with small curves that stayed small are unlikely to show up here.

There are definitely a lot of people who were told that they didn't need to worry about their curves, as they were skeletally mature, and who woke up one day to find that their curves had increased significantly. But, there are also plenty of people with curves of all sizes, who are unaffected by their scoliosis, despite having been told that they'd probably need surgery some day. And, I have to tell you that while we occasionally see someone in the first group, while we do more regularly see patients in the second group.

I think that we don't really have a clue about the natural history of scoliosis. I sure would love to do a study of unfused idiopathic scoliosis patients who have films that cover a 20-30 year period. While I'm sure there are plenty of people who films covering 20-30 years, they're not exactly easy to find.

--Linda

[Pooka1]

Yes I agree reading testimonials here is no way to gather data.

But when we have a previous thread wherein a surgeon tells a young adult that her progression from clearly sub-surgical at maturity to needing fusion is not unusual then I find that curious. That surgeon should have been dumbfounded and yet he was not.

And here we have a 20* - 21* degree curve at maturity (age ~22 yo) that becomes WAY surgical when the woman is 38??? I would love to know if her surgeon finds that completely astounding (or not). Wouldn't you?

ETA: If surgeons start to admit they don't really have a clue as to any particular case, that is is largely a crapshoot, then that is yet another nail in the bracing coffin in my opinion. The thing that kept my kid going in brace was the hope it would hold her curve to mid 30*s so as to avoid surgery. That was not necessarily a realistic hope for a few reasons as it turns out not the least of which being in the mid 30*s at maturity is no guarantee to avoid fusion. Or being at 20*-21* for that matter. Just astounding.

Do you have some sense of the variability out there? I suspect it is larger than what has been reported. I think if that was accurately communicated then folks would be in a better position to make decisions about bracing.

[LindaRacine]

Yes I agree reading testimonials here is no way to gather data.

But when we have a previous thread wherein a surgeon tells a young adult that her progression from clearly sub-surgical at maturity to needing fusion is not unusual then I find that curious. That surgeon should have been dumbfounded and yet he was not.

And here we have a 20* - 21* degree curve at maturity (age ~22 yo) that becomes WAY surgical when the woman is 38??? I would love to know if her surgeon finds that completely astounding (or not). Wouldn't you?

ETA: If surgeons start to admit they don't really have a clue as to any particular case, that is is largely a crapshoot, then that is yet another nail in the bracing coffin in my opinion. The thing that kept my kid going in brace was the hope it would hold her curve to mid 30*s so as to avoid surgery. That was not necessarily a realistic hope for a few reasons as it turns out not the least of which being in the mid 30*s at maturity is no guarantee to avoid fusion. Or being at 20*-21* for that matter. Just astounding.

Do you have some sense of the variability out there? I suspect it is larger than what has been reported. I think if that was accurately communicated then folks would be in a better position to make decisions about bracing.

I think you're seeing things in black and white, when there are mostly lots of shades of gray. Since I've never been in the room when a surgeon told a patient that their curves would never increase, I can't comment on the actual statement. But, surgeons have always known (or should have known) that it's the majority of patients they were talking about. They might have said "your curve has 0% chance of increasing", which would clearly be an error. Or, they might have said, "on average, kids with your type and size of curve will not progress enough to require treatment." In my experience, patients occasionally recall statements very differently than what I recall. ;-)

Regards,
Linda

[Pooka1]

I think you're seeing things in black and white, when there are mostly lots of shades of gray. Since I've never been in the room when a surgeon told a patient that their curves would never increase, I can't comment on the actual statement. But, surgeons have always known (or should have known) that it's the majority of patients they were talking about. They might have said "your curve has 0% chance of increasing", which would clearly be an error. Or, they might have said, "on average, kids with your type and size of curve will not progress enough to require treatment." In my experience, patients occasionally recall statements very differently than what I recall. ;-)

Regards,
Linda

Linda, I'm going to suggest to you that there would be much less brace wear if having a curve in the 30*s was still a complete crapshoot in terms of avoiding fusion. I can't recall exactly what the surgeon said but I can say that I did not come away with a sense that this was quite so variable.

I'm also going to suggest that the great run of parents on this forum would think their kids were very likely out of the woods on fusion if they stayed below 40* at maturity. And I would bet my house that almost to a person would think they were out of the woods if they were 20* - 21* at maturity. I could be wrong.

You can have a small or a huge standard deviation about the same mean. I am saying I had no sense of the hugeness of the variation from what I was told. I am shocked at these testimonials but I'm going to have to get over it.

[foofer]

Sharon

I think that we don't really have a clue about the natural history of scoliosis. I sure would love to do a study of unfused idiopathic scoliosis patients who have films that cover a 20-30 year period. While I'm sure there are plenty of people who films covering 20-30 years, they're not exactly easy to find.

--Linda

Linda,

I have films starting at age 31, ending with age 55...I would love to eventually be a part of a study, especially if I do not have surgery. My latest x-rays showed measurements of 57T and 56L (Dr Rand). Six months prior, my measurements were 64T and 65L (Dr Boachie). I never did see the x-ray in Dr Rand's office to get a sense of does it look better than last time, but I have a request in to radiology and will try to post when I receive them, if it looks unusual.

Nell,

Welcome to the forum! I hope someone with specific knowledge on this forum will explain the terminology to you. Lots of us would be interested. I have also had sciatica on and off through the years and have never been fused. It's not debilitating, just kind of comes and goes with the weather, the exercise program, or just whatever.

Glad to have you!

Amy

[Confusedmom]

Sorry to respond late to this; for some reason I missed the question directed to me earlier.

Anyway, my doctor at age 22 didn't say my curve would never progress. What he said was I would likely never need surgery. I think he was just thinking I was at skeletal maturity and my curve wasn't too bad and not progressing too rapidly.

My current doc is a totally different doc, so, no, he is not dumbfounded that it went from 33* to 67* in 16 years. In fact he says he has several patients who have had significant progression as adults.

Anyway, interestingly, it turns out I also have a connective tissue disorder. However, it is a rather undramatic dermatological condition that no one has ever connected with my scoliosis. But who knows? Maybe that's why the bracing didn't work.

Evelyn

[LindaRacine]

Linda,

I have films starting at age 31, ending with age 55...I would love to eventually be a part of a study, especially if I do not have surgery. My latest x-rays showed measurements of 57T and 56L (Dr Rand). Six months prior, my measurements were 64T and 65L (Dr Boachie). I never did see the x-ray in Dr Rand's office to get a sense of does it look better than last time, but I have a request in to radiology and will try to post when I receive them, if it

That's great that you have so many films. If you have them al in your possession please hang onto them. I hope to eventually have at least 5-10 patients with a similar history.

To what do you feel caused the reductions in your curves over the last 6 months?

--Linda

[Pooka1]

Sorry to respond late to this; for some reason I missed the question directed to me earlier.

Anyway, my doctor at age 22 didn't say my curve would never progress. What he said was I would likely never need surgery. I think he was just thinking I was at skeletal maturity and my curve wasn't too bad and not progressing too rapidly.

My current doc is a totally different doc, so, no, he is not dumbfounded that it went from 33* to 67* in 16 years. In fact he says he has several patients who have had significant progression as adults.

Okay. What we have here and with other testimonials is essentially kids going through the crapshoot of brace wear and then even if it works to hold the curve well below surgical range that they are nevertheless still in another crapshoot about needing surgery even as a young adult.

I do not believe that brace patients are aware that there are two crapshoots, not one. I suggest it would be impossible to gain compliance in brace wear if it was known that a second crapshoot looms even if the they successfully navigated the first crapshoot.

That's my impression.