I'm amazed & few questions

[ans]

Yes indeed. I had a two-level epidural for what the radiologist called "moderate" interforminal spinal stenosis with something protruding into one of the formen so maybe it was severe in that one foramen.

This pain has blown my mind. I felt like I was hit with a baseball bat in the shins and accompanying muscles.

So, questions: I have extensive DDD and the levels are not where I have a blown L5-S1 disc acc'd to a discogram. Pending a discogram which could blow a disc (cute!), would having a foraminotomy be a reasonable idea w/a disectomy (some central canal bulges). I sure hate the idea of fusion and can't afford an ADR; also, an ADR at L4-L5 gets me nervous in case of uh "revision". (But I'm a great worrier anyhow!).

So, does a foraminotomy itself upset the architecture of the disc in terms of accentuating spondylothesis and who knows what?

Of course I w/get opinions about this but thought I'd put this out there as maybe some have "been there".

I heard they used to use a "bone wax" to prevent the osteophytes from growing but this isn't used much or at all I think.

My best,

ans

[Alastair]

Oh dear, you are confused!

The formina is the sheath that covers the spinal chord so they would inject dye into that to see if there is any impingment from either a disc or osteophyte. Its a tilting table job.

Stenosis is where the formina is impinged by the bones of the inner channel of the spinal vertibrae . That will not affect your discs, but your discs might affect your formina and spinal chord as they are hard.

Spodolythesis is where you get a sliding of the or a spine vertibrae forwards due to malformation or other problem.

I think you need to look in the FAQ`S to get your terms sorted out.
Just because a disc has does NOT make it a "Pain Generator" that is sorted out with discography which you sound as if you have had
Best
Alastair

[2cool4U]

Originally Posted by Alastair

The formina is the sheath that covers the spinal chord so they would inject dye into that to see if there is any impingment from either a disc or osteophyte. Its a tilting table job.

Stenosis is where the formina is impinged by the bones of the inner channel of the spinal vertibrae . That will not affect your discs, but your discs might affect your formina and spinal chord as they are hard.

Spodolythesis is where you get a sliding of the or a spine vertibrae forwards due to malformation or other problem.

Alastair

The meninges is the covering of the spinal cord. It contains three layers: the dura, arachnoid and pia maters.

The term foramen means a small opening. In spine talk, it usually refers to the space beside the vertebral bodies on each side created by the pedicles of the vertebral bodies of two adjacent levels. Each neural foramen contains a nerve root. In the thoracic and lumbar spine, the nerve roots exit the neural foramina just below the respective vertebra. For example, the L5 nerve roots descend from the bottom of the cord through the spinal canal and then exit the canal just under the pedicle of L5 at the L5-S1 level. In the cervical spine, each nerve root exits above the respective level. For example, the C4 nerve root exits between C3 and C4.

If you have disc material or bone spurs in the neural foramina (plural) that are clinically significant, you will have symptoms of the specific nerve root involved. However, those symptoms can vary widely, and some patients can have minimal stenosis (narrowing) and have severe symptoms while others can have severe narrowing but mild or no symptoms.

You don't need a myelogram to look for foraminal stenosis. It can be seen on MRI or CT. However, if these tests are not diagnostic or if the patient cannot undergo MRI, then a myelogram (injection of contrast into the spinal canal around the cord) is performed. It is also useful after metal hardware has been placed, as artifact from the hardware obscures portions of the spine on MRI.

Spinal stenosis refers to narrowing of the spinal canal itself. This can be due to bone spur, disc rupture, fractures with movement of bone back into the canal, infection or tumors most commonly. It is different from neural foraminal stenosis described above, but you can have both.

Spondylolisthesis is where a defect in the pars interarticularis exists on both sides and one vertebral body moves forward relative to its subjacent level.

Spondylolysis is where there is a defect in the pars but no movement of the vertebra.

Spondylosis is degenerative arthritis of the spine. Joint space narrowing, loss of proper disc function, bone spur formation, etc.

Three very similar terms with different definitions, but they can be related. You can have one, two, or all three conditions. There are varying theories about those pars defects. Some believe they result from earlier undetected stress fractures. Others believe a lack of blood flow may have occurred in utero or in early childhood. I'm not sure it has been completely worked out.

And, BTW, disc material is not hard. It is spongy and compliant, properties which make it useful as a shock absorber for the spine and allow for movement of the spine. Bone spurs (osteophytes) are hard.

Hope this clears things up a little. Google some of those terms to get pictures.

-tc-

[Jack]

Good picture of the cord and foramina. I initially found this for a search for cauda equina, the end of the spinal cord. Funny how a person remembers names like this from school. The name is Latin or some such foreign language for horses tail because that is what it looks like.

Cauda equina syndrome can also cause pain.

http://www.google.com/images?sa=3&q=...=Search+images

[ans]

Thank you TC. I used to think that stenosis also meant when the discs were close together but alas, there's a word for this!

Well A, you'll recover 'ol buddy.

[ans]

Hi. I'm posting so much that I worry if I have Dependent Personality Disorder.

I have something to "moderate" central canal stenosis at this level, the one most implicated from my readings to cause CES.

OK. So given the natural history of DDD, does severe compression at this level mean that one will get cauda equina syndrome? It would seem "yes", b/c the cauda equina is w/the disc is pressing on.

Always the paranoid.

Thanks in advance.

Chow - ans