Inflammation finally leads to bone scarring. Pathologically, these changes are called modic changes and are grouped into 3 types. I) Modic type 1 changes show signs of active inflammation. These signs are pain, presence of minor fractures and other breakages near the endplate area, accumulation of inflammatory fluid in the region leading to swelling. This stage is very painful and the pain usually correlates with the amount of inflammation. Ii) Modic type 2 is when the marrow gets substituted by yellow fat. Iii) Modic type 3 is the stage where all inflammation is finally replaced by bone scarring. Since your mri is showing modic type 1 changes, you have active inflammation in your back adjacent to end plates, which is giving you the pain.
Grade 1 Retrolisthesis
Can you suggest any good doctor in Kerala? Reply : It is evident from your mri that you are having a lot of back pain. Let us first know what these modic changes are. These are vertebral endplate and subchondral bone marrow changes due to the degeneration of discs. These are observed on mri as signal intensity changes in vertebral body near the end plates of the affected discs. With increasing age and repeated stress, wear and tear occurs in our back. This includes: wearing out of the cushions provided between two vertebrae. Shortening of the height between two vertebrae. Minor fractures in the bony areas (like trabeculae) of the vertebrae. Presence of signs of inflammations in the area, that is swelling etc. Later on, fat tissue may get deposited.
No evidence of spondylolisthesis seen. Vertebral bodies, pedicles, laminae, spinous processes and facetal articulation appear normal. Normal marrow signal intensity preserved. Mid sagittal spinal canal measurement. L1-L217 mm L214 mm, l2-L316 mm L314 mm, l3-L415 mm L413. L4-L511 mm L513 mm, l5-S111 mm, sir in this case, i am eagerly waiting your precious suggestions. Kindly inform me if surgery is guaranteed its only remedy? We have so many doubts whether the operation would be success or not.
Its result is shown below: revelation At L1-L2, L2-L3 and L3-L4 no disc desiccation seen. Discs show no significant bulge/herniation. No evidence of significant primary canal / foraminal stenosis seen. At L4-L5 disc desiccation seen with reduced disc height. Para-discal bone marrow appears hypointense on T1w, hyperintense on T2W images suggestive of modic type i changes. Posterior disc protrusion causing significant spinal canal and bilateral foraminal stenosis with compression of the exiting nerve roots. At L5-S1 no disc desiccation seen. Posterior annular disc bulge causing bilateral foraminal stenosis and mild spinal canal stenosis. Vertebral alignment appears normal.
The remainder of the abdominal and pelvic viscera are unremarkable. No abdominal or inguinal lymphadenopathy. No free intraperitoneal fluid or gas. 4mm anterolisthesis of L4. No suspicious bony lesion. Conclusion, numerous bilateral pulmonary 'cannonball' metastases. No evidence of metastatic disease elsewhere. Q : dear doctor, since 3 years I have been suffering from backache. On 24th February 2011, i took an mri scan of lumbar spine.
Treatment for anterolisthesis of the spine
Lumbar stenosis results from a spinal canal diameter of less than 12 mm in some patients; a diameter of 10 mm is definitely stenotic. Keim and colleagues present the summary following lumbar spinal stenosis (LSS) anatomical classification scheme 18 : Lateral, secondary to superior articulating process (SAP) hypertrophy medial, secondary to inferior articulating process (IAP) hypertrophy central, due to hypertrophic spurring, bony projection, or ligamentum flavum/laminar thickening Fleur de lis. From the case: Cannonball metastases from endometrial cancer, numerous pulmonary nodules and masses scatttered throughout all the lobes. No pleural or pericardial effusion. No axillary, hilar or mediastinal lymphadenopathy.
No evidence of mass causing tracheal deviation. No breast lesion or axillary lymphadenopathy. The kidneys are slightly atrophic and contain multiple hypodense cysts, great too small to characterise. No solid lesion seen. The uterus is not seen, consistent with prior hysterectomy. Fatty atrophy of the pancreas.
5, 6, 10, 11, 12, 13, 14, cervical spondylosis refers to age-related degenerative changes of the cervical spine. These changes, which include intervertebral disk degeneration, disk space narrowing, spur formation, and facet and ligamentum flavum hypertrophy, can lead to the narrowing of the cervical spinal canal. Cervical spondylotic myelopathy (CSM) refers to the clinical presentation resulting from these degenerative processes. Csm is the most common cause of spinal cord dysfunction in adults older than 55 years. Degenerative changes of the cervical spine have been observed in as many as 95 of asymptomatic individuals older than 65 years.
Myelopathy is believed to develop in up to 20 of individuals with evidence of spondylosis. 5, 11, 13, 14, 15, 16, 17 lateral cervical stenosis results from encroachment on the lateral recess and the neuroforamina of the cervical region, primarily as a result of hypertrophy of the uncovertebral joints, lateral disc annulus bulging, and facet hypertrophy. Thoracic spinal stenosis The thoracic spinal canal varies from 12 to 14 mm in diameter in the adult. Thoracic spinal stenosis is often associated with focal disease of a long-standing nature. It may be associated with disk bulging or herniation, hypertrophy of the posterior elements (namely, the facet and ligamentum flavum and, occasionally, calcification of ligamentum flavum. Primary central thoracic spinal stenosis is rare. In some cases, hypertrophy or ossification of the posterior longitudinal ligament results in central canal stenosis. 6 lateral thoracic stenosis may result from hypertrophy of facet joints with occasional synovial cyst encroachment. Lumbar spinal stenosis The diameter of the normal lumbar spinal canal varies from 15 to.
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In hyperextension, the cervical cord increases in diameter. Within the canal, the anterior first roots are pinched between the annulus margins and spondylitic bony bars. In the posterior canal, hypertrophic facet joints and thickened infolded ligamentum flavum compress the dorsal nerve roots. In hyperflexion, neural structures are tethered anteriorly against the bulging disc annulus and spondylitic bars. In the event of a vertebral collapse, the cervical spine loses its shape, which may result in anterior cord compression. In the central cervical spinal region, hypertrophy of the ligamentum flavum, bony spondylitic hypertrophy, and bulging of the disc annulus contribute to development of central spinal stenosis. In each case, the relative significance of each structure contributing to the stenotic pattern is variable. Congenital stenosis of the cervical spine may predispose an individual to myelopathy as a result of minor trauma or spondylosis.
Such compression occurs with far lateral vertebral body endplate osteophytosis and when the sacral ala and L5 transverse process impinge on the L5 spinal wodehouse nerve. Cervical stenosis, the anteroposterior (AP) diameter of the normal adult male cervical canal has a mean value of 17-18 mm at vertebral levels C3-5. The lower cervical canal measures 12-14. Cervical stenosis is associated with an ap diameter of less than 10 mm, while diameters of 10-13 mm are relatively stenotic in the upper cervical region. Sagittal measurements taken of the anteroposterior diameter of the cervical spinal canal are highly variable in otherwise healthy persons. An adult male without spinal stenosis has a diameter of 16-17 mm in the upper and middle cervical levels. Magnetic resonance imaging (MRI) scans and reformatted computed tomography (CT) images are equally as effective in obtaining these measurements, while radiography is not accurate. View Media gallery, movement of the cervical spine exacerbates congenital or acquired spinal stenosis.
consequently, arises from facet joint sap hypertrophy. Other causes include developmentally short pedicle and facet joint morphology, as well as osteophytosis and hnp anterior to the nerve root. The lumbar nerve root compressed below sap retains the same segmental number as the involved vertebral level (eg, L5 nerve root is impinged by L5 sap). The mid zone extends from the medial to the lateral pedicle edge. Mid-zone stenosis arises from osteophytosis under the pars interarticularis and bursal or fibrocartilaginous hypertrophy at a spondylolytic defect. Exit-zone stenosis involves an area surrounding the foramen and arises from facet joint hypertrophy and subluxation, as well as superior disk margin osteophytosis. Such stenosis may impinge the exiting spinal nerve. Far-out (extracanalicular) stenosis entails compression lateral to the exit zone.
View Media gallery, trefoil appearance characteristic of central canal stenosis due to a combination of zygapophysial joint and ligamentum flavum hypertrophy. Lumbar computed tomography (CT) myelogram scan demonstrates a normal central canal diameter. Lateral recess stenosis (ie, lateral gutter stenosis, subarticular stenosis, subpedicular stenosis, foraminal canal stenosis, intervertebral foramen stenosis) is defined as narrowing (less than 3-4 mm) between the facet superior articulating process (SAP) and the posterior vertebral margin. Such narrowing may impinge the nerve root and subsequently elicit radicular pain. This lateral region is compartmentalized into entrance zone, mid zone, exit zone, and far-out stenosis. Amundsen and colleagues found concomitant plan lateral recess stenosis in all cases of central canal stenosis. 9 (see the image below.
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Central canal stenosis, commonly occurring at an intervertebral disk level, defines midline sagittal spinal canal diameter narrowing that may elicit neurogenic claudication (NC) or pain in the buttock, thigh, or leg. Such stenosis results from ligamentum flavum hypertrophy, inferior articulating process (iap facet hypertrophy of the cephalad vertebra, vertebral body osteophytosis, vertebral body compression fractures, and herniated nucleus pulposus (HNP). Abnormalities of the disk usually do not cause symptoms of central stenosis in a normal-sized canal. In developmentally small canals, however, a prominent bulge or small herniation can cause symptomatic central stenosis. Large disk herniations can compress the dural sac and compromise its nerves, particularly at the more cephalad lumbar levels where the dural sac contains more nerves. (see the images below.). Lateral T2-weighted magnetic resonance imaging (MRI) scan demonstrating narrowing of the central spinal fluid signal (L4-L5 suggesting central canal stenosis. View Media gallery, axial T2 database magnetic resonance imaging (MRI) scan (L4-L5) in the same patient as in the above image, confirming central canal stenosis.