@annie1 Annie, Spine surgery is something you do NOT want to rush into unless it is emergency surgery for a serious condition. Once done, you cannot undo it. Most spine surgeries are elective and come after years of spine degeneration. You have to make sure that you are picking a solution that is beneficial, and sometimes there are different choices. I have heard of surgeons asking patents to do a year of bone building injections before undergoing spine surgery. You also cannot rush healing and the body takes it's own sweet time.
Have you considered working with a physical therapist? They can't fix stenosis, but they can try to keep the spine aligned and address issues with muscle spasms and that may help reduce symptoms. I also had gait disturbances from spinal cord compression and that was cured by my surgery. One question to ask is are if you are taking any drug prescriptions that have side effects that can be contributing to osteoporosis? I don't know if drinking alcohol contributes, but these are good things to know and ask about if there are things to do or change to improve your chances. I have bioidentical hormone replacement that according to my doctor should help prevent osteoporosis. There is an active group for osteoporosis here too if you wanted to read some patient experience.
I had worries of a wheelchair in my future too. My parents were both in wheelchairs and I took care of them. Having that degree of disability is hard and it doesn't just happen overnight with a gradual spine change. If you can make a plan that can improve bone quality and then address spine issues, it would be the best of both worlds. You need to know what your bone scores mean and how much it may be possible to improve them and how to go about improving things. I have read that laminectomy can cause spine instability. A laminectomy is kind of like raising the roof on a house when you want to build a 2nd floor. They cut through the top side part of the bone that arches over the back of the spinal cord. That leaves the disc intact between the vertebrae and the facet joints supporting the spine. If those are failing as in a bad disc or arthritis in the facets, it creates a problem and that may be why it leads to a fusion. Often with fusion, they screw a plate on the front of the spine and screws can be bad for osteoporosis as they can pull out. I don't have a front spine plate because I requested no hardware and that was possible with a singe level fusion.
World Health Organization criteria for BMD classify patients as:
Normal (T-score at or above -1.0),
Osteopenia (T-score between -1.0 and -2.5), or
Osteoporosis (T-score at or below -2.5).
FRAX(R) Estimated 10-year Fracture Risk:
10-year fracture risk estimate was calculated using the FRAX(R)
fracture risk assessment tool using your reported risk factors
and femoral neck BMD if you meet the following National
Osteoporosis Foundation (NOF) criteria: are an untreated
postmenopausal woman or man older than 50 years with T-score
between -1.0 and -2.5 with no prior hip or vertebral fracture
and current bone mineral density measurement in the hip.
10-year Fracture Risk:
=================================================================
FRAX not reported because:
Some T-score for Spine Total or Hip Total or Femoral Neck at
or below -2.5
Treated for osteoporosis
=================================================================
All treatment decisions require clinical judgment and
consideration of individual patient factors, including patient
preferences, comorbidities, previous drug use, risk factors not
captured in the FRAX model (e.g., frailty, falls, vitamin D
deficiency, increased bone turnover, interval significant
decline in bone density) and possible under- or overestimation
of fracture risk by FRAX.
@annie1 Annie, my mom with severe osteoporosis has a DEXA scan of -4, and I see your lowest DEXA number is -3. The spine DEXA for you says -2.4 which is close to the score for osteoporosis that starts at -2.5. I can understand why the surgeon is concerned. From what I've read this can change for the worse. Only your treating specialist knows if your scores are changing for the better and how to interpret them for your care. You bone quality could be moving toward better or worse and has to be monitored because if you were to stop treatment for osteoporosis, it likely would begin to degrade again according to what I've read on Mayo's website. I've also read that if bone were to crumble after spine surgery, that may make the problem un-fixable.
I believe that when my mom broke her foot and her pelvis (when she fell on the kitchen floor) that her foot probably fractured when she stepped on it and caused the fall. She didn't twist her ankle, but just lost her balance and fell on her side which fractured her pelvis in 3 places. Several years later she had a spontaneous spine compression fracture in her lumbar spine. I hope that gives you a frame of reference for possible risks associated with DEXA scores. My mom does use a wheelchair, and doesn't have weight bearing exercise now because she can hardly walk. She has arthritic deformity in her feet.
Are you having difficulty walking? With the uneven gait due to spinal stenosis, I was wondering if that affected your ability to do weight bearing exercise that is beneficial for bone building? I know you like swimming, but that doesn't help osteoporosis as much because you don't stress the bones with added weight and pressure during movement.
@annie1 Annie, my mom with severe osteoporosis has a DEXA scan of -4, and I see your lowest DEXA number is -3. The spine DEXA for you says -2.4 which is close to the score for osteoporosis that starts at -2.5. I can understand why the surgeon is concerned. From what I've read this can change for the worse. Only your treating specialist knows if your scores are changing for the better and how to interpret them for your care. You bone quality could be moving toward better or worse and has to be monitored because if you were to stop treatment for osteoporosis, it likely would begin to degrade again according to what I've read on Mayo's website. I've also read that if bone were to crumble after spine surgery, that may make the problem un-fixable.
I believe that when my mom broke her foot and her pelvis (when she fell on the kitchen floor) that her foot probably fractured when she stepped on it and caused the fall. She didn't twist her ankle, but just lost her balance and fell on her side which fractured her pelvis in 3 places. Several years later she had a spontaneous spine compression fracture in her lumbar spine. I hope that gives you a frame of reference for possible risks associated with DEXA scores. My mom does use a wheelchair, and doesn't have weight bearing exercise now because she can hardly walk. She has arthritic deformity in her feet.
Are you having difficulty walking? With the uneven gait due to spinal stenosis, I was wondering if that affected your ability to do weight bearing exercise that is beneficial for bone building? I know you like swimming, but that doesn't help osteoporosis as much because you don't stress the bones with added weight and pressure during movement.
@annie1 My opinion isn't what counts here, and while we can discuss things, the decisions will be yours along with your doctors. I don't have an opinion about what your best choices will be because I don't have the expertise to judge that. Only a specialist who is treating you can properly advise your care. I am happy to help any way that I can if it helps gain insight and understanding.
You may post images from your MRI on Connect if you remove your personal information from them (name, birth date). I know you have spinal cord compression and that is hard to live with, and living with that brings uncertainty for the future. I would want to fix a spine problem too, but I don't have osteoporosis. I don't know how to judge bone quality or know if some places of your spine would be better than others. I looked at content on Mayo's website to understand some of the issues before writing my responses.
Did you see the links about Mayo's research on improving bone quality for patients who need spine surgery? I think that would be something to ask your bone specialist about in case there is anything new that is available to improve your bone.
Annie, I started my physical therapy within about a week after surgery. I had my surgeries at Mayo in Rochester so I saw my family doctor for post op visits and had a phone call with my surgeon about 6 weeks after surgery. I had an in-person visit about a year later with the surgeon. You can do your requested x-rays and/or MRI's if needed at your local hospital. My first post-op with my family doctor was about a month after surgery. If your surgery is done at Mayo, they will provide you with a phone number you can call to reach your surgeon's assistant to ask questions or report complications after your surgery. I traveled home the day I was released from the hospital. We stopped about every 1 1/2 to 2 hours on the way home so I could walk with my walker. My orders after the surgery said walking is adequate exercise. You need to have some form of strengthening exercise to complete your recovery process. If you choose not to exercise, less blood flow to the surgical site can prolong your healing process. My physical therapy focused on exercise to increase the core strength in my spine and lower body. I didn't start anything more strenuous until about a month after surgery. I started walking immediately, increasing my distance slightly each day. You will tire easily in the early days after your surgery. I would lay on my bed and listen to relaxing music or nature sounds and take a nap. Patients who listen to music before and after surgery show reduced pain scores, anxiety and need for pain relievers. I found it extremely relaxing, I slept well and I was off pain relievers within about 6-10 days.
I'm trying to find out who knows what these numbers mean.
I feel at the end of my rope with people telling me what to do. Last night I had a excruciating leg cramp that last almost 4 hours. I believe it is from my continued degenerative stenosis. The neuro surgeon who would do a minimally invasive laminotomy said the below numbers are more important than the first listed numbers. I have Osteopenia in three places and Osteoporosis in 2 places. I had a friend who had a Laminectomy, also has Osteoporosis and is doing fine. Also the surgeon who warned me against surgery gave me no hope except is referring me back for pain management for the rest of my life. So I am not going by his recommendation. As far as he is concerned, my quality of life dosen't seem to matter nor my future if the stenosis keeps going, which it has.
-----------------------------------------------------------------
Region Area BMC BMD T-score Peak Z-score Age
cm2 g g/cm2 Reference Matched
-----------------------------------------------------------------
L1 11.46 7.84 0.684 -2.8 69 -0.8 88
L2 13.94 9.70 0.696 -3.0 68 -0.8 88
L3 14.35 10.84 0.756 -3.0 70 -0.7 91
L4 19.31 17.58 0.910 -1.4 86 1.0 113
L1-L2 25.40 17.54 0.691 -2.6 71 -0.6 92
L1,L3 25.81 18.68 0.724 -2.6 71 -0.5 93
L1,L4 30.77 25.42 0.826 -1.9 80 0.3 104
L2-L3 28.28 20.55 0.726 -3.0 69 -0.8 89
L2,L4 33.24 27.28 0.821 -2.3 76 -0.1 99
L3-L4 33.66 28.42 0.844 -2.3 77 0.0 100
L1-L3 39.75 28.39 0.714 -2.8 70 -0.6 91
L1-L2,L4 44.70 35.12 0.786 -2.3 76 -0.1 99
L1,L3-L4 45.12 36.26 0.804 -2.3 76 0.0 99
L2-L4 47.59 38.13 0.801 -2.5 74 -0.3 97
L1-L4 59.05 45.97 0.778 -2.4 74 -0.2 97
-----------------------------------------------------------------
Comparison With Previous Exams:
=================================================================
Region Exam Age BMD T-score BMD Change BMD Change
Date g/cm2 vsBaseline vsPrev
=================================================================
I'm trying to find out who knows what these numbers mean.
I feel at the end of my rope with people telling me what to do. Last night I had a excruciating leg cramp that last almost 4 hours. I believe it is from my continued degenerative stenosis. The neuro surgeon who would do a minimally invasive laminotomy said the below numbers are more important than the first listed numbers. I have Osteopenia in three places and Osteoporosis in 2 places. I had a friend who had a Laminectomy, also has Osteoporosis and is doing fine. Also the surgeon who warned me against surgery gave me no hope except is referring me back for pain management for the rest of my life. So I am not going by his recommendation. As far as he is concerned, my quality of life dosen't seem to matter nor my future if the stenosis keeps going, which it has.
-----------------------------------------------------------------
Region Area BMC BMD T-score Peak Z-score Age
cm2 g g/cm2 Reference Matched
-----------------------------------------------------------------
L1 11.46 7.84 0.684 -2.8 69 -0.8 88
L2 13.94 9.70 0.696 -3.0 68 -0.8 88
L3 14.35 10.84 0.756 -3.0 70 -0.7 91
L4 19.31 17.58 0.910 -1.4 86 1.0 113
L1-L2 25.40 17.54 0.691 -2.6 71 -0.6 92
L1,L3 25.81 18.68 0.724 -2.6 71 -0.5 93
L1,L4 30.77 25.42 0.826 -1.9 80 0.3 104
L2-L3 28.28 20.55 0.726 -3.0 69 -0.8 89
L2,L4 33.24 27.28 0.821 -2.3 76 -0.1 99
L3-L4 33.66 28.42 0.844 -2.3 77 0.0 100
L1-L3 39.75 28.39 0.714 -2.8 70 -0.6 91
L1-L2,L4 44.70 35.12 0.786 -2.3 76 -0.1 99
L1,L3-L4 45.12 36.26 0.804 -2.3 76 0.0 99
L2-L4 47.59 38.13 0.801 -2.5 74 -0.3 97
L1-L4 59.05 45.97 0.778 -2.4 74 -0.2 97
-----------------------------------------------------------------
Comparison With Previous Exams:
=================================================================
Region Exam Age BMD T-score BMD Change BMD Change
Date g/cm2 vsBaseline vsPrev
=================================================================
The T-score represent numbers that compare the condition of your bones with those of an average young person. The T-score is usually the most important number to pay attention to. T-scores are usually in the negative or minus range. The lower the bone density T-score, the greater the risk of fracture. Normal bone density is +1 to –1. If the numbers are between –1 and –2.5 you have osteopenia. A score of –2.5 or less is defined as osteoporosis.
The Z score represent numbers that compare the condition of your bones with an average person of your age. A negative Z-score of –2.5 or less should raise suspicion of a secondary cause of osteoporosis. Osteoporosis can be missed in a senior person if the diagnosis is based on the Z-score. The Z-scores help diagnose secondary osteoporosis, which is osteoporosis due to a clinical disorder rather than aging which is the primary cause of osteoporosis.
Your second chart is more important because it is showing your T-scores and that is what the doctors will pay attention to when determining the condition of your bones. It appears that your T-scores have improved in some areas from 2022 and 2020. Did you have all your DEXA scans taken at the same facility?
On January 1, 2024 at age 71 the Bone Mass Density measured at AP Spine (L1-L4) was 0.778 g/cm2 with a T-score of -3.0. I am guessing that the percentage numbers are your 10 year risk of fracture at that location. If I am reading this correctly the upper chart which represents says you have osteoporosis in your lumbar spine in L1-L3. The lower chart suggests that you have osteopenia at those same areas of your spine. I would suggest you ask a doctor to explain your results so that you can fully understand what they mean. I hope I was able to explain the DEXA report well enough for you to understand the basics of what it is telling you.
Osteoporosis has often been considered a contraindication for spinal surgery. Today, advances in surgical and anesthetic technology make it possible to operate successfully on elderly patients who don't want to accept disabling physical conditions. Recent literature suggests the outcomes of surgical treatment are more favorable than conservative treatment. I know you have been searching for some time to find a doctor to do the right surgery, a doctor that you can trust. Your doctor and his team will need to able to treat a person with osteoporosis and have a good deal of experience. Check with US News & World Report for hospital evaluations to find the best hospitals for spinal surgeries. Mayo Clinic has been cited as the #1 hospital in the world. But, there are other good doctors and hospitals around the country. I know that the Cleveland Clinic is well known for spinal surgeries and also fusions. I would look at a teaching hospital or one that has a lot of research going on. Ask your friend about the doctor she saw too. The orthopedic doctor who did my fusion surgery is widely known for his research on bone health, regeneration, and engineering human bone.
Taking time to decide on surgery is a good idea. Doing research and asking lots of questions is very important. If you are going to have surgery, I would recommend doing it sooner rather than later. My mother had osteoporosis in her hips and when she finally decided to have a needed surgery, it had to be repeated the next day because the bone damage wasn't found until the doctor was in the operating room. She had a successful surgery but it took months longer for her recovery.
By the way, I went to a surgeon who was totally against doing surgery, even though he is a surgeon.
So I asked what his recommendation was for my future progress and this is what his nurse practitioner said,
By having patients work on their core strength the symptoms of spinal stenosis are controlled. Increasing core strength will give the support the spine needs. In addition, the pain management portion helps alleviate the pain associated with spinal stenosis.
I have severe lumbar stenosis. Is this to be believed ?
The T-score represent numbers that compare the condition of your bones with those of an average young person. The T-score is usually the most important number to pay attention to. T-scores are usually in the negative or minus range. The lower the bone density T-score, the greater the risk of fracture. Normal bone density is +1 to –1. If the numbers are between –1 and –2.5 you have osteopenia. A score of –2.5 or less is defined as osteoporosis.
The Z score represent numbers that compare the condition of your bones with an average person of your age. A negative Z-score of –2.5 or less should raise suspicion of a secondary cause of osteoporosis. Osteoporosis can be missed in a senior person if the diagnosis is based on the Z-score. The Z-scores help diagnose secondary osteoporosis, which is osteoporosis due to a clinical disorder rather than aging which is the primary cause of osteoporosis.
Your second chart is more important because it is showing your T-scores and that is what the doctors will pay attention to when determining the condition of your bones. It appears that your T-scores have improved in some areas from 2022 and 2020. Did you have all your DEXA scans taken at the same facility?
On January 1, 2024 at age 71 the Bone Mass Density measured at AP Spine (L1-L4) was 0.778 g/cm2 with a T-score of -3.0. I am guessing that the percentage numbers are your 10 year risk of fracture at that location. If I am reading this correctly the upper chart which represents says you have osteoporosis in your lumbar spine in L1-L3. The lower chart suggests that you have osteopenia at those same areas of your spine. I would suggest you ask a doctor to explain your results so that you can fully understand what they mean. I hope I was able to explain the DEXA report well enough for you to understand the basics of what it is telling you.
Osteoporosis has often been considered a contraindication for spinal surgery. Today, advances in surgical and anesthetic technology make it possible to operate successfully on elderly patients who don't want to accept disabling physical conditions. Recent literature suggests the outcomes of surgical treatment are more favorable than conservative treatment. I know you have been searching for some time to find a doctor to do the right surgery, a doctor that you can trust. Your doctor and his team will need to able to treat a person with osteoporosis and have a good deal of experience. Check with US News & World Report for hospital evaluations to find the best hospitals for spinal surgeries. Mayo Clinic has been cited as the #1 hospital in the world. But, there are other good doctors and hospitals around the country. I know that the Cleveland Clinic is well known for spinal surgeries and also fusions. I would look at a teaching hospital or one that has a lot of research going on. Ask your friend about the doctor she saw too. The orthopedic doctor who did my fusion surgery is widely known for his research on bone health, regeneration, and engineering human bone.
Taking time to decide on surgery is a good idea. Doing research and asking lots of questions is very important. If you are going to have surgery, I would recommend doing it sooner rather than later. My mother had osteoporosis in her hips and when she finally decided to have a needed surgery, it had to be repeated the next day because the bone damage wasn't found until the doctor was in the operating room. She had a successful surgery but it took months longer for her recovery.
My Surgeon teaches at Columbia University, in the Neurosurgery department. I think that's a pretty good credential. As well as doing surgeries. He did look at my DEXA scan and the numbers I posted and said he is not doing fusion, my numbers are pretty good and also he is doing minimally invasive laminotomy. He told me that the longer I waited to do surgery the more risk I take of becoming immobile. I already can only walk 2 blocks before I have pain. He said I do not need to be on bone building medications to do this surgery, although I have been on Reclast for 3 yrs already. What do you think of the numbers I posted ? As I said he didn't think I was at risk for something going wrong, vs waiting and losing more mobility.
If my comment comes up twice, I briefly left the page and it was gone!
It sounds like you have found an excellent surgeon. A minimally invasive laminotomy is about 90% effective and has about a 6 week recovery rate. There is less damage to the muscles around the bone with this procedure. A laminectomy is open surgery and the incision is 2 to 5 inches long depending on the number of levels involved.
A laminectomy does not bring the spine back to its complete normal functioning and flexibility. A small degree of stiffness is usually present and usually remains life-long.
The T-score numbers on your latest DEXA look good. The Reclast treatment appears to be helping you. Doing a minimally invasive laminotomy shouldn't be a difficult surgery for you.
I chose to do my surgery because I had no quality of life and the pain was overwhelming me. I had to give up dancing, gardening, bike riding, long hikes and skiing. I was only sleeping 3 to 4 hours per night in my recliner. I couldn't lie in bed in any position. I couldn't walk to the end of my driveway and my husband was doing our grocery shopping. I had to sit on a chair to cook. Working on your core strength is important and you will need to do that the rest of your life. There comes a point though when the exercises and pain management won't be enough to help you. It sounds like you are either close to or at that point. I was in physical therapy for two years without much success and then a disc ruptured and the pain was unbearable. Most back surgeries are elective. Your doctor has offered a surgery he feels will help you but you are the only one who can make the decision to have the surgery. Good luck to you...
@annie1 I'm so sorry they are not taking the time to address your concerns and I understand why that upsets you. They have to be careful how they answer you because of insurance and legal issues and they don't want to promise something that wouldn't be covered by insurance. I don't know how big your incision will be for minimally invasive surgery or how many incisions they will need. It may be an easier recovery than most lumbar procedures, but I don't have experience there. My surgery was not minimally invasive, and a fusion has a longer recovery time. My incision was about 3 inches.
I think it is reasonable to ask a surgeon to see you before the procedure for a few minutes. My surgeon at Mayo did that for me and I was much calmer because of it. Is this surgeon rushing to get through too many cases in a day? I want to know that a surgeon who cuts on me is calm and unhurried. It takes a couple of minutes to say hello and reassure a patient that you are in charge and concerned about their well being. It is hard to be a patient facing fears and get no compassion from providers. My surgeon's nurse held my hand in the operating room.
I know this is a difficult time for you, and this doesn't make it easy to trust your surgical team. I fired a surgeon like that, but he wasn't going to help me anyway because he didn't really understand the diagnosis and didn't take enough time to even know that. He spent 5 minutes at the most in the consultation and wouldn't answer questions having looked at my imaging without me. Well, no thank you. You have to do what you think is right for you. If you want to call Mayo tomorrow and ask about care there, you can do that if that is a feasible option for you as in insurance and wait time, etc.
Is this non-communication causing anxiety for you? Only you know how much pain and disability you live with now and if you had to wait for a different surgeon, would you be able to do that?
I know how hard this is, and what it is like to deal with a nurse like that. One surgeon's nurse refused to make appointments for me with the surgeon because they didn't believe my symptoms were connected to my spine problem, and this was a big head of department at a major medical center making this mistake. I had to look elsewhere. It took me 2 years and seeing 5 surgeons wasting my time before I came to Mayo.
What do you want to do? Is this surgeon highly recommended to you by your private physician? Have you checked out his background and reputation? Any disciplinary actions against him with your state's regulatory medical board? I don't want to give you more to worry about, but it makes me worry to hear these things about a surgeon. You have to hire the surgeon you trust and who offers you the best solution. FYI, you should still be able to edit your post now if you wanted to remove your name from it.
Update, I did see the surgeon and I am scheduled in 2 days for minimally invasive surgery. The NP told me they stabilize with the piece of my own bone that was cut out during the laminotomy.
As of this morning a different concern came up, that is drinking chamomile tea two weeks before surgery. I had no idea this could cause potential bleeding. I googled it after being told to stop taking chinese herbs before my surgery and found a few articles saying it is not recommended, that it can cause potentially more bleeding, however the articles didn't say how much tea I would have to drink to pose a risk. The NP said since they are doing minimally invasive this wouldn't be a problem. I really want to do this surgery. It's alot of work doing all this research. I don't think the surgeon would want to risk any problems for me either. I am waiting to hear back again from the NP in the morning, after her first response. I like her alot more now than in the past.
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This is my DEXA scan. Please let me know what you think.
Dual-Energy X-ray Absorptiometry (DXA)
A DXA scan was performed on January 03, 2024 using a Hologic
Horizon W densitometer.
Indication: postmenopausal osteoporosis; monitoring
treatment;
Bone Density Results:
TECHNICAL LIMITATIONS:
None
------------------------------------------------------------------------------
DIAGNOSIS:
OSTEOPOROSIS based on the lowest T-score (-3.0) using the World Health Organization criteria
and ISCD guidelines for diagnosis.
------------------------------------------------------------------------------
=================================================================
Region BMD T-score Z-score Classification
=================================================================
AP Spine(L1-L4) 0.778 -2.4 -0.2 Osteopenia
Femoral Neck L 0.521 -3.0 -1.1 Osteoporosis
Total Hip L 0.644 -2.4 -0.9 Osteopenia
Femoral Neck R 0.515 -3.0 -1.1 Osteoporosis
Total Hip R 0.646 -2.4 -0.8 Osteopenia
=================================================================
World Health Organization criteria for BMD classify patients as:
Normal (T-score at or above -1.0),
Osteopenia (T-score between -1.0 and -2.5), or
Osteoporosis (T-score at or below -2.5).
FRAX(R) Estimated 10-year Fracture Risk:
10-year fracture risk estimate was calculated using the FRAX(R)
fracture risk assessment tool using your reported risk factors
and femoral neck BMD if you meet the following National
Osteoporosis Foundation (NOF) criteria: are an untreated
postmenopausal woman or man older than 50 years with T-score
between -1.0 and -2.5 with no prior hip or vertebral fracture
and current bone mineral density measurement in the hip.
10-year Fracture Risk:
=================================================================
FRAX not reported because:
Some T-score for Spine Total or Hip Total or Femoral Neck at
or below -2.5
Treated for osteoporosis
=================================================================
All treatment decisions require clinical judgment and
consideration of individual patient factors, including patient
preferences, comorbidities, previous drug use, risk factors not
captured in the FRAX model (e.g., frailty, falls, vitamin D
deficiency, increased bone turnover, interval significant
decline in bone density) and possible under- or overestimation
of fracture risk by FRAX.
Extended Spine:
-----------------------------------------------------------------
Region Area BMC BMD T-score Peak Z-score Age
cm2 g g/cm2 Reference Matched
-----------------------------------------------------------------
L1 11.46 7.84 0.684 -2.8 69 -0.8 88
L2 13.94 9.70 0.696 -3.0 68 -0.8 88
L3 14.35 10.84 0.756 -3.0 70 -0.7 91
L4 19.31 17.58 0.910 -1.4 86 1.0 113
L1-L2 25.40 17.54 0.691 -2.6 71 -0.6 92
L1,L3 25.81 18.68 0.724 -2.6 71 -0.5 93
L1,L4 30.77 25.42 0.826 -1.9 80 0.3 104
L2-L3 28.28 20.55 0.726 -3.0 69 -0.8 89
L2,L4 33.24 27.28 0.821 -2.3 76 -0.1 99
L3-L4 33.66 28.42 0.844 -2.3 77 0.0 100
L1-L3 39.75 28.39 0.714 -2.8 70 -0.6 91
L1-L2,L4 44.70 35.12 0.786 -2.3 76 -0.1 99
L1,L3-L4 45.12 36.26 0.804 -2.3 76 0.0 99
L2-L4 47.59 38.13 0.801 -2.5 74 -0.3 97
L1-L4 59.05 45.97 0.778 -2.4 74 -0.2 97
------------------
@annie1 Annie, my mom with severe osteoporosis has a DEXA scan of -4, and I see your lowest DEXA number is -3. The spine DEXA for you says -2.4 which is close to the score for osteoporosis that starts at -2.5. I can understand why the surgeon is concerned. From what I've read this can change for the worse. Only your treating specialist knows if your scores are changing for the better and how to interpret them for your care. You bone quality could be moving toward better or worse and has to be monitored because if you were to stop treatment for osteoporosis, it likely would begin to degrade again according to what I've read on Mayo's website. I've also read that if bone were to crumble after spine surgery, that may make the problem un-fixable.
I believe that when my mom broke her foot and her pelvis (when she fell on the kitchen floor) that her foot probably fractured when she stepped on it and caused the fall. She didn't twist her ankle, but just lost her balance and fell on her side which fractured her pelvis in 3 places. Several years later she had a spontaneous spine compression fracture in her lumbar spine. I hope that gives you a frame of reference for possible risks associated with DEXA scores. My mom does use a wheelchair, and doesn't have weight bearing exercise now because she can hardly walk. She has arthritic deformity in her feet.
Are you having difficulty walking? With the uneven gait due to spinal stenosis, I was wondering if that affected your ability to do weight bearing exercise that is beneficial for bone building? I know you like swimming, but that doesn't help osteoporosis as much because you don't stress the bones with added weight and pressure during movement.
In searching Mayo Clinic information I found that smoking, alcohol use, thyroid problems, steroid use, and some medications can contribute to thinning bones. I did find this interesting article describing regenerative medicine research at Mayo to try to fix thin bones in spine patients. At the end it has links to the labs and departments doing this research. I don't know what is possible today for patient treatment or if this is just an experimental stage, but you may want to look at this. Here are some of the links I found interesting.
https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/optimizing-bone-health-before-complex-spinal-surgery/mac-20542607
https://www.mayoclinic.org/medical-professionals/endocrinology/news/new-tools-to-predict-fracture-risk/mac-20430573
https://newsnetwork.mayoclinic.org/discussion/tuesday-q-a-treatment-for-bone-disorders-focuses-on-strengthening-bones-slowing-bone-loss/
Jennifer
Can I send you my MRI image ? That may make you think a little differently about this.
@annie1 My opinion isn't what counts here, and while we can discuss things, the decisions will be yours along with your doctors. I don't have an opinion about what your best choices will be because I don't have the expertise to judge that. Only a specialist who is treating you can properly advise your care. I am happy to help any way that I can if it helps gain insight and understanding.
You may post images from your MRI on Connect if you remove your personal information from them (name, birth date). I know you have spinal cord compression and that is hard to live with, and living with that brings uncertainty for the future. I would want to fix a spine problem too, but I don't have osteoporosis. I don't know how to judge bone quality or know if some places of your spine would be better than others. I looked at content on Mayo's website to understand some of the issues before writing my responses.
Did you see the links about Mayo's research on improving bone quality for patients who need spine surgery? I think that would be something to ask your bone specialist about in case there is anything new that is available to improve your bone.
Jennifer
I'm trying to find out who knows what these numbers mean.
I feel at the end of my rope with people telling me what to do. Last night I had a excruciating leg cramp that last almost 4 hours. I believe it is from my continued degenerative stenosis. The neuro surgeon who would do a minimally invasive laminotomy said the below numbers are more important than the first listed numbers. I have Osteopenia in three places and Osteoporosis in 2 places. I had a friend who had a Laminectomy, also has Osteoporosis and is doing fine. Also the surgeon who warned me against surgery gave me no hope except is referring me back for pain management for the rest of my life. So I am not going by his recommendation. As far as he is concerned, my quality of life dosen't seem to matter nor my future if the stenosis keeps going, which it has.
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Region Area BMC BMD T-score Peak Z-score Age
cm2 g g/cm2 Reference Matched
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L1 11.46 7.84 0.684 -2.8 69 -0.8 88
L2 13.94 9.70 0.696 -3.0 68 -0.8 88
L3 14.35 10.84 0.756 -3.0 70 -0.7 91
L4 19.31 17.58 0.910 -1.4 86 1.0 113
L1-L2 25.40 17.54 0.691 -2.6 71 -0.6 92
L1,L3 25.81 18.68 0.724 -2.6 71 -0.5 93
L1,L4 30.77 25.42 0.826 -1.9 80 0.3 104
L2-L3 28.28 20.55 0.726 -3.0 69 -0.8 89
L2,L4 33.24 27.28 0.821 -2.3 76 -0.1 99
L3-L4 33.66 28.42 0.844 -2.3 77 0.0 100
L1-L3 39.75 28.39 0.714 -2.8 70 -0.6 91
L1-L2,L4 44.70 35.12 0.786 -2.3 76 -0.1 99
L1,L3-L4 45.12 36.26 0.804 -2.3 76 0.0 99
L2-L4 47.59 38.13 0.801 -2.5 74 -0.3 97
L1-L4 59.05 45.97 0.778 -2.4 74 -0.2 97
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Comparison With Previous Exams:
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Region Exam Age BMD T-score BMD Change BMD Change
Date g/cm2 vsBaseline vsPrev
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AP Spine (L1-L4)
01/03/2024 71 0.778 -2.4 10.1%* 13.3%*
07/22/2022 70 0.687 -3.3 -2.9% -2.9%
08/06/2020 68 0.707 -3.1
Total Hip(Right)
01/03/2024 71 0.646 -2.4 4.9%* -0.9%
07/22/2022 70 0.652-2.4 5.9%* 5.9%*
08/06/2020 68 0.615 -2.7
Femoral Neck(Right)
01/03/2024 71 0.515 -3.0 4.2% -1.2%
07/22/2022 70 0.521 -3.0 5.4% 5.4%
08/06/2020 68 0.494 -3.2
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*Denotes significance at 95% confidence level, LSC for AP Spine
= 0.022 g/cm2, LSC for Total Hip = 0.027 g/cm2
Follow up examinations must always be performed on the same DXA
machine to allow comparison.
Hi Annie
The T-score represent numbers that compare the condition of your bones with those of an average young person. The T-score is usually the most important number to pay attention to. T-scores are usually in the negative or minus range. The lower the bone density T-score, the greater the risk of fracture. Normal bone density is +1 to –1. If the numbers are between –1 and –2.5 you have osteopenia. A score of –2.5 or less is defined as osteoporosis.
The Z score represent numbers that compare the condition of your bones with an average person of your age. A negative Z-score of –2.5 or less should raise suspicion of a secondary cause of osteoporosis. Osteoporosis can be missed in a senior person if the diagnosis is based on the Z-score. The Z-scores help diagnose secondary osteoporosis, which is osteoporosis due to a clinical disorder rather than aging which is the primary cause of osteoporosis.
Your second chart is more important because it is showing your T-scores and that is what the doctors will pay attention to when determining the condition of your bones. It appears that your T-scores have improved in some areas from 2022 and 2020. Did you have all your DEXA scans taken at the same facility?
On January 1, 2024 at age 71 the Bone Mass Density measured at AP Spine (L1-L4) was 0.778 g/cm2 with a T-score of -3.0. I am guessing that the percentage numbers are your 10 year risk of fracture at that location. If I am reading this correctly the upper chart which represents says you have osteoporosis in your lumbar spine in L1-L3. The lower chart suggests that you have osteopenia at those same areas of your spine. I would suggest you ask a doctor to explain your results so that you can fully understand what they mean. I hope I was able to explain the DEXA report well enough for you to understand the basics of what it is telling you.
Osteoporosis has often been considered a contraindication for spinal surgery. Today, advances in surgical and anesthetic technology make it possible to operate successfully on elderly patients who don't want to accept disabling physical conditions. Recent literature suggests the outcomes of surgical treatment are more favorable than conservative treatment. I know you have been searching for some time to find a doctor to do the right surgery, a doctor that you can trust. Your doctor and his team will need to able to treat a person with osteoporosis and have a good deal of experience. Check with US News & World Report for hospital evaluations to find the best hospitals for spinal surgeries. Mayo Clinic has been cited as the #1 hospital in the world. But, there are other good doctors and hospitals around the country. I know that the Cleveland Clinic is well known for spinal surgeries and also fusions. I would look at a teaching hospital or one that has a lot of research going on. Ask your friend about the doctor she saw too. The orthopedic doctor who did my fusion surgery is widely known for his research on bone health, regeneration, and engineering human bone.
Taking time to decide on surgery is a good idea. Doing research and asking lots of questions is very important. If you are going to have surgery, I would recommend doing it sooner rather than later. My mother had osteoporosis in her hips and when she finally decided to have a needed surgery, it had to be repeated the next day because the bone damage wasn't found until the doctor was in the operating room. She had a successful surgery but it took months longer for her recovery.
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3 ReactionsBy the way, I went to a surgeon who was totally against doing surgery, even though he is a surgeon.
So I asked what his recommendation was for my future progress and this is what his nurse practitioner said,
By having patients work on their core strength the symptoms of spinal stenosis are controlled. Increasing core strength will give the support the spine needs. In addition, the pain management portion helps alleviate the pain associated with spinal stenosis.
I have severe lumbar stenosis. Is this to be believed ?
My Surgeon teaches at Columbia University, in the Neurosurgery department. I think that's a pretty good credential. As well as doing surgeries. He did look at my DEXA scan and the numbers I posted and said he is not doing fusion, my numbers are pretty good and also he is doing minimally invasive laminotomy. He told me that the longer I waited to do surgery the more risk I take of becoming immobile. I already can only walk 2 blocks before I have pain. He said I do not need to be on bone building medications to do this surgery, although I have been on Reclast for 3 yrs already. What do you think of the numbers I posted ? As I said he didn't think I was at risk for something going wrong, vs waiting and losing more mobility.
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1 ReactionIf my comment comes up twice, I briefly left the page and it was gone!
It sounds like you have found an excellent surgeon. A minimally invasive laminotomy is about 90% effective and has about a 6 week recovery rate. There is less damage to the muscles around the bone with this procedure. A laminectomy is open surgery and the incision is 2 to 5 inches long depending on the number of levels involved.
A laminectomy does not bring the spine back to its complete normal functioning and flexibility. A small degree of stiffness is usually present and usually remains life-long.
The T-score numbers on your latest DEXA look good. The Reclast treatment appears to be helping you. Doing a minimally invasive laminotomy shouldn't be a difficult surgery for you.
I chose to do my surgery because I had no quality of life and the pain was overwhelming me. I had to give up dancing, gardening, bike riding, long hikes and skiing. I was only sleeping 3 to 4 hours per night in my recliner. I couldn't lie in bed in any position. I couldn't walk to the end of my driveway and my husband was doing our grocery shopping. I had to sit on a chair to cook. Working on your core strength is important and you will need to do that the rest of your life. There comes a point though when the exercises and pain management won't be enough to help you. It sounds like you are either close to or at that point. I was in physical therapy for two years without much success and then a disc ruptured and the pain was unbearable. Most back surgeries are elective. Your doctor has offered a surgery he feels will help you but you are the only one who can make the decision to have the surgery. Good luck to you...
Update, I did see the surgeon and I am scheduled in 2 days for minimally invasive surgery. The NP told me they stabilize with the piece of my own bone that was cut out during the laminotomy.
As of this morning a different concern came up, that is drinking chamomile tea two weeks before surgery. I had no idea this could cause potential bleeding. I googled it after being told to stop taking chinese herbs before my surgery and found a few articles saying it is not recommended, that it can cause potentially more bleeding, however the articles didn't say how much tea I would have to drink to pose a risk. The NP said since they are doing minimally invasive this wouldn't be a problem. I really want to do this surgery. It's alot of work doing all this research. I don't think the surgeon would want to risk any problems for me either. I am waiting to hear back again from the NP in the morning, after her first response. I like her alot more now than in the past.
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