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Hello, I joined today to get help in deciding what medication to begin
Osteoporosis & Bone Health | Last Active: Aug 11 10:11pm | Replies (70)Comment receiving replies
@windyshore
We've been waiting for the x-ray results of my husband's spine. They came in today and I haven't yet spoken to his doctor. I read over them quickly (busy working so didn't have a lot of time) and it is all very confusing. Not sure what all this means. I would love your thoughts if you have time to look this over.
IMPRESSION:
1. Given differences in technique, mildly 11 anterior wedge compression deformity with no retropulsion, or progression.
2. New superior endplate compression deformity of L1 vertebral body measuring approximate 25% with no retropulsion. New/newly recognized superior endplate Schmorl's node versus central superior endplate compression deformity of L3 vertebral body. No retropulsion.
3. Degenerative changes of the thoracolumbar spine as described above.
4. Ancillary findings as described above.
EXAM: XR LUMBOSACRAL SPINE AP AND LAT, XR THORACIC SPINE 3 VIEWS
EXAM DATE AND TIME: 6/17/2024 7:40 AM
HISTORY: CLINICAL CONCERN: new low back pain, eval compression fracture (differential diagnosis or r/o)
COMPARISON: CT of the neck, chest and abdomen 3/5/2024.
TECHNIQUE: AP, lateral and swimmer's views of the thoracic spine. AP and lateral views of the lumbar spine.
FINDINGS:
Thoracic spine:
The visualized thoracic spine demonstrates normal alignment without significant curvature. Given differences in technique, stable anterior wedge compression deformity of T11 vertebral body. New superior endplate compression deformity of L1 vertebral body. No retropulsion. Osteopenia. No listhesis. Mild diffuse degenerative disc disease of the mid thoracic spine.
Visible regional adjacent bones and soft tissues of the medial chest and upper abdomen are otherwise unremarkable.
Lumbar spine:
Dextroscoliosis of the thoracolumbar junction. New superior endplate compression deformity of L1 vertebral body measuring approximately 25%. No retropulsion. Superior endplate Schmorl's node versus compression deformity of the central 7. Endplate L3. No retropulsion. Moderate diffuse degenerative disc disease L2-3 through L5-S1. Subtle grade 1 anterolisthesis of L3 on L4. No pars defects.
Mild osteopenia.
Soft tissues unremarkable.
Replies to "@windyshore We've been waiting for the x-ray results of my husband's spine. They came in today..."
Isabelle,
DXA can't determine fracture. It only determines weak bone and possibility of fracture. While X-Ray delineates fracture, but can't determine osteoporosis. (although dxa is technically x-ray) Nice that they collaborated with CT. CT can sometimes detect hairline fractures not detected by X-Ray or even MRI which I'd prefer to the X-Ray, as more sensitive especially to current fracturing than X- Ray.
I'd be curious about the T-score at L-3 which may be measuring the smorls node and would be a lower score. And shouldn't be included in the total lumbar number -3.3 And maybe it isn't.
Smorls nodes are areas where the disc has displaced bone either because of a herniated disc or birth presence. Herniated discs can be painful. The nucleus of the disc is able to penetrate the bone because it is very acidic. Breeching the endplate with fracture or smorls makes the vertebra more vulnerable to further compression.
His spine has good alignment wherever you see not lithesis or retropulsion. Which is almost everywhere. There is a "subtle anterolithesis" of L3 on L4 (L3 is sliding slightly forward over L4). No pars is cited so that you know there is no fracture at the appendage on the back of the vertebra which can cause a vertebra to slide forward.
After a short period of concentration the terminology sets up an unnerving vibration in the ear. I'm thinking that this is enough. If you want more torture, I[m on call, even though I've no training.
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His doctor will go over this. I am not trained.
It looks like the T11 fracture is mild and stable.
L1 fracture is 25%, not bad in my experience.
L3 looks more complicated (see definitions if you follow links below).
Posture is still good so curvature of spine is not apparent- that's good!
https://www.healthline.com/health/schmorl-nodes#fa-qs
https://www.spineinfo.com/conditions/anterolisthesis-definition-causes-symptoms-prevalence-diagnosis-and-treatments/
The imaging has certainly found reasons for low back pain I would think. I hope he has a doctor he trusts. Sometimes an orthopedist who does not do surgery can be helpful (again in my experience).
He has osteopenia so why is he fracturing? That seems to be a big question that may guide treatment.