Dear NeuroTalk Spinal Disorders and Back Pain posters,

This is the relevant information from my Lumbar MRI from last Tuesday,

L3-L4: Small disc bulge with facet hypertrophy and ligamentum flavum
infolding. Marked narrowing of the central canal. Minor narrowing of the
bilateral neural foramen. A left sided facet effusion is associated with a
12 x 9 mm synovial cyst extending into the dorsal aspect of the spinal
canal (axial T2 series 4 image 18) at the level of the L4 vertebral body;
this mildly effaces the dorsal thecal sac.

It started with strong pain down right leg, from the hip to the ankle, about three weeks ago. Problems with the hip were ruled out with X-ray, and I was sent for this MRI.

I am seeing a spine pain specialist week after next.

At this point I don't have pain at night (thank goodness) but as soon as I stand up the pain starts and is quite difficult for me.

Due to many other problems, including profound Peripheral Neuropathy in both legs, I already take the pain meds I can manage (no codeine based meds, I am allergic to them). So I have nothing in reserve for this pain.

I cannot be upright for any time and then I am exhausted from the pain and must sit or lie down.

Does anyone else have this problem? Or has had this problem? What do you do for it? I am already having difficulty with housework and now I can do almost nothing. I am so frustrated.

I have gone to the pool to exercise a couple of times, in the beginning hoping it would 'cure' whatever the problem was. Now I know it won't, but I must get some exercise or become a complete 'slug'.

Please give me any help or comments that you can.

Hugs, ElaineD

My myelogram shows

At L3/L4 a hemangioma
a vascular tumor
In addition
There is levoscoliotic deformity of lumbar spine
Trace grade 1 retrolisthesis of L3 on L4 and on L4 on L5
At L3/L4 bulging disc and at L4/L5
Osteoarthropathy
My entire spine in terrible condition
Having ACDF fusion failed in 2010
and PCDF to fix the problem only that was botched in 2011
Since then having the myelogram showing my spine in such bad shape having any other surgery is meaningless
Pain is a part of my everyday life
This all came to a head at the age of 49
I am 55 now and have declined since then
Hoping all will be well with you
Take good care
Me

Dear Eva,

Oh dear dear me. You are having the back problems of my worst nightmares.

I am 74, and have avoided back problems, until now. tho' I have more than my share of other problems.

I will have to look up your surgeries.

I just don't know what to do, from all I've read having the cyst aspirated doesn't do much good and you have to go back and have it surgically removed.

That is the word that scares me "surgically removed".

This is what my spine looks like on the MRI:

Findings:
The vertebral body heights are well-maintained. Small Schmorl's node of the
opposing L2 and L3 endplates. The bone marrow signal is normal, with mild
degeneraPve endplate changes.
Minor grade 1 anterolisthesis of L3 on L4 and L4 on L5. The lumbar lordosis
is otherwise well-maintained.
The conus terminates at the level of the superior L1 endplate. The conus
terminalis and cauda equina are of normal signal characterisPcs.
T12-L1: Small disc bulge without significant central canal or neural
foraminal narrowing.
The L1-L2 level is seen only on the sagital images; no posterior disc
bulge, canal narrowing, or foraminal narrowing at these levels.
L2-L3: Minor disc bulge, facet hypertrophy, and ligamentum flavum
infolding. Moderate narrowing of the central canal. Minor narrowing of the
bilateral neural foramen.
L3-L4: Small disc bulge with facet hypertrophy and ligamentum flavum
infolding. Marked narrowing of the central canal. Minor narrowing of the
bilateral neural foramen. A left sided facet effusion is associated with a
12 x 9 mm synovial cyst extending into the dorsal aspect of the spinal
canal (axial T2 series 4 image 18) at the level of the L4 vertebral body;
this mildly effaces the dorsal thecal sac.
L4-L5: Small disc bulge with facet hypertrophy greater than ligamentum
flavum infolding. Mild narrowing of the central canal and bilateral neural
foramen.
L5-S1: Small disc bulge with facet arthropathy. No significant narrowing of
the central canal. Very minor narrowing of the neural foramen.
Visualized SI joints: Normal.
Visualized so` Pssues: Trace asymmetric atrophy of the right paraspinal
muscles.

I cannot walk at all now, with the pressure of the cyst on my spinal canal.

OH, my Cervical spine has places where both nerve and muscle are unresponsive (dead), and is generally a mess. But I can live with that pain.

I thought someone would be able to help, but I guess not.

Regards, Miamax

may a miracle wash over us
at 55 the future bleak
a chair will be the end result
after the second botched surgery
and two neurosurgeons advising against anymore
i will never go under the knife again
when healing from the first surgery i found a lump in my right breast
had them both taken off as it was found early
fed my four babies with them
it to was botched
i have no trust or faith in surgeons
i told the breast surgeon you will be the last to cut away
and he screwed it up
hope you can find answers
well wishes

Elaine,
What does your doctor suggest you have done with the cysts?? Cysts can still come back; I would think draining them would help relieve some of the pressure. I had several cysts in an out of my lumbar vertebra removed along with spinal fusion/laminectomy.

From what I read, it appears, thank God, that you do not have significant spinal cord narrowing. I did need to have a wide laminectomy at L4-5 with the fusion. Even tho the worst part of the narrowing of the spinal cord has been removed (the lamina covering spinal cord); I continue to have spinal stenosis in the rest of the spinal cord.

I do take daily opioid meds for the continuing spinal pain/stenosis, along with dealing with PN.

Gerry

Dear Gerry,

I see the first spine doctor today.

I have this at the sit of the cyst: Marked narrowing of the central canal.

You are the FIRST PERSON I've met who has had cysts. I am so excited to meet you and I so hope you can share you experience, strength and hope as I go through the experience.

I am very frightened. I cannot take opioid medications, and if I have to have surgery I can't imagine how i will manage any of it.

PLEASE know how grateful I am that you have posted.

i also have profound PN and wear braces to be able to WALK at all. I have a high tolerance for pain, but this pain from the cyst when I stand has me confined to a chair and to my bed most of the time. For five minutes standing it takes 20 minutes for the pain to subside.

Please help me as I know I will have questions after I see this first spine doctor at Duke. He is NOT a surgeon. Should I start with cyst aspiration? I understand it is not often successful for more than 2-3 months?

Thanks so much for answering my call for help.

Hugs, ElaineD

Elaine,
It appears that the Synovial is causing the narrowing pressure rather than the canal having to have the lamina removed due to the narrowing.

From what I read, these cysts have a thick wall which draining is not always successful; but if there was a choice, I think it would be to attempt to drain before having surgery. Surgery would be a last resort. At least draining, if only for a short time might give you enough relief and help you decide in the future whether to do surgery or not.

I do know the pain of extreme narrowing because of the narrowing of the spinal cord which was relieved thru the removal of a wide part of the lamina. It would appear your cyst is causing pressure to the spinal cord, possibly causing similar pain.

The cysts I had was something the surgeon said he had never seen before. As I mentioned, they went in and our of each of the lumbar vertebra. He removed them at the time of the fusion/laminectomy. I still am dealing with spinal stenosis pain in other areas; but nothing like the area with excessive narrowing. The removal of the lamina (laminectomy) in that area has allowed the spinal cord more space and not be so badly compressed.

Let me know how your doctor visit goes today.


Gerry

I saw the spine specialist this morning and he is going to try to 1) drain the cyst 2) burst the cyst and/or 3)Inject the cyst with cortisone.

I don't think he will do all of those things, but which he will do depends on what he finds when he tries to penetrate the cyst.

He's doing the procedure with an epidural on an out patient basis, in a special suite in the office. I'm having it done on August 25, and I asked to be put on the list if someone cancels sooner.

I didn't realize that having the cyst removed surgically means cutting through bone, so I surely hope it doesn't come to that!

I cannot take any opioids and fear any major surgery ever.

I had arthroscopic surgery on my knee with only Tylenol for post surgical pain.

I can do that, but not a knee replacement, for Pete's sake!

I'm exhausted by the visit to the doctor this morning.

the narrowing of my spinal canal is caused by osteoarthritis causing the surrounding bone to close in. I have terrible osteoarthritis.

More later, and thanks so much for your posts.

Regards, ElaineD

Elaine,

That sounds like a good plan. Possible he may just do all of the above. The steroid injection will help with inflammation.

The large type of cyst you have is as painful as the large area of spinal stenosis where my laminectomy was performed at the L4-5 level. The surgery you describe seems similar to a laminectomy; (removal of lamina; the protective covering of spinal cord) in order to remove the cyst.

The only plus about your not being able to take opioids is the terrible side effects of constipation. I have to take multiple doses of Miralax daily or I will get impacted. I'm just not up to going thru withdrawal from years of opioids in addition to whatever remaining pain there is; as well as the additional medical pain problems that I have incurred because of the straining. I wish I could turn back the clock.

It has been a stressful day for you. I'm sure you are looking forward to getting this over with.



Gerry