A Jawdropping CT Scan

The most recent CT scan study of my Thoracic spine follows.

After a fusion, it is common for the levels above to become weaker and possibly herniate.  I used to joke that my discs would just keep herniating up the spine as each level is fixed.

Unfortunately, that is not a joke anymore. 

The report is three pages long, chock full of great medical terms to review, such as 'Schmorl nodes' (which is simply herniation of the nucleous pulposus) and reads like a medical school freaky-spine to study for what you do not want to see as a doctor having to deal with a patient housing such a network of spinal pathologies.

The Radiologist starts at Thoracic Spine vertebrae #1, and Thoracic Spine vertebrae #2.  This is written as T1-T2.  Levels are read in 'doubles' as each bony vertebrae joins together to the one above and below.  The disc, made up of a gelatinous material, lies in the middle of the two joining vertebrae, cushioning the large body of each vertebrae.

And off we go..... 

 T1-T2:  There is a 1-2 mm circumferential disc bulge noted.  Costovertebral hypertrophy is noted.  Foraminal compromise identified.

Yikes!  Right off the line and already starting off with a messy first level.  The Thoracic spine is the rarest area to have problems.  Herniated discs, osteophytes, etc, are not seen in the T-spine as often as they are seen in the Lumbar spine. OK, on we go... 

 T2-T3: There is a 1-2 mm circumferential disc bulge noted.  Costovertebral hypertrophy noted.  Foraminal compromise identified.

 T3-T4: There is a 1-2 mm disc bulge noted.  Costovertebral hypertrophy noted.  Foraminal compromise identified.

T4-T5: There is a 1-2 mm disc bulge noted.  Costovertebral hypertrophy noted.  Foraminal compromise identified. 

Did I just write the same thing four times?  4 herniated discs--multiple levels--and I am only on the 4th level of 12 vertebrae of the Thoracic spine.  Costovertebral hypertrophy is the area the rib joins the vertebrae and it is abnormally large. Foraminal compromise means the foramen—the opening in the vertebrae in which the nerves pass through—is compressed and narrowed. This often leads to neuropathy and other nerve-related conditions. I consider myself very fortunate with so many levels in which the foramen is compromised, to not have severe and painful nerve issues in these four levels. 

T5-T6: There is a 1-2 mm disc bulge noted.  Costovertebral hypertrophy noted.

(That was #5 herniated disc in as many levels.)

T6-T7:   There is a 2 mm circumferential disc bulge noted.  There is a right paracentral disc protrusion that indents the Thecal sac.  It measures 6x3 mm in the transverse and AP dimension.  There is bilateral foraminal compromise.  At the level of the disc protrusion right of the midline, the AP dimension of the canal is on the order of 9mm.  Costovertebral hypertrophy noted.  Foraminal compromise identified. 

T7-T8:  There is a circumferential disc osteophyte complex that is prominent to the right anteriorly.  There is a right paracentral calcified disc protrusion that measures 6x3 in the transverse and AP dimensions respectively.  There is indentation of the Thecal sac.  Bilateral foraminal compromise and moderate costovertebral hypertrophy at this level.

T8-T9:  There is a bulky right anterior disc osteophyte complex that measures 1.5 x 1.5 cm in size.  There is moderate bilateral costovertebral hypertrophy, slightly greater on the right.  There is calcification of the Ligamentum flavum.  There is a right paracentral calcified disc protrusion that indents the thecal sac.  It measures 5 x 3 mm.  There is bilateral foraminal compromise.  There is indentation of the thecal sac. 


**I am at level nine out of 12 levels of the thoracic spine.  Not one level has been untouched by disc protrusion/herniation, foraminal compromise, bone hypertrophy, osteophytes, and the last 3 levels show the thecal sac is indented. The thecal sac is a membrane covering the spinal cord, which contains CSF or cerebral spinal fluid. We do not want to see thecal sac indentation, that is getting too close to the spinal cord which brings a whole other set of very serious potential problems.

T9-T-10:  There is a 2mm disc osteophyte complex.  There is a right paracentral calcified disc protrusion that indents the thecal sac.  It measures 3 x 3 mm on the transverse and AP dimension.  There is moderate bilateral foraminal compromise.

T10-T11:  There is a 2 mm circumferential disc osteophyte complex eccentric to the left posteriorly.  Bilateral foraminal compromise.  There is resection of the left costovertebral joint and portions of the left rib with some bone fragments remaining in the postsurgical bed.  There is hypertrophy of the left transverse process.    

**T10-T11 is where my second open Thoracic spine surgery was, called a Costotransversectomy and fusion. My neurosurgeon called it, “The Big Surgery”, with stern warnings about the post-op pain and realistic recovery time. The name suggests the surgeon used a transverse approach, removing parts of the left rib along with part of the joint where the rib meets the vertebrae. He then removed the herniated disc he accessed when the rib was out of the way, followed by a fusion using the bony fragments of the rib and CV joint. Fusions are commonly done with cadaver bone or a metal of sorts.  He opened my back in a straight incision above my spine, then went in on the side at the ribs to perform the transverse entry.

 

T11-T12:  There is a 2 mm circumferential disc osteophyte complex eccentric to the left posteriorly.  Bilateral moderate foraminal compromise with probability of impingement of the exiting nerve roots.  Ligamentum flavum hypertrophy and mild facet hypertrophy noted bilaterally.

**This level shows the nerve roots with ‘probability of impingement’ due to moderate compromise of the foramen bilaterally (both sides). And again, I am so thankful that up to this point I do not have neuropathy in this area. 

T12-L1:  There is a 2mm circumferential disc bulge noted.  There is mild left foraminal compromise.  There is no nerve root impingement.
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Knowing what I do from my past surgeries, my experience as a spine surgery patient, and my medical knowledge as a nurse, my spine is  "really messed up."  These words were spoken by the kind pain management doctor that saw me for the Morphine pump.  As he read the CT results, he looked at me to say how bad my spine is, and my eyes clouded with tears.  I knew already that what was there, and what had been fixed surgically, was already a 'huge mess'.  Yet this CT scan showed me exactly why my pain has been rising steadily and is becoming out of control.  

I was told by a close friend the other day, just how strong I am.  She saw me after a long, very active day- and my pain was crazy-high.  Yet somehow I was able to press on and do the things that I needed to do.  It felt good to hear that.  Yet even I do not know where the incredible strength comes from!  How I am able to push through the barrier that occurs when pain hits hard and I am unable to rest, and just keep going?  It is from God.  For if you saw me on the street, you would never know my name was on a CT result such as above.    

I may have severe spinal issues.  I may have a spine that will never allow me to return to nursing.  (THAT alone causes the tears to well up.)  But I will never allow all of this to keep me down.  I refuse to fade off into the background while life goes on around me.  I would much rather experience life and all that it brings, in severe pain, than to not have those experiences.  Better to live my life in pain than....well, what is the other choice?  NOT live?  Actually, that IS the reason we have many deaths by suicide in the chronic pain community.  For there is NO other choice than to learn to live with the crazy pain.  

And I would rather feel life in all it's wonder......and in pain......than to feel nothing.       

 
Gentle Hugs....

Stay strong~
                     ~just for today~