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#222383 - 11/30/11 03:06 PM what does spondylitis look like on mri?
lauralynn Offline
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Registered: 10/31/10
Posts: 32
Loc: MI
so, I'm having a strange day, well couple of months really and so I'mready to ask forhelp...

does anyone know what early A.S. or spondylitis looks like on an mri?


I had a lumbar mri done. have a herniated disk at l4-l5 and now have a few tests planned, emg and standing flexion/extension xrays.

But I also in all my amateur skills look at the mri and I see alot of white streaks in the front of the spine where the anterior ligament should be. Before the bamboo happens what does it ;ook like? Is it like calcification of the ligaments? And what is the normal occurence with the disks?

Should I be considering a "fusion" on aspine that is tring to fuse itself?

If I wait, it'll just fuse itself right?

okay, I'm trying to understand. Cause in 3 months with the onset of severe right hip pain I've had an MRI on lumbar/cervical/hip, have found I need a total hip replacement, now possibly fusion,and to boot my leftknee has started locking up with stair climbing and after sitting... dr says should mri, however why.. I'm not considering knee surgery I need hip and back taken care of.



So, ... anyone know what a white anterior ligament means in the lumbar spine.

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#222387 - 11/30/11 03:56 PM Re: what does spondylitis look like on mri? [Re: lauralynn]
sequoia
Unregistered


so, wait laura, what is your doc doing for you in the way of meds or other treatment? you should be getting on with going past the mri reading stage.

btw just about no one here is licensed to read mri's. i wouldn't even begin to compare. not like an xray or bone scan. get a copy of the report and take an xray and/or bone scan, or at least ask about them.

basically, you do NOT wait til you fuse to do something about the symptoms. your doc is not a good doc if s/he is waiting for that.

what do they say when you have your appointment?

you need to talk to your doc, or get a new one if they will not explain things to you. it is so tough and so many of them are not familiar enough with our dx to really help sometimes.

ask questions. sorry could not be more help. prayers and peace, sequoia

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#222388 - 11/30/11 04:20 PM Re: what does spondylitis look like on mri? [Re: lauralynn]
Tacitus Offline
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Registered: 06/06/03
Posts: 2747
Loc: Palm Springs area, California
Hi, lauralynn:

Quote:
does anyone know what early A.S. or spondylitis looks like on an mri?

INVISIBLE.


Quote:
Before the bamboo happens what does it ;ook like? Is it like calcification of the ligaments? And what is the normal occurence with the disks?


"squaring" of the vertebrae, "loss of curvature in lower spine," and osteophytes that become "bridging" or meeting up in between the vertebrae to become syndesmophytes.

But the process can take many years and You will experience a loss of height due to collapsing spine and osteopenia/osteoporosis even kidney stones as a sign of deep mineral depletion of the spine; the osteophytes are just deposited in proximity to the mineral (mostly calcium) loss.

Before calcification and fusion, there is a stage called fibrosis that can last over two years and also cause a restriction of movement. This can be reversed but once the fusion has occurred the damage is permanent.

Quote:
Should I be considering a "fusion" on aspine that is tring to fuse itself?

NEVER--surgical fusion--before it is absolutely necessary--would probably be unethical at least and almost certainly malpractice.

Quote:
If I wait, it'll just fuse itself right?

Possibly, especially if You do nothing in addition to what most physicians are capable of telling You.

Fusion is a terrible condition--to be avoided at all expense of effort and capital. And it can only be avoided with the patient's full participation and cooperation; nobody can do it for them.

HEALTH,
John
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#222389 - 11/30/11 05:02 PM Re: what does spondylitis look like on mri? [Re: Tacitus]
Banana Offline
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Registered: 07/23/06
Posts: 6075
Loc: New York
Have you read what was written? It takes special knowledge to read an MRI, ask your doctor. Mine says straightening, squaring etc etc.

Has your doctor discussed treatment? If you have OA in your hip and knee, it can really mess with your spine. The mechanics are quite complicated.

Anna
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Actema IV once a month (with pre loading for allergic reaction), Cymbalta x1 daily, Arava 20mg daily. Diagnosed with AS in 2004, suffered undiagnosed since 1982.

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#222391 - 11/30/11 05:15 PM Re: what does spondylitis look like on mri? [Re: Banana]
KimD592 Offline
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Registered: 08/25/11
Posts: 2156
I agree...you need to read what the report says. The white "streaks" you are seeing may be just artifact. Was the MRI done with contrast? If so, it could be remnants of the contrast, but really you should not be interpretting your own MRI, because it takes a trained eye to understand it.

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#222399 - 11/30/11 06:20 PM Re: what does spondylitis look like on mri? [Re: KimD592]
JenInCincy Offline
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Registered: 05/19/08
Posts: 13279
Loc: Cincinnati, OH
There are spondylitis images to be found online - one organization, ASAS, has a great library of slides including many of MRIs: http://slides.asas-group.org/app/slides/search?q=&c=ALL&k=ALL

I don't know what an inflamed ligament would look like on an MRI - hopefully when you get a copy of the report your question will be answered, but if not, ask your doctor! Try not to fret, it's not at all clear that areas of the worst inflammation are the ones that end up fusing - and unfortunately there is nothing that can slow/reverse fusion (although the anti-TNFs can sometimes heal enthesitis.) That said, NSAIDs and anti-TNFs can often result in dramatic improvement in symptoms by reducing inflammation; and also, many people with spondylitis do not end up with fusion in the spine.
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"Science is the father of knowledge, but opinion breeds ignorance." -- Hippocrates

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#222402 - 11/30/11 07:38 PM Re: what does spondylitis look like on mri? [Re: JenInCincy]
NotMeToo Offline
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Registered: 07/12/04
Posts: 1027
Loc: United States
I know it is hard, but try to hold off on worrying about what the MRI shows until you talk to your doctor or at least get the MRI report from the Radiologist. One problem in trying to read our own MRI films is that most of us are not trained or qualified to do so. Radiologists have 14 or more years of training to interpret radiology images (4 years of pre-med, 4 years of medical school, 1 year of internship, 4 years of residency and 1 or more years of fellowship).

You could compare images over the internet. (The information on the site Jen linked is excellent.) However, what most people do not keep in mind (or don't know) is that the images we see on our computer monitors change and need to be interpreted differently based on the signal characteristics, fat saturation, number and thickness of slices visualized and use (or not) of contrast. Without knowing all that information, it would be impossible to accurately interpret an MRI image. (For instance, an active inflammatory image appears hypointense on a T1 weighted image, but hyperintense on a STIR image.)

Relax, take a deep breath. and talk to your doctor.
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#222403 - 11/30/11 07:46 PM Re: what does spondylitis look like on mri? [Re: JenInCincy]
sunflower Offline
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Registered: 06/07/11
Posts: 320
Loc: Kansas
What you are asking about sounds like you may have seen pictures of the "dagger sign"? I am reaching here!!! It is a sign that the ligaments are calcifying but I have only seen pictures of it on xrays, and have no idea what that would look like on an MRI.

The link Jen gave you is awesome to look at. But, when you go to look at your own actual MRI's it is difficult to interpret what you see. You can find pictures with the dagger sign - just google that and you will find them.

Next appointment, take the MRI and have your doctor look at the pictures and explain what you see. I have done that with my sinus pictures and it is very helpful.

Your doctor probably wants an MRI of the knee to help visualize what is causing the locking up. It may or may not be related to the other things going on. It is common to visualize the cartilige (sp?) in the knee that way to see if there are visible tears.
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#222410 - 11/30/11 09:44 PM Re: what does spondylitis look like on mri? [Re: sunflower]
cemc Offline
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Registered: 01/15/10
Posts: 2930
Loc: UK
Is the doc that ordered these MRIs actually a rheumatologist or is he some kind of orthopaedic or surgical guy? I'm just asking because rheumatologists don't usually talk surgery or fusions - they talk about getting inflammation down and meds. If you aren't seeing a rheumatologist, then maybe you should be. They are the ones who will really be able to read those MRIs and tell you the significance of them.

I have MRIs that I really want to understand too, but you just have to hang out until you see a doc who can actually explain them to you. Interpretation is very complex and even what might look obvious isn't always what you think.
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Cauda equina type neurogenic bladder problems. Coeliac disease. Sicca syndrome. Ataxic gait and use crutches. Non-specific gut problems. Current treatment: Low dose naltrexone, low starch diet (Guts shredded by NSAIDs. Previously diclofenac worked well, not eligible for anti-tnfs, hypersensitivity to SSZ). Also short bursts of pred for bad flares

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#222551 - 12/01/11 08:04 PM Re: what does spondylitis look like on mri? [Re: cemc]
lauralynn Offline
Registered Visitor

Registered: 10/31/10
Posts: 32
Loc: MI
Thanks for all your responses, I guess I was just wondering if anyone had similar experience with all the multiple events at once.


My comment about reading the MRI myself was a tongue in cheek statement, but you can't hear the humor in my voice when I type.

And no I am not deciding what the next step would be, that's definitely up to the docs.

I will look at the mri site jen mentioned, it will be fun to look, thats all.

My rheumy sent me to PCP for hip pain, who ordered an MRI then referred to ortho for the hip pain; the ortho wants to send me to a different orthosurgeon that specializes in total hip, since I need both socket and ball joint replaced and with the spondylitis and meds and mrsa it complicates things. In the mean time I received an injection in the hip which only worked for a few days, and have continued with lumbar pain which seems to radiate down right leg. This prompted my PCP to order repeated mri on lumbar spine. Results indicate herniated disk at L4-L5 with a free fragment and new retrolithesis of L4, previous spondylolithisis. Radiologist also noted problem with uterus that needs addressed, but that is being put totally on back burner for now. So after MRI results PCP referred to Neurosurgeon. Neurosurgeon needs more information on whether a fusion is the proper treatment, as it appears I have too much flexion and movement in spine from front to back. The knee pain has only been addressed by PCP at appt for hip and back as a side note, since I've been compensated the right hip and leg pain and stressing my movements with left knee, especially up and down any stairs, she xrayed the knee and based on the results wants to MRI but right now I asked to hold off there until we address the back/hip problem as that is what causes the magority of pain and limits my mobility. I feel like all my "parts" are breaking down.

MRI's have been read by Radiologist and all Drs have the results. Nothing was mentioned on the lumbar report about the ligaments, it was just an obvious white streak on the front of the spine at L5, L4, L3, L2... not inbetween, however we were focusing on the disk areas of hip/groin/leg pain.

So the next direction from the Neurosurgeon is to have EMG's of both legs, and a series of flexion xrays to determine level of instability of the spine with position changes. An appointment with another neurosurgeon who specializes in the fusion to weigh the pros and cons, as it would be a joint surgery between the 2 drs.

Somewhere in there I need to get back to the rheumy to discuss viability of surgery on methotrexate, plaquenil, celebrex, etc. (I failed the trial of Humira in August, with frequent infections and MRSA boils and haven't tried anything else yet.)

So, I'm still in the Process so to speak. My PCP wants to send me to a tertiary rheumy at University of Michigan, they are booked out til February.

My question about the "self fusion" was also a bit tongue in cheek, that maybe if my body is already trying to "fuse" the vertebra then why not let it do it naturally and not do a "fusion" surgery with all the risks, etc.

So, hopefully this clarified my post.

I'm just the curoius type and like to know if others have experienced stuff like this, thats all.

I'm content with my current dose of pain meds, it allows me to continue to work a desk job at least, at an acceptable pain level most days.




Edited by lauralynn (12/01/11 08:17 PM)
Edit Reason: spelling
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