This is way to tl/dr response, but you did ask.
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Originally Posted by ReasonableGuy
Just curious, if you don't mind, what does this mean in layperson's language and what is the treatment plan?
Calli is right in that your spine (or vertebral column) is comprised of a series of bones stacked upon one another with a disc between each of them that provides a cushion or shock absorber to distribute the forces more-or-less evenly when your back comes under a strain like when lifting or jumping or even walking. The main part of each bone is called the body and basically looks like a cube when viewed on an X-ray or other scan. It is far and away the strongest part of each vertebra. However, some other bony parts of the vertebrae form a kind of bony ring that encases your spinal cord and provide other contact (or articular) surfaces with the vertebra above and below that level. Surrounding and between the vertebra are various small ligaments as well as a some large muscles that run up and down your back.
By a large margin, the most common injuries that affect the back involve straining the paraspinous muscles or even spraining some of the small ligaments between the vertebra. This is the injury most people suffer when trying to lift heavy objects or sustain whiplash type injuries. They almost always get better with conservative treatment in a few days or a week. However, despite the relatively benign and self-limiting nature of these injuries, they continue to be a source of significant medical and legal expense because folks will continue to complain of pain in an effort to obtain narcotics and /or a legal settlement "from that guy that rear-ended me." A long time ago, a lawyer pal of mine told me that "the lumbar spine supports the upper two thirds of the body and the lower third of the Bar."
Another smaller, but still common group of problems involve the disks themselves. As we age, those shocker absorbers become less elastic, desiccate or dry up and get smaller. Under certain circumstances, they can rupture and their contents push into the spinal cord, or more commonly, impinge on the nerves that come off the spinal cord between each vertebra. The symptoms will entirely depend on where the rupture occurs. Rupture a disk in your neck and you're gonna have arm and/or upper torso trouble. Your hips and legs will be affected by a lumbar disk rupture. It is noteworthy that ruptured disks occur commonly in the neck and low back, but are very rare in the thoracic (mid back) disks.
Another group of injuries are called "compression fractures." Simply put, these occur when an external force-usually traumatic in nature- is suddenly distributed to the vertebral column but is not uniformly distributed through the vertebral bodies. The result being that the vertebral body is "squished" or compressed and fractures. This injury is most common in the elderly with osteoporosis where the force necessary to cause a compression is greatly reduced. These injuries almost always result from a fall in which someone lands directly on their tailbone or, interestingly, when they land directly on their heels and keep their legs straight in the process. They are common among roofers and other people who jump off ****. Since the force is applied from the lower back upward thru the spine, it should come as no surprise that these injuries are most common in the lumbar area, less common in the thoracic spine and almost nonexistent in the neck.
Unless there is involvement of the spinal cord, treatment of these injuries is conservative. Medications and occasionally a back brace. Incidentally, cord involvement with these injuries is exceedingly rare for a couple of reasons. First, the compressive force simply flattens the vertebra and the bone is contained in place (as opposed to a "burst fracture" which shatters the bone and spews fragments in multiple directions). Second, the spinal cord gets smaller as it goes from the neck down the back and, fortunately, the spinal canal (you remember, the canal formed inside the vertebra thru which the cord travels) gets larger. The cumulative effect of all of this is that your spinal cord is
much less likely to be injured or affected with mid and low back compression injuries.
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Originally Posted by pig4bill
And you don't have any "samples" lying around?
Narcotic "samples" are nonexistent these days. Many years ago, the DEA required strict accounting for all narcotics, especially at the point of distribution. That was pretty easy for pharmacies with their point of sale and inventory software. Samples given to, then distributed by, doctor's offices were not easily accounted for and resulted in nightmares for docs. But the real reason that docs don't have narcotics in their office- samples or not- is the substantial risk of robbery and break-ins.
Regarding the cost of MRIs, here's helpful hint that will allow you to know the minimum price the hospital would potentially accept as payment. Call your insurance company and ask what their allowable reimbursement is for the test. That number may vary a bit depending on your provider (the larger the insurer, the lower the reimbursement). Whatever that number is- and you're likely to be surprised how low it is- you can rest assured the hospital is making a profit at that rate. MRIs will never be considered "loss leaders."
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Originally Posted by callipygian
The spine is made up of segments called vertebrae (plural of vertebra) that are numbered C1 to C5 (?) in the neck (don't know what C stands for), T1 to T12 in the thorax (chest) and L1 to L4 in the lumbar (abdomen). Doc cracked T12 and it hurts because the spinal cord, which runs down the middle of the spine, is getting jostled. Edema is just inflammation/swelling which is normal whenever your body is injured, but sometimes makes things worse. The MRI is a non-invasive scan which uses magnetic fields and radio waves to tell the density of water in different parts of your body (different tissues show up as different colors).
Dilaudid is a painkiller (opoids are a class of painkillers related to morphine and heroin). Steroids (not necessarily anabolic steroids which build muscle - steroid refers to the chemical structure) reduce inflammation (to address the edema). Doc also listed a benzodiazepine, which are neurological drugs which relax muscles / calm anxiety (I assume it was prescribed for the former effect since leo doc doesn't seem like the hysterical patient that would need it to STFU).
Not sure what the long term plan is, whether there's a surgical option or whether it's just pain management while the body heals itself.
Pretty much all correct, but a few points. There are 7 cervical, 12 thoracic and 5 lumbar vertebra. MRI description is correct and it's great at detecting local edema (unlike CT) because of what it measures. In my case, it not only showed the compressed vertebra, but also the edema in and about the fracture site.
Regarding the drugs, I was having involuntary and debilitating muscle spasms when I went from a supine to an upright stance. Oddly, this only happened when trying to arise from lying flat on my back. Since the MRI required me to do so, I got "stuck" on the stretcher until a little pharmacological help arrived. And yes, the Ativan was used as a muscle relaxer, altho I'll admit had that ordeal have gone on for another ten minutes, the STFU part may well have come into play.
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Originally Posted by pig4bill
On first reading I figured the **** was a synonym for "poop". On second reading I now think it may have been something else.
Call Howard for any future clarifications.
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How are you going to lean over a patient if you have to?
I can flex my back to a pretty significant degree without pain. If I have to pick something up, I just lower my body by flexing my knees.