CT Scan or MRI

[Ash]

Hello,

I am curious, after you have an ADR and say you still have some back issues, how would you go about further diagnosing it? As far as I know, an MRI wouldn't tell you anything since there are artifacts from the metal. X-ray just shows the bones. Would a CT scan show anything such as pinched nerve, another disc bulging?

Thanks,

Ash.

[Maria]

Sorry Ash I prematurely tried to answer a post/questions by you without having read this.. I have no hardware in only two failed back surgeries/discectomies so hopefully someone here with ADRs will give you an answer. I hope that whatever you do and whatever the findings are that the overall outcome for you will be successful (pain relief). Good luck!
Maria

[mmglobal]

Ash, I'm facing these issues now. This is very complex.

Your question is primarily about the difficulty imaging around the implants. You would not believe how dramatically the metal will effect an MRI. After my wife's endoscopic discectomy, she had substantial artifact on MRI from microscopic bits of metal that are left behind during the endoscopic surgery. The amount of metal in an ADR is many thousands (if not millions) times more than the debris left behind.

So yes, you are somewhat screwed by the difficulty imaging around the prostheses, but it is much more complicated than that. By the time you are considering surgery after ADR, you've already had at least one surgery in the area... likely more. (my case is pretty common... 2 lumbar discectomies before 2 level lumbar ADR.) Once you get to the place that you've made changes and are still having pain, diagnosing is difficult, if not impossible. EVEN WITHOUT the difficulty of imaging, sorting out the pain generators and possible solutions.

Note that I'm not suggesting that the surgeries are not indicated or that the difficulties we face if we have ongoing problems trumps the need for surgery. When we are considering spine surgery, we have very few options and they are all bad.

For me, the next step in troubleshooting my problems is cervical and thoracic MRI and CT. MRI is better at soft tissue for seeing ligaments, disc protrusions, etc.... The CT is better for seeing bone... that includes fusion masses that you want to see following a fusion surgery, or autofusion that you don't want to see after ADR surgery.

A myelogram would be better than a CT. The downside of a myelogram is the risk of injecting contrast into your spinal canal. The plan for me is to do the CT first, then do a myelogram only if necessary. The downside of this plan is that I would be subjected to twice the radiation from having 2 CT's. (MRI's have no radiation... a CT scan is like having a bunch of xrays... I've seen it presented that one lumbar CT is the equivalent of 1500 chest xrays.

Mark

[Ash]

Would an MRI only block out the region where the ADR is, in my case l5/s1, would we still be able to see the l4/l5?

[Jim M2]

Yes, you should be able to see L4-5. I have a L5-S1 and I can see L4-5 in my MRI.

[fuzzy]

I had both to try to rule out further problems in my C-spine and between the 2 it was enough to rule out 100% the need for a myleogram CT.