Re: low back pain with radiculitis (Full Version)

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Synergy -> Re: low back pain with radiculitis (August 25, 2005 2:57:00 PM)

ROFL @ Ben!



chiroortho -> Re: low back pain with radiculitis (August 25, 2005 4:50:00 PM)

Yogi I'm really not sure what the arrow's pointing to. The sacrum is oddly shaped, kind of curving to the right,and notice how the sacral foramina are different on the left as compared to the right. The articular facets at the top of the sacrum also appear to be oriented in different planes (more or less sagittal plane on the right and coronal on the left). Not good biomechanically.

Greg



chiroortho -> Re: low back pain with radiculitis (August 26, 2005 4:16:00 AM)

Yogi, looking at that picture again it looks like it may be pointing to an anomalous articular process that formed in an odd place on the posterior sacrum. Very odd. The surface of it appears to have a smooth surface, maybe even hyaline-type cartilage or at least a smooth subchondral surface. Hard to tell.



Jeep -> Re: low back pain with radiculitis (August 26, 2005 8:26:00 AM)

"FINDINGS: AP, lateral, and spot lateral lumbosacral views were obtained. There is apparent hypoplasia of the L5 and S1 vertebral bodies on the left side with mild focal curvature of the lumbar spine centered at L2-3. The remaining vertebral bodies are normal in appearance. No significant soft tissue abnormalities are noted.

IMPRESSION: Hypoplasia of the left sides of L5 and S1, likely congenital in nature. This can be better evaluated with CT if clinically indicated."


Alex-
with all due respect, that is one of the saddest rad reports I have ever read. Extremely disappointing. If I received this report, I would give the rad a call and question him/her about the use of "hypoplastic". EG. Short pedicles could be referred to as "hypoplastic". Anomolous, dysplastic would be far more accurate amd certainly expected of a specialist. The remaining 2-3 sentences say nothing.

IMO- we(posters here) did a much better job of evaluating these films than the rad.

It would be very interesting to give these films to another rad and compare reports. I do know that these films would have generated a good/informative 1 page report from the rad I use(as opposed to the 2-3 sentences here).

If you have any say as to what rad reads your films, ......I would use another.



JLS_PT_OCS -> Re: low back pain with radiculitis (August 26, 2005 8:39:00 AM)

It seems there is as much an art as a science to the interpretation of RAD films.
Some of us are better at the art than others, I guess...
Maybe I'm just miffed they didn't mention my DDD at L5/S1. :)
J



Jeep -> Re: low back pain with radiculitis (August 26, 2005 8:43:00 AM)

Jason-
For what it's worth---------
IMO- "your" DDD@L5/S1(Degenerative disc?) Would be better identified as a rudimentary disc. ie- it was never a fully formed disc.



JLS_PT_OCS -> Re: low back pain with radiculitis (August 26, 2005 10:47:00 AM)

Thanks Jeep, I'll take your opinion over mine on the spine films any day, man...
Good education is always a good thing.
J



jma -> Re: low back pain with radiculitis (August 27, 2005 11:18:00 AM)

Would another radiogist come up with the same findings?



Jeep -> Re: low back pain with radiculitis (August 27, 2005 1:30:00 PM)

What "findings" were even in this report?


IMO- Another radiologist would not "come up with the SAME findings". But I strongly beleive that another radiologist would come up with SOME findings.


I would certainly like to inquire of him of his "hypoplasia" descriptive. I do not think it is a sound "finding"(the only one detailed in the report and I question it). The rest of the report is standard page filler jargon.(Unless Alex did not post the complete report).



ehanso -> Re: low back pain with radiculitis (August 29, 2005 9:26:00 AM)

I worked with an orthopaedic surgeon and we did presentations together for sports related injuries. One of his slides showed a man in scrubs with a big set of hedge clippers clipping a hedge. The caption was "The national flower of the Radiologist, The Hedge." Still has some ongoing truth to it.



Jeep -> Re: low back pain with radiculitis (August 29, 2005 12:44:00 PM)

Good one Falls!----------HA HA!!!!



JLS_PT_OCS -> Re: low back pain with radiculitis (August 30, 2005 10:34:00 AM)

Love that one!!
J



Alex Brenner PT MPT OCS -> Re: low back pain with radiculitis (August 31, 2005 3:50:00 AM)

Hi. I am actually in the US for two weeks and am just now getting to a computer with internet access.

Sorry about the poor rad report but that is all I got. It did generate some good discussion here which is one of the best aspects of this forum and one of the goals of this forum. Thanks.

Alex



jma -> Re: low back pain with radiculitis (August 31, 2005 8:03:00 AM)

Keep them coming Alex.



SJBird55 -> Re: low back pain with radiculitis (September 9, 2005 4:14:00 AM)

Alex... when you get back online, let us know how that darn knee is.



tim -> Re: low back pain with radiculitis (September 23, 2005 9:36:00 PM)

OK< I have to ask.......why Dx this as a radiculitis? What's the evidence of radicular involvement? There are no neuro signs so we can't call it a radiculopathy but where's the positive SLR? What angles was it positive at? Was it hard or soft positive? Without a + SLR, you shouldn't call it a radiculitis, it would probably be deep referred pain and the congenital anomaly may or may not be a factor.
:)
-tim



Alex Brenner PT MPT OCS -> Re: low back pain with radiculitis (September 28, 2005 2:21:00 AM)

I guess it depends on what your definition is of radiculitis. Correct me if I am wrong but I thought that a radiculitis was lumbar pain which follows a radicular type pattern but on physical exam there are no findings of a specific dermatomal pattern, sensation is usually normal as well as reflexes. A radiculopathy on the other hand there would be pain into a specific dermatomal pattern, sensation decrease in a specific dermatomal pattern, and possible absent reflex. Hence, why we name the radiculopathies S1 radicuopathy, L4 radiculopathy, C6 radic etc.

Radiculitis does not equal radiculopathy.

Right?



jma -> Re: low back pain with radiculitis (September 28, 2005 8:13:00 AM)

I concur with that.



tim -> Re: low back pain with radiculitis (September 28, 2005 9:24:00 AM)

Yup.....they are not equal but what do you define a "radicular pattern" as? To diagnose this patient as having a radiculitis means that there is something irritating the nerve root. Commonly, the clinical signs of a radiculitis are: Positive SLR (that is an SLR that reproduces the patient's reffered pain) and usually, but not always, hyperalgesia or hyperesthesia in a dermatomal pattern. You still need to name which nerve root(s) is/are irritated. Using the prefix Radic- is implying that you "know" the pathoanatomical structure is the nerve root, it can't be all of them eh? If it were, there's be other symptoms as well (probably autonomic).



chiroortho -> Re: low back pain with radiculitis (September 29, 2005 6:10:00 PM)

My general definition of radiculitis v. radiculopathy is that radiculitis is a transient condition of nerve root inflammation with no changes on electrodiagnostic testing whereas radiculopathy is 'permanent' nerve damage documentable on EDx testing.

I think you can have a dermatomal pattern with radiculitis, and that it will resolve with/without treatment. A foot drop due to radiculopathy will persist even after surgery.

This is not a hard and fast distinction, but it's how I explain it in depositions. My feeling is that a radiculopathy is essentially a radiculitis that has become chronic. I think another adjective that might describe 'itis' would be 'temporary' or 'short-lived'.

To be practical, when a patient comes in with reasonably dermatomal leg pain I almost always call it a radiculopathy.



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