Can X-rays show fractures of L3,L4,L5 transverse Process and MRI reveal nothing !
Question: Can X-rays show fractures of L3,L4,L5 transverse Process and MRI reveal nothing wrong!.!?
3 months ago I fell on a large rock wall and landed on my mid back!. X-ray showed Transverse Process fracture of L4 and 3 months later I am in more pain!. Next set of X-rays showed Transverse Process Fracture of L3,L4,L5!. Doctor sent me for MRI that showed nothing only loss of L1-2 disc level!. No evidence of anything else!. I am in more pain in my lower back!. Hurts to sit for long periods and lying down is not much better!. Doctor can't explain what happen!. TSH level is also below normal and liver enzymes two high!. I ache all over!. Before this I was so fit, worked out and in great shape!. I am 48!. Doctor sending me for bone scan!. Can anyone help on what I should do!. Still in pain!.Www@Answer-Health@Com
Answers:
Hello,
I am sorry about this!. I think you are asking several questions,
(1) Is the X-ray diagnosis of fractured transverse processes of lumbar vertebrae 3, 4, and 5, (presumably on the same side), reliable!? Yes, I think it is!.
Here is a diagram of the lumbar vertebrae, to refresh your memory of the anatomy, http://www!.spineuniverse!.com/displaygrap!.!.!.
The lumbar vertebrae look like square [actually cubic] childrens' building blocks piled up, (centre)!. We are looking from the top (back) here, so the transverse processes are seen as 'wings' of bone sticking out, (labelled)!.
Bone X-rays are a bit confusing, because the bones show up as *white* outlines against a black background, and of course I have not seen your X rays, - but here is an X-ray of fractured left lumbar transverse processes 3, 4 and 5, the same as yours!. http://www!.injuryupdate!.com!.au/images/sc!.!.!.
The lumbar vertebrae, as I say, look like square childrens' building blocks piled up, (centre)!. We are looking from the front, in this view, so the left transverse processes are on the right of the your picture, again as 'wings' of bone sticking out!.
There are transverse processes on each side here, right and left!. I don't know if you can see, but all the right transverse processes (on the left of your picture), are in one piece, if you follow their outline with a pencil point (recommended)!.
But compare this good right side, to the left side, - - the bottom 3, left-sided processes, (on your right), are each in two pieces, and the outer broken pieces are detached and moved downwards, - the middle one by quite a lot!.
If you have a good X ray picture, like this one, the appearance is un-mistakabe and very convincing!.
(2) Is it normal for fractured transverse processes still to be very painful after 3 months!? Yes, it can be!. It's very difficult to find a current research paper for this on the Internet (I've tried!), but here is a post from someone with a transverse process fracture http://www!.healthboards!.com/spinal-cord-!.!.!.
Sometimes the broken pieces of a fractured transverse process are separated by quite a distance, and only 'fibrous' (scar tissue) healing takes place!.
I assume that your pain is very localized to where the fractures are in your back,!.!.!. that you do not have any pain shooting from your back down your legs, for example!? That would be a different question!.
On the other hand, lumbar transverse process fractures are not uncommon in young, highly-motivated professional footballers,!.!.!. and aggressive professional physiotherapy in this group, can lead to return to normal play within 4 weeks, *whether the fractures are actually healed or not,*!! - see http://www!.mdconsult!.com/das/article/bod!.!.!.
(3) Can an MRI scan miss a bony fracture!? Well, it should not!. But MRI scans are much better at showing 'soft' parts of the body than 'hard' parts like bone!. That's why an MRI scan is used to diagnose relatively 'soft' problems like slipped discs!.
Your MRI scan shows narrowing of your L1- L2 disc space, which is very likely to be due to 48 years of 'fair wear and tear,' and to be a completely incidental finding!.
Here is disc-space narrowing (arrowed) in an ordinary spine X-ray, side-view, between the lumbar vertebrae L3 and L4, - - it just indicates some wear-and-tear or some early osteo-arthritis, that's all, http://www!.aafp!.org/afp/20071201/afp2007!.!.!.
(4) What's with the bone-scan!? Here is what a bone scan looks like!. What are shown (as black dots) are bone 'hot spots,' that is to say spots where the bone is metabolically 'active,' - - which is to say where new bone is forming, or where bone is being re-absorbed!. 'Untroubled' bone is visually 'quiet!.' http://brighamrad!.harvard!.edu/Cases/jpnm!.!.!. (In these pictures a benign over-growth of bone called an 'osteoma' is shown up by its bony over-activity)!. In your case, your doctors are hoping for black spots of bone-activity in your transverse processes, where the 'activity' should equal ' normal healing activity!.' Is there any healing activity at the 3- month point!? Any other (abnormal) bone activity will also be shown!.
(5) What's with the thyroid-stimulating hormone level !? ("TSH"),!.!.!. the background is, that the pituitary gland at the base of the brain produces a hormone (called TSH), - to stimulate the 'thyroid gland' in your neck, - if the pituitary gland senses a lack of thyroid hormone in the blood!. This is a normal control mechanism!.
Conversely, if the pituitary gland senses too much thyroid hormone in the blood, it stops stimulating the thyroid gland to produce any more!. It depends how 'low' is 'low,' but this is likely to be another incidental finding, and nothing to do with your bones!. 'Parathyroid' hormone might, but that is quite different!. It may not even indicate thyroid trouble in your case!.
(6) What's with the high liver enzymes!? Again, it depends how 'high' is 'high,' but liver enzyme levels -
- (a) in the low hundreds, are most commonly due to a relatively generous alcohol consumption, (in which case the 'mean corpuscular volume' or 'MCV' in your 'complete blood count' or 'CBC' will be high too),
- (b) in the thousands, are most commonly caused by 'hepatitis', a virus infection of the liver, which normally causes marked yellow jaundice!.
I think again this is likely to be an incidental finding!.
(7) What do I think you should do!? Well, accepting that at 48 you are not going to heal as quickly as a young professional footballer, - - nevertheless I think you need the same sort of treatment, aggressive active physiotherapy from a professional, maybe even a sports professional, as you seem to be in that sort of orbit!.
Fractured transverse processes are (relatively) minor bone fractures, because, -
(a) they are nowhere dangerous (the transverse processes are safely embedded in back-muscle),
(b) a return to good back function does not need bony healing, - - 'fibrous' or 'scar tissue' healing is just as good, and
(c) bone deformity, - if it heals up very crooked, - doesn't matter a bit, (like it would in the leg or arm)!.
It's just so painful because these bony wings are 'bone levers' for muscle attachment to the spine!. I know it's easy for me to tell you to 'tough it out,' but I think that's what I would recommend!. Active re-mobilization, as doctors would say!. Hot packs against your back, like wheat-bags heated in a microwave oven, and lots of pain-killers!.
I hope this is of some help!.
Best wishes,
Belliger (retired uk gp)Www@Answer-Health@Com
I am sorry about this!. I think you are asking several questions,
(1) Is the X-ray diagnosis of fractured transverse processes of lumbar vertebrae 3, 4, and 5, (presumably on the same side), reliable!? Yes, I think it is!.
Here is a diagram of the lumbar vertebrae, to refresh your memory of the anatomy, http://www!.spineuniverse!.com/displaygrap!.!.!.
The lumbar vertebrae look like square [actually cubic] childrens' building blocks piled up, (centre)!. We are looking from the top (back) here, so the transverse processes are seen as 'wings' of bone sticking out, (labelled)!.
Bone X-rays are a bit confusing, because the bones show up as *white* outlines against a black background, and of course I have not seen your X rays, - but here is an X-ray of fractured left lumbar transverse processes 3, 4 and 5, the same as yours!. http://www!.injuryupdate!.com!.au/images/sc!.!.!.
The lumbar vertebrae, as I say, look like square childrens' building blocks piled up, (centre)!. We are looking from the front, in this view, so the left transverse processes are on the right of the your picture, again as 'wings' of bone sticking out!.
There are transverse processes on each side here, right and left!. I don't know if you can see, but all the right transverse processes (on the left of your picture), are in one piece, if you follow their outline with a pencil point (recommended)!.
But compare this good right side, to the left side, - - the bottom 3, left-sided processes, (on your right), are each in two pieces, and the outer broken pieces are detached and moved downwards, - the middle one by quite a lot!.
If you have a good X ray picture, like this one, the appearance is un-mistakabe and very convincing!.
(2) Is it normal for fractured transverse processes still to be very painful after 3 months!? Yes, it can be!. It's very difficult to find a current research paper for this on the Internet (I've tried!), but here is a post from someone with a transverse process fracture http://www!.healthboards!.com/spinal-cord-!.!.!.
Sometimes the broken pieces of a fractured transverse process are separated by quite a distance, and only 'fibrous' (scar tissue) healing takes place!.
I assume that your pain is very localized to where the fractures are in your back,!.!.!. that you do not have any pain shooting from your back down your legs, for example!? That would be a different question!.
On the other hand, lumbar transverse process fractures are not uncommon in young, highly-motivated professional footballers,!.!.!. and aggressive professional physiotherapy in this group, can lead to return to normal play within 4 weeks, *whether the fractures are actually healed or not,*!! - see http://www!.mdconsult!.com/das/article/bod!.!.!.
(3) Can an MRI scan miss a bony fracture!? Well, it should not!. But MRI scans are much better at showing 'soft' parts of the body than 'hard' parts like bone!. That's why an MRI scan is used to diagnose relatively 'soft' problems like slipped discs!.
Your MRI scan shows narrowing of your L1- L2 disc space, which is very likely to be due to 48 years of 'fair wear and tear,' and to be a completely incidental finding!.
Here is disc-space narrowing (arrowed) in an ordinary spine X-ray, side-view, between the lumbar vertebrae L3 and L4, - - it just indicates some wear-and-tear or some early osteo-arthritis, that's all, http://www!.aafp!.org/afp/20071201/afp2007!.!.!.
(4) What's with the bone-scan!? Here is what a bone scan looks like!. What are shown (as black dots) are bone 'hot spots,' that is to say spots where the bone is metabolically 'active,' - - which is to say where new bone is forming, or where bone is being re-absorbed!. 'Untroubled' bone is visually 'quiet!.' http://brighamrad!.harvard!.edu/Cases/jpnm!.!.!. (In these pictures a benign over-growth of bone called an 'osteoma' is shown up by its bony over-activity)!. In your case, your doctors are hoping for black spots of bone-activity in your transverse processes, where the 'activity' should equal ' normal healing activity!.' Is there any healing activity at the 3- month point!? Any other (abnormal) bone activity will also be shown!.
(5) What's with the thyroid-stimulating hormone level !? ("TSH"),!.!.!. the background is, that the pituitary gland at the base of the brain produces a hormone (called TSH), - to stimulate the 'thyroid gland' in your neck, - if the pituitary gland senses a lack of thyroid hormone in the blood!. This is a normal control mechanism!.
Conversely, if the pituitary gland senses too much thyroid hormone in the blood, it stops stimulating the thyroid gland to produce any more!. It depends how 'low' is 'low,' but this is likely to be another incidental finding, and nothing to do with your bones!. 'Parathyroid' hormone might, but that is quite different!. It may not even indicate thyroid trouble in your case!.
(6) What's with the high liver enzymes!? Again, it depends how 'high' is 'high,' but liver enzyme levels -
- (a) in the low hundreds, are most commonly due to a relatively generous alcohol consumption, (in which case the 'mean corpuscular volume' or 'MCV' in your 'complete blood count' or 'CBC' will be high too),
- (b) in the thousands, are most commonly caused by 'hepatitis', a virus infection of the liver, which normally causes marked yellow jaundice!.
I think again this is likely to be an incidental finding!.
(7) What do I think you should do!? Well, accepting that at 48 you are not going to heal as quickly as a young professional footballer, - - nevertheless I think you need the same sort of treatment, aggressive active physiotherapy from a professional, maybe even a sports professional, as you seem to be in that sort of orbit!.
Fractured transverse processes are (relatively) minor bone fractures, because, -
(a) they are nowhere dangerous (the transverse processes are safely embedded in back-muscle),
(b) a return to good back function does not need bony healing, - - 'fibrous' or 'scar tissue' healing is just as good, and
(c) bone deformity, - if it heals up very crooked, - doesn't matter a bit, (like it would in the leg or arm)!.
It's just so painful because these bony wings are 'bone levers' for muscle attachment to the spine!. I know it's easy for me to tell you to 'tough it out,' but I think that's what I would recommend!. Active re-mobilization, as doctors would say!. Hot packs against your back, like wheat-bags heated in a microwave oven, and lots of pain-killers!.
I hope this is of some help!.
Best wishes,
Belliger (retired uk gp)Www@Answer-Health@Com