Question about Mom

1. My mom just called me and asked me to look up some information regarding the MRI she had done, and I can't find anything in my books...
   
   She has been having back pain, so she went and had the MRI, here is what they said..
   
   She has degenerative disk changes in L5 and L1 (I think she might mean S1, but maybe not) and she also has a small broad based disk protrusion @ L5 and L1 with disk material abutting the thecal sac??
   
   #1. What the heck is a thecal sac and
   #2. What does this mean in terms that I could explain to my mom..
   
   Thanks
2. 

   About Ortho_RN

   Joined: Nov '01; Posts: 1,616; Likes: 37
   New RN Grad... Just passed NCLEX.. Working on a Ortho floor

   7 Comments

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3. 
   Jan 3, '03

   Occupation: QI - medical review coordinator Joined: Mar '02; Posts: 530; Likes: 14

   Hello nurs2b,
   
   First of all, I am not a neuro nurse, but I've had a couple of back surgeries and am fairly well versed in spinal anatomy. To answer your questions,
   
   1. The thecal sac is the membrane that surrounds the spinal cord and holds the cerebrospinal fluid (CSF). The CSF is necessary for cushioning the spinal cord and the brain. It also transports nutrients and waste products. The CSF must be able to circulate freely to perform these functions.
   
   2. The MRI demonstrated degenerative changes in her lumbar vertebrae. These changes can occur as the result of an injury, but are usually the result of normal "wear and tear" on the spinal column as we age. The vertebrae have discs between them to cushion the bony surfaces of the vertebrae. The discs are surrounded by a fibrous outer layer that holds the softer cushiony inner portion. Aging or injury also affects the discs, and they sometimes bulge. When they bulge toward the spinal cord, surrounded by the spinal or thecal sac, it can disrupt the circulation of the CSF, or actually press against the spinal cord or one of its roots. This can cause pain in the back as well as down into one or both legs. Numbness or tingling can also occur. The first figure shows the normal and abnormal anatomy of the lumbar spine. The MRI below that shows the bulging disc pressing against the thecal sac.
   
   There are several treatment possibilities. The first treatments are non-surgical or conservative. This involves oral medications to relieve pain and inflammation. Physical therapy may also be beneficial. Another non-surgical treatment is the injection of cortisone into the epidural area. If these treatments are not effective, surgery is often considered.
   
   I hope that your mother doesn't need to have surgery, because it isn't always a good thing either. I hope that this helped some. Here is a website that may help to explain it as well.
   
   http://www.yoursurgery.com/ProcedureDetails.cfm
   
   
   Chuck
   
   

   Last edit by cbs3143 on Jan 3, '03
4. 
   Jan 3, '03

   Occupation: RN, B.S.N. Specialty: 5 year(s) of experience in Rural Hospital (we do it all) ; Joined: Dec '02; Posts: 105; Likes: 6

   My mother also suffered from DDD for many years.
   
   L1 and L5 refer to the top and bottom lumbar vertebrae. Deterioration of bone mass may occur as a result of injury, disease, inadequate nutrition, excess weight , ect. Unfortunatly, it is also part of the aging process which can develope a separate outcome for each individual.
   
   "Thecal sac" refers to the membrane that encloses the spinal nerves in this particular case.
   
   Check out these websites for comprehensive explanations related to this disorder.
   
   www.spine-health.com
   www.spinesolver.com
   
   "Their is no greater love, than a mother's love."
5. 
   Jan 3, '03

   Occupation: research nurse Joined: Oct '01; Posts: 1,878; Likes: 44

   Hi - I was a neuro nurse, and you guys really explained it well.
   
   Interestingly enough, a bulging disc is not always a cause for surgery. The famous "they" did a study where they MRI'd a large number of healthy, asymptomatic people and found a certain percentage of people of all adult age groups have bulging discs.
   
   The lumbar back is really WAY under-engineered for what we expect it to do. The L4-L5 disc and the L5-S1 disc are the ones I've seen the most surgery on. Cervical discs are problem-makers after that. In all the years I did neuro, I saw one (maybe two) thoracic surgeries.
   
   Conservative treatment can range from PT to steroid injections into that intrathecal space. If the damage is in that L4-L5-S1 type region, it can affect the sciatic nerve and cause pain and weakness in the leg. That unpleasantly unprotected nerve comes out and crosses diagonnally across and down the buttocks. It ennervates the buttocks, down the outside of the thigh and then crosses around to the front of the leg. I tore the two muscles the sciatic nerve runs between, and my "sciatica" causes a very deep and unpleasant pressure and pain in my kneecap! P.S. - severe damage/irritation to the sciatic nerve can cause edema in the affected LE.
   
   I hope your mum feels MUCH better, very soon! When your back/leg and all that hurt, nothing much feels good.
   
   Love
   
   Dennie
6. 
   Jan 3, '03

   Occupation: LPN Joined: Jan '02; Posts: 539

   All I can say is WOW what good information, like better than an encyclopedia, there are so many wonderful people that post here. I hope your mom does well. deb
7. 
   Jan 3, '03

   Occupation: QI - medical review coordinator Joined: Mar '02; Posts: 530; Likes: 14

   Hi Dennie,
   
   I'm one of those rare thoracic laminectomy victims. They went in twice, but I probably should only count as one surgery. The second surgery was done to go back in and get a spur that was extending off of one of the vertebrae at the surgical site that was missed on the initial surgery. That was at Rochester, MN, so I guess nobody's perfect. My symptoms (peripheral neuropathy) didn't resolve. They had also found a syrinx formation in the T6 to T8 region. They talked about doing surgery to that area if the initial surgery didn't help, but I told them "No frigging way!"
   
   My incision scar runs from about the area of T10 down to just above my right hip area. When I took PT back in my hometown, they brought in some of the students and other therapists to see my scar, because none of them had seen a thoracic laminectomy patient before.
   
   I would recommend a second opinion before any back surgery, even if God himself is supposed to be holding the scalpel. I didn't get one (because I figured if the Mayo Clinic didn't know what they were doing, nobody did) and have had another neurosurgeon tell me that he didn't know why the surgery was performed.
   
   
   Chuck
8. 
   Jan 3, '03

   Occupation: New RN Grad... Just passed NCLEX.. Working on a Ortho floor Joined: Nov '01; Posts: 1,616; Likes: 37

   Thank you all very much.. I knew ya'll would have the answers
9. 
   Jan 4, '03

   Joined: Dec '00; Posts: 830; Likes: 64

   As a Surgical RN , on the Neuro and Heart teams I want to Say WOW that was some of the best explantions of the symptoms and the processes I have seen. You all will and are the best assest to Nursing. Its a shame that the Dr didnt explain the results to your mother as the Dr should have. Leaving a patient in a confused state is the worst way to leave the patient, only to speculate the worst about thier conditions.
   Im thankful to the knowledge and the information that you passed in the assistance of the poster so that she can help her mother with the status of the results. The visuals will help not only help her show her mother what you are explaining but also help her daughter to understand as well.
   Hats off to the posters that contributed with the information....
   Im proud as Nurse to know that Help can be located here and the willingness to assist .
   Just my thoughts
   Zoe

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