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Forum Name: Rheumatology Topics

Question: Swelling and Edema in Lower Back


 hethr24g - Fri Sep 18, 2009 9:27 am

Had an MRI with results of localized swelling and edema in my lower back. The pain started 4 months ago 2 days after having a surgical procedure (NovaSure). Finally convinced my physician to order MRI. She wants me to see a Rheumatologist, however, I can't get in to see one for another 2 months. My question is: Due to the circumstance of having this develop after a surgical procedure, is a Rheumatologist the right choice? And if so, can this swelling and edema wait another 2 months or should I been seen ASAP? Thank you.
 Tom Plamondon PA-C - Sun Sep 20, 2009 9:14 pm

User avatar Hello,
The endometrial ablation should not have caused the low back pain.

An MRI should rule out disc disease or nerve impingement and abnormal shifts in the lumbar spine.

I would check on the specific MRI results.

If a rheumatologic disorder is suspected (e.g. ankylosing spondylitis (AS)) then check sed rate and CRP, do a spine x-ray and determine if the pain is worse with inactivity and lying down and morning stiffness greater than 30 minutes - symptoms of AS.

Not sure if rheumatology is the best option. Depends on the MRI, spine x-ray, labs and history and physically - some of which I have noted above.

Take care.
 hethr24g - Mon Sep 21, 2009 2:59 pm

Thank you for your reply. I got a copy of the MRI report for further knowledge. Not sure I understand and can't wait for another 2 months before I see a Rheumatologist. Just to let you know, I am a 37 yr old female with no known medical problems. Could you please tell me your opinion based on the following from my MRI report?

There is right-sided marrow edema in the inferior endplate of L4 throught L5 and at the superior endplate of S1. Anterior superior L1 subentheseal marginal edema is present and there is some accentuation of marrow fat at the anterior superior margin of L2. Discs have a slightly biconcave appearance. The distribution of marrow edema at L5 also extends anteriorly in a circumferential manner and there is some left-sided discongenic edema at the margins of L4-5 as well. No overt collapse can be seen. No destructive lesions can be identified on out of phase gradient images. The central canal is patent. No evidence of a disc herniation. No clear evidence for an endplate fracture. Foramina are patent. Lateral recesses are unremarkable and facet joints are unremarkable. Distribution of marrow edema could be seen with an inflammatory spondyloarthropathy. Possible that endplate deformities represent minor chronic osteoporotic deformities but mineralization on prior xray shows no specific abnormality to suggest osteoporosis. The sacral lateral view shows minor subentheseal sclerosis anterosuperiorly at L5 which would suggest early spondyloarthropathy. No evidence of significant disk disease facet arthrosis, central canal narrowing, lateral recess or foraminal encroachment to suggest mechanical source of back pain. Numerous locations of marrow edema in lumbar spine end plate of L1 and to some extent of L2. No abnormalities to suggest stress fracture. Numerous minor end plate concave deformities are probably developmental as I do not see evidence of an osteoporotic compression fracture. DXA exam may be of help.

Again, thank you for your time and interpretations. At least I can have some type of heads up what may be the issue and possible treatments.
 Tom Plamondon PA-C - Sun Sep 27, 2009 9:32 pm

User avatar Hello,
The MRI essentially says that the spinal cord, the canal which houses the cord, the discs and the small joints of the vertebrae themselves are all normal.
However, the marrow edema and endplate findings raise the suspicion of "inflammatory spondyloarthropathy".

This would include diagnosis like ankylosing spondylitis (AS)and back pain associated with psoriatic arthritis or inflammatory bowel disease (IBD).

Seeing a rheumatologist may help pin down the diagnosis and add some treatment options however, you can start on a regimen of NSAIDS and exercise and follow up with the family physician to review the list of possible inflammatory conditions causing this low back pain.

Here is the list of possible diagnosis for "inflammatory spondyloarthropathy"


Take care

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