How to manage sacralisation of the lumbar vertebrae?
Q: Several weeks ago, I sat back into a chair which caused a sharp pinch in my spine. Since then I have been awakening to significant discomfort that has rendered me stiff for at least 1/2 hour each morning. A recent x-ray report showed: Thorasic Spine: A mild S shaped scoliosis is present in the thorasic region. Normal vertebral body height and disc spaces are reasonably well preserved. Minimum degenerative change appears to be present in the upper thorasic region with no paravertebral mass lesion present. Lumbosacral Spine: Minor sacralisation of L5 present with small Schmorls nodes present in the vertebral end plates of the upper lumbar vertebrae. Overall body height and disc spaces well preserved with SI joints normal in appearance. What is sacralisation of L5? What complications is it likely to produce? Is it reversible and how do I stop further onset of this condition? What in particular must I change or be conscious of? How are Schmorls nodes likely to affect me? Are they the cause of my pain? What should I do to improve my current condition? Will this cause complications in later years? What strategies do I need to adopt? Do I need an MRI to determine to what extent this condition is present? Should I be considering specialist help now?
A:The lower part of the vertebral column is made up of five separate bones called the lumbar vertebrae. They are numbered from above down. Below the 5th lumbar vertebra is a block of bone called the sacrum. Sometimes, due anomalous development, there are 4 lumbar vertebrae, the 5th being part of the sacrum. This is termed sacralisation of the 5th lumbar vertebra. It causes no symptom or abnormality in the patient. It should be ignored as an anomaly. It needs no treatment. Likewise, Shmorls nodes represent migration of a small part of the intervertebral disc into the substance of the vertebra above or below. This causes no symptoms and is best ignored. As regards the cause of your pain, this is best determined by your being examined by an experienced orthopaedic surgeon or neurosurgeon. This doctor will decide whether an MR scan is required, what needs to be done. Yes, you should consult a specialist as noted in the preceding paragraph.