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Dr. David Solsberg
Your Emcee this evening is, AOLiveMC2 (LouMD). OnlineHost: Welcome to Columbia's physician chat. Columbia is the nation's largest healthcare services provider with more than 330 hospitals, 125 outpatient surgery centers and 150 home health agencies. Tonight's chat will feature Dr. Dave Solsberg, neuroradiologist. This chat will last for 45 minutes. Thank you Dr. Solsberg.
AOLiveMC2: Welcome to Center Stage, Dr. Solsberg!
Dr Solsberg: It's a pleasure to be here
AOLiveMC2: We will begin with this first question:
Question: Why is it necessary to have a painful myelogram after a CT has shown collapsed discs?
Dr Solsberg: A myelogram provides an image of the nerve roots by filling the sac with fluid that we can see on x-ray. This gives us the detailed anatomy to determine if there is nerve root compression.
Question: I recently had Harrington rods placed along my spine to correct kypho-scoliosis. I was told that I couldn't have an MRI with them in. Is this true?
Dr Solsberg: Yes, the metal in your rods creates an artifact obscuring the underlying anatomy on MRI. No harm would be done. The study would just not be diagnostic.
Question: How sensitive is MRI compared to CT in detecting HNP in the lumbar region?
Dr Solsberg: They are approximately equally as sensitive to disc protrusions however, MRI is more useful for a specific diagnosis and to exclude other pathologies.
Question: I just had an epidural today with steroids and I was wondering when the pain will stop from the needle?
Dr Solsberg: Usually needle related pain resolves in 24-48 hours.
AOLiveMC2: Another question coming up.
Question: Dr. Dave, what do you think about alternative methods for discovering spine problems, such as reflex testing?
Dr Solsberg: I am not familiar with reflex testing. Are you referring to reflex testing as in neurological examination?
Question: I have ruptured L-4 disc affecting 20% of nerve in right leg, would you prescribe surgery?
AOLiveMC2: Another question.
Question: Are there cumulative effects from CT like too many x-rays?
Dr Solsberg: Yes if you were to have multiple CT scans in a short period of time, one could exceed the recommended dose, but this is very unlikely in diagnostic studies.
Question: I've been away from medicine for 3 years - are there any new breakthroughs in x-raying the back?
Dr Solsberg: Yes, there are now methods using dynamic MRI i.e. MRI with the back in motion.
Question: If you are in the machine and there is a power failure, how do you get the patient out?
Dr Solsberg: That happened today!!! There is a backup device to remove the patient. Comment: Is there any new use for spinal radiology to determine degree of MS progression?
Dr Solsberg: There are many new sequences that have been developed to assess the progression of multiple sclerosis including magnetization transfer contrast and FLAIR.
Question: Can you please elucidate the role of radiation therapy in the acute occasion of a cord compression?
AOLiveMC2: We are talking with Dr. Dave Solsberg, neuroradiologist.
OnlineHost: To interact with your hosts or their guests, use the Interact Button and select either "Ask a Question" or "Send a Comment" -- please be aware that your hosts may not be able to address all items sent to the stage due to time constraints. Questions or comments sent that are not relevant to the conference in progress will not be addressed in order to
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Question: Is surgery out of the question when there are more than 6 discs involved?
Dr Solsberg: I think that question would be better answered by your surgeon.
Question: Doctor - can you describe a myleo CT scan & how invasive/painful it is?
Dr Solsberg: Myelography is no longer a painful procedure. In the past large needles were required typically, now the procedure is done with a skinny needle on an outpatient basis and has a complication rate of less than 1 in 50. After the injection, the patient is scanned in the CT scanner which takes approximately 20 minutes.
Question: Hi. I had an anterior spinal fusion at T12-L1 six months ago and now have recurring symptoms of acute leg weakness. MRI shows acutely angled kyphosis compression of the thecal sac and apparent cord atrophy, Does this mean I am looking at posterior fusion?
Dr Solsberg: Posterior fusion may be required but this is best discussed with your surgeon.
Question: I think my question may have gotten lost, so re-sending sorry, please elucidate the use of RT in cord compression injuries associated with oncological emergencies.
Dr Solsberg: This can be a useful method in patients with a known malignancy. This question may be better fielded by a radiation oncologist.
Question: Can a non-specific brain lesion cause an individual to lose continence?
Dr Solsberg: Yes. One of the control mechanisms for continence resides in the frontal lobes in the brain. Incontinence can also be seen in spinal cord lesions, although most cases are due to gynecological or urological abnormalities.
Question: What is your view on the subluxation complex?
Dr Solsberg: Instability is a very controversial subject. I personally feel it is a rare cause of pain. Many orthopedic surgeons would have a valid but
different opinion.
Question: I have had constant minor hip pain and achy legs for months now. X-rays and blood tests normal. Could X-rays have missed something?
Dr Solsberg: Yes. Radiographs are insensitive to early inflammation. Sometimes bone scans or even an MRI may be indicated. You could discuss
this with your managing Doctor. When I say bone scan I mean nuclear medicine study.
Question: I have been to 2 ortho Drs. as well as a urologist for constant low back pain - told arthritis and some degeneration. I am 45 year old female and currently awaiting results from cystoscopy. Urologist claims pain is not uro related. Ortho MD says exercise. Pain is severe.
Dr Solsberg: Chronic low back pain is a difficult but common problem. Once structural causes have been ruled out with MRI and nerve blocks etc., many patients and doctors are faced with a dilemma. A multidisciplinary approach with physiotherapy, anti-inflammatory agents and careful manipulation usually works. Many other alternative medical therapies are also available and as effective as traditional surgical treatment in functional back pain.
Question: What information do you get from a myelogram after you have done an MRI of the same area?
Dr Solsberg: An artifact is associated with MRI that results in overestimation of narrowing or bony compression of the nerves that is
better assessed with CT scanning.
Question: Dr. Dave, if a woman is unaware that she is pregnant and an x-ray is taken, is it inevitable that damage will be done?
Dr Solsberg: No, it is rare for any fetal problems to occur in patients exposed to diagnostic x-rays. (Less than 10 rads).
Question: Please elaborate on FLAIR.
Dr Solsberg: FLAIR= fluid attenuated inversion recovery. This makes the brain fluid look black on MRI. Typically, MS lesions are near the
ventricles that contain the fluid so this makes these lesions more conspicuous. This does not increase the cost of the study, only improves the sensitivity.
Question: Do you believe that Chiropractic is relevant?
Dr Solsberg: Chiropractic has a long tradition of treating patients with back pain.
Question: One year ago I had an anterior cervical discototmy where 2 discs were removed and 3 vertebrae fused. It was an MRI that identified my problem, but I have only had x-rays to see the success of the procedure. Shouldn't my doctor want to see an MRI again?
Dr Solsberg: The follow up x-rays are to assess the stability of your fusion. If your symptoms have resolved then MRI should not be needed.
Question: If a C5-6 disc reaches the cord is this dangerous or require surgical intervention?
Dr Solsberg: Cord compression is a serious diagnosis. However, just because a disc is in contact with the cord, surgery is not necessarily indicated. You should discuss your images and physical examination with your surgeon.
Question: Does anterior spinal fusion weaken discs above and below the site causing them to weaken and bulge?
Dr Solsberg: Yes. Unfortunately this is a common complication following lumbar fusion. This is less common in neck fusions.
Question: 52 year old female with radicular symptoms right arm. MRI of c spine shows "changes typical for age." What is the next study?
Dr Solsberg: Get a second opinion on your MRI if that was really the diagnosis before any other investigations. The radiologist should describe the anatomical compression if present.
Question: When is CT of the brain superior to MRI and vice versa?
Dr Solsberg: MRI is usually superior to CT scanning except in trauma, suspected hemorrhage (aneurysm) and calcifications in the brain and when MRI is contraindicated. (pacemaker or metal in the head etc.)
Question: I have grade I spondylolisthesis of L5 and S1 secondary to bilateral pars interarticularis defects at L5 and mild disc space narrowing posteriorly at L4-L5. Told to take Tylenol for pain and strengthen lower lumbar muscles with exercise. Any suggestion?
Dr Solsberg: This sounds like a good conservative therapeutic approach.
Weight loss can also be very helpful as can physiotherapy.
Question: What is your opinion of discograms? Valid test or voodoo?
Dr Solsberg: Discograms are very controversial. I perform discograms and I think that under specific circumstances such as in multilevel disc disease with leg and back pain that it is a useful test.
Question: What is your opinion of these new open MRI's?
Dr Solsberg: They are terrific for claustrophobic patients and provide diagnostic examinations.
Question: As a primary care provider that suspects nerve compression as a source of pain which is the appropriate test to order?
Dr Solsberg: If the pain has been present for less than twelve weeks and the neurological examination is normal, then no investigations may be necessary. But if there is progressive pain or weakness etc., then MRI is the best screening method for surgical lesions.
Question: My son's pediatrician said that he has scoliosis. We had it
x-rayed two years ago. He is almost 12 now. I understand that they can develop problems when they hit puberty. What should we be looking for?
Dr Solsberg: Changes in posture, loss of height, back pain. Scoliosis measurement and screening I think should be performed by your pediatrician periodically.
Question: what are the chances I will need surgery - have a herniated disc in my neck - weakness in left hand.
Dr Solsberg: Your surgeon would answer this better, but pretty high.
Question: Is there a role for ultrasound in spinal imaging?
Dr Solsberg: No. Except in the neonatal period before the bones are calcified, then yes.
AOLiveMC2: We have time for one more question.
Question: Some radiologists use the term protrusion while others call the same thing a herniation. Is there a difference on MRI?
Dr Solsberg: The term herniation is nonspecific. A protrusion is a focal bulge of the disc. I think that the term herniation should be discarded as it is confusing and may be misleading.
OnlineHost: All good things must come to an end. Time is up for this event.
AOLiveMC2: Dr. Solsberg, this was indeed a wonderful conference. Thanks for taking our questions tonight.
Dr Solsberg: Thank you for having us. I want to thank all of the participants for your excellent questions and good night and God bless : )
AOLiveMC2: Thanks, Everyone, for submitting your questions. Goodnight!。