Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Lumbarisation of S1???

Hi All and my congratulations to any Turkish national in the forum for the valiant performances of the Turkish Soccer team in the Euro Cup.

I had been prescribed a MRI of the LS Spine and and a whole body bone scan after the earlier MRI of the SI joints, X-rays and blood tests had not given, according to my rheumatologist, no conclusive indication of AS.

Now the bone scan has revealed:
1. sacroilitis,and
2. 'concentration of radio tracers over both knee joints" consistent with osteo-arthritic changes.(It is funny because I have never had noticeable pain in my knees)

And the MRI indicates:
1. lumbarisation of S1
2. dessication of S1 and S2
3. and a bony island in left ilium.

Fortunately, they have not found any herination of disc or any stenosis.

But there are too many things in these reports to digest and understand. I guess I'll have to wait for the doctor to make sense of it on Monday.

However,do you think that these findings are consistent with Ankylosing spondylitis?

Many many thanks

Saurabh

hi,

i can't answer your questions as i'm still trying to get dx'ed myself.
however, i have a few questions for you:

i had an xray of my SI which said everything was A-OK.....
my GP is surprised the rheumie stopped there and doesn't understand why he didn't order an MRI or better yet, a bone scan, so we're moving on to find a new rheumie.

but, here are my questions:

how long have you had symptoms?
how long ago was the original MRI?

thanks,
sue

anyone,

i just looked up lumbarization. could this fusing process of the last lumbar vertebrae and first sacral vertebrae cause this area to be "always" misaligned?

thanks,

sue

Hi, Saurabh:

Quote:

---

However,do you think that these findings are consistent with Ankylosing spondylitis?

---

Yes, consistent...if not definitive.

Good luck,
John

Thanks John and Sue.....I omitted some of the details in the last post in an attempt to keep it short.

The pain in the lower back and stiffness after rest, especially in the morning started in 2000 and I was first told about AS and a HLA b-27 test in 2001.

The pain spread to the upper back and neck and difficulty in deep breathing started by 2003-04. I have found it painful to jog or run since 2006.

The doctors in New Delhi had confirmed the diagnosis of AS as late as in 2005 based on the clinical symptoms even though there was nothing in the X-rays. I was told that it typically takes 5-6 years before AS is revealed in X-rays. MRIs are usually eschewed in India because of its costs and suggested only when the pain is very serious.

What took me to the rheumatologist this time is a new kind of numbing pain from my left-lumber region down to calf which started in April after once I lifted a partially filled bucket. This pain gets worse with exercise and walking and occasionally extends to the left arm.

So, I had my first ever MRI of the SI joints in May and few other X-rays and they did not reveal anything remarkable. The ESR and CRP readings had also come down. So, this doctor in Kolkata says it is not AS. There should have been some signs of AS - either sacroilitis or elevated ESR/CRP after 8 years of symptoms. Since then, I have had a round of tests.

Therefore, I am quite relieved with the Bone scan showing sacroilitis.

But I am still not sure if these findings indicate the cause for pain from the lumbar region to my left leg and left arm.

Lumbarisation seems rather harmless from what you say and what I could gather from the net.

Thanks for your suggestions and time.

Sue, I do hope that you get a considerate rheumatologist and get a confirmed diagnosis soon.

Saurabh

Saurabh,
I know something about #1, lumbarisation of S1.

Ordinarily, there are 5 lumbar vertebrae and 5 sacral vertebrae. The lumbar vertebrae are separated by fibrous discs, while the sacral vertebrae are fused together into one bone. So, a normal spine looks like this:

L1
disc
L2
disc
L3
disc
L4
disc
L5
disc
S1
S2
S3
S4
S5

S1 to S5 are fused in the normal spine.

This is not the case for you, however. Your first sacral vertebra is separated from the rest of your sacrum, so that you essentially have 6 lumbar vertebrae and 4 sacral vertebrae, like this:
L1
disc
L2
disc
L3
disc
L4
disc
L5
disc
S1
disc
S2
S3
S4
S5

This is a congenital condition and not terribly uncommon. It will cause your lumbar area to be somewhat more unstable and prone to injury and pain. When you have this along with AS, you have a double whammy in the lumbar area and are very prone to pain there.

Karen

Thanks Karen for your simple and clear explanation. I am also wondering if it interacts with AS in any manner.

I am quiet relieved that the bone scan has revealed sacroilitis. I hope that the rheumy will now accept that clinical symptoms of AS do not lie and it will put an end to this joyride with specialists and more tests

Saurabh

Saurabh,

good luck with everything yourself.
it always amazes me how long it seems to take so many people here to get straight answers.

sue

Hello All,

After all the merry-go-round with different specialists over the last two months, my rheumatologist has finally conceded that I have AS based on the bone scan results which showed sacroilitis. He also felt that mild anemia in my blood reports could also be caused by AS.

He said that he would have prescribed sulfasulzine but for my reduced platelet count. Platelet count has further gone down from 1,15,000 in May to 1, 05, 000 in July. He also asked me to stay away from any NSAID too for they can further damage platelets.

But he is not sure about the occasional numbing pain in my left arm as the MRI is clear. He suspects that some nerve may be getting irritated during muscle spasms. But he cannot be certain without any conclusive evidence on MRI.

But it has been a relief to have a confirmed diagnosis before leaving India. Balancing all these visits to different specialists along with my studies would have been harrowing in a new country.

Saurabh

so glad you got your diagnosis.
where are you off to study? good luck with that,

sue