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Spine and Back Health

Lumbar Myelogram

08/01/2011

Question:

What and where is paravertebral soft tissue? My report reads_ "There are pedical screws at L3 and L4 and previous L3 and L4 laminectomies. The right pedical screw at L3 level does not traverse the pedicle but passes lateral to the pedical into the right paravertebral soft tissues.

What damage can the screw cause with the soft tissue and exactly what and where at vertebrae is this tissue. I suffer from terrible pain from between shoulder blades on spine to bottom of tailbone and knife stabbing pain from above hip on right and rips through buttocks and terrible pain in right thigh. This causes imbalance and unable to walk. Thank you for your answer if possible. I will be going to a new doctor and need to properly discuss this with him and make sense when I do. Current DR. has not!

Answer:

Hello, thank you for your question. "Paravertebral" literally means "around the vertebra." In this case, they are saying that rather than traveling through bone and ending up within the spinal bone, the screw is malpositioned and is sticking into the tissue around the bone. Usually this means it would protrude into some muscle tissue alongside the spine. In most cases this doesn't cause any harm. You would need someone to look at it and make sure the screw isn't near any major blood vessels or near the L3 nerve root. This kind of problem would not cause pain across such a vast area of the spine like you describe (from shoulder blades to tailbone). However, if the screw is irritating or pressing on the right L3 nerve that could give you nerve pain that would go into the front of your right thigh between the groin and the knee. If that is where you have pain in your right thigh it's possible you might need that screw removed and properly repositioned. The other question to ask is whether the overall hardware has a good, solid grip on the bone. If one of the four screws is not in the bone, it might affect the stability of the hardware overall. Be sure to discuss these issues with your surgeon. Good luck!

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Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University