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What are spinal lytic lesions?
January 26, 2011 4:44 PM   Subscribe

I know YANMD, and you're not giving medical advice. But help me understand some medical info while I wait for my followup.

I had a thoracic spine MRI to check for potential damage that might have been causing some neurological symptoms I experienced last year.

As far as I can tell my referral form says "lytic lesion in t-spine r/o neoplasm at t11, t12".

My neurologist said there was damage there and that it can be caused by some kind of infection or inflammation.

He recommended I have a second, contrast MRI. But he's unexpectedly out of his office this week, which means I won't have a chance to follow up until sometime early next month.

What are lytic lesions, exactly? Google is kind of unclear. What might all this mean? What might be next? Being told you have spine lesion(s) is pretty frightening, especially if that was the cause of one of the scariest moments of your life.

I'd like to understand whether or not I should be concerned at all or at least better understand what's going on in my body to ease my mind some while I go through this agonizing wait.
posted by Fire to Health & Fitness (7 answers total)
 
You should call and ask him to explain these terms to you instead of trying to figure it out on your own. If you turn to the internet for answers you'll only freak yourself out. His nurse/ secretary may be able to answer your questions as well since they probably get the same question all the time.

(Advice based on many hours of hanging out with a neurologist in his office. People who did lots of internet research tended to get panicky, usually overly so. And the people answering the phones at the office usually know the answers to your questions.)
posted by GastrocNemesis at 4:49 PM on January 26, 2011


Fire, I can't tell you what's going on with you, but I can tell you what your referral form means.

It means that you have a lesion in your thoracic spine that looks like an area where there is less bone than the rest of the spine. Areas like this can be benign i.e. "bone cysts", but the concern and the reason for further evaluation is to look for cancer (that is what "rule out neoplasm" means).

It sounds like your lesion is in the lower thoracic spine, T11 and T12 are two different vertebrae in the lower thoracic spine.

What happens next would depend on the results of the contrast MRI, but I would try to take your mind off it as much as possible until then (easy for me to say, I know)... because there is really no way to say what it means until you know more. All I can say is, if you're a young, healthy person, having lytic lesions in your spine from cancer would be extremely unusual.
posted by treehorn+bunny at 4:58 PM on January 26, 2011 [4 favorites]


I'm not a medical professional. This is not medical advice.

GastrocNemesis is probably right, you should wait until you can talk to your doctor. On the other hand, that would just make me freak the fuck out, so if you want my naive, uninformed by medical study or praxis, layman's reading of the plain sense of the words:

lytic = separating, breaking
lesion = abnormal tissue
t-spine = thoracic spine = spine in the chest
r/o = rule out (thus the second MRI)
neoplasm = cancer, tumor
t11, t12 - two specific thoracic vertebrae

This page has more: SOLITARY LYTIC BONE LESION Differential Diagnosis, including this: "Most of the lytic lesions are benign conditions with the exception of 'M' (Metastasis and Multiple Myeloma)".
posted by orthogonality at 5:13 PM on January 26, 2011


In general, medical forms that say "r/o {something}" mean that the doctor thinks it's unlikely you have the something, but wants to rule it out. So just based on the language written on your form, it seems like your doctor thinks it's unlikely you have cancer.

Not that benign spinal lesions are any goddamn walk in the park, of course. I am sorry you are having to deal with this tough health challenge!
posted by Sidhedevil at 5:17 PM on January 26, 2011


Just to hopefully reduce any anxiety the big "Cancer" word being thrown around..... I don't know about your particular healthcare situation - but when specialists see something that looks like it is likely to be cancerous, they don't generally WAIT.... they get a follow-up test immediately, as fast as possible.

So - this goes along with the above comment - they'll still want to rule out Cancer -that's the correct thing to do (and don't NOT do it, or avoid it, or anything like that - it's still important) - but if they thought it was likely to be cancerous they'd have you in for follow-up tests immediately.
posted by TravellingDen at 7:21 AM on January 27, 2011


As a person who works in a doctor's office (sorry, not a neurologist!), if your doctor thought there was anything urgent going on with you, he very likely would have asked you to go and see someone else this week if he can't make your appointment. Lots of appointments get rescheduled, but when something is urgent, arrangements are made for an alternative! So consider the fact that your follow-up has been delayed a vote in favour of nothing serious.

Also, I wouldn't necessarily take GastrocNemesis' advice and ask the people at the front desk. Front desk people sometimes know what they're talking about, but not always. And if they DO know what they're talking about, they shouldn't be willing to tell you about it. I always avoid that kind of conversation with patients... it's not my job, I'm not qualified, I don't have all of the information, and I wouldn't want to give someone the wrong idea.

But you definitely could ask front desk people to put you in email contact with your neurologist, or ask them to have him call you. Since it's his fault he's not around, there should be no barriers to this.
posted by equivocator at 4:31 PM on January 27, 2011


Thanks for the responses. I am pretty young, but I had some scary mystery symptoms that preceded all this testing. I am unable to get anything until at least next week. I've tried. To be clear, I was sent for the contrast MRI pretty much right away. I had it a few days after my last visit. He mentioned that even if things are okay now, I'm still looking at another MRI later in the year and followup. Now it's pretty much just the seemingly long wait until I can get some answers.
posted by Fire at 12:20 AM on January 28, 2011


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