pedicle edema

[ctts]

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My general question is, do you all do anything in particular for pedicle edema? Is it just a matter of time for it to hopefully heal?

The specific scenario is: I have a 62 year old patient who works as a CNA, injured 2.5 months ago, when helping boost up a >300 pound patient at work, developed right low back pain. MRI shows L4 and L5 pedicle edema, without definite fracture. (Bone density scan in 2016 was normal.) Failed PT. Pain is worse with extension more than flexion, so could be facet, but I think the pedicle edema is probably the main issue. I may be wrong, but for that reason, I think facet injection may not be so helpful. Advised it should get better with more time (maybe 3-6 months?). MRI shows L5-S1 disc right sided annular tear. So will see if Workers Comp will approve right L5-S1 transforaminal ESI to address possible discogenic component of pain.

 

[emd123]

Pedicle edema without fracture, by itself, is non-specific. Acute back pain and pedicle edema in an 18 year old gymnast (impending stress fracture?) is different than pedicle edema in a 60+ patient with arthritic facet joints (simple stress reaction & inflammation from nearby arthritic facet joint?) Piecing together the overall clinical picture is what should guide your course, which is what it sounds like you're doing. I do like seeing pedicle edema however, because it's a clue that something organic is going on, as opposed to "normal MRI" but "my back is infinity on a scale of 1-10".

 

[SSdoc33]

agree that the finding itself is non=specific, and actually probably was there before the "injury". personally, id go after the facets

 

[ctts]

Thanks. That makes sense. I suppose the pedicle edema could be analogous to seeing endplate marrow degeneration/edema, which one can also say is often non specific and present before injury.