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Old 03-08-2012, 10:16 AM  
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Interpret MRI results

Ok, all you experts...should I really be hurting this bad or what! Can anyone decode this for me?

Findings: Alignment and bony structures: Mild leftward convexity scoliosis is notes. Bipedicle screws and longitudinal rod fixation are noted at L4-5 and L5-S1. Prominent endplate degenerative change at L3-L4 is noted 5mm grade I spondylolisthesis at L5-S1 is noted. Minor endplate degenerage change is also seen at T11-12.
Conus Medullaris: Normal size, signal and position
T11-12 disc space: Disc desiccation. Disc space narrowing. Minor bulge. Foramina are possibly minimally narrowed. Central canal is adequate.
L3-L4 disc space: Degenerative disc disease. Disc space narrowing. Moderate bulge. Moderte facet hypertrophy. There is moderate left and moderate to severe right foraminal stenosis. Mild central canal and lateral recesss stenosis crowds descending nerve roots.
L4-5 disc space: Postop change with hardware is noted. Facet arthropathy is prominent on right side.
L5-S1 Disc desiccation. Grade I spondyolisthesis. Probably dorsal laminectomies. Central canal is adequate. Mild biforminal stenosis crowds exiting nerve roots.

I left out a few things...that said...i.e., normal....ok, am i hurting or am I crazy?

 
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Old 03-08-2012, 11:58 AM  
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Re: Interpret MRI results

Sweetpea? Tetonteri? Anyone have any comments? I am not afraid of honesty!!

 
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Old 03-08-2012, 04:11 PM  
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Re: Interpret MRI results

Hi, I was out this afternoon and just saw your email.

I gather you have had a fusion at L4-S1? Is this the first MRI you have had since the surgery? The reason I ask is because the report indicates there is a small amount of spondylolisthesis at L5-S1, and I am wondering if it has developed since the surgery, or this is what you were left with after the surgery. It would be important to correlate this to an earlier MRI to find this information.

It looks like you have some nerve compression at two levels that very well could be causing you pain. One is at the L3-L4 segment...where there is stenosis in both the central canal and the left and right foramen, which is affecting the descending nerve roots. The narrowing, or pinching is worse in the right foramina than the left.

There is also some degeneration at the facet joint at this level. This too could be a source of pain.

I don't know how long ago you had the fusion surgery, but it can speed up any degeneration in adjoining areas. The report indicates you have DDD going on at the L3-L4 level...the facet issues here too, and then the spinal nerves that are being pinched at this level.

There is more of this facet arthritis at the level of the fusion...at L4-L5.

At the next segment, there is more narrowing of the foramen on both sides, but it is less severe than at the L3-L4 level.

What symptoms are you having? When was your fusion and how did the surgeon access the spine?

 
Old 03-08-2012, 04:24 PM  
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Re: Interpret MRI results

I posted earlier...in January I believe, about my surgeon telling me I needed to extend my fusion. My first fusion was 03/08/2010. Pain free about a year,then gradually during the next year pain has become unbearable.

I felt really great about my recovery and the success of my first surgery....guess I still do, just did not expect to be back in the same boat again so quickly.

This is the first MRI since the surgery, and the notes are compared to my MRI 12/19/2007!

My previious fusion is s1-l5-l4. Access is a 5-6 inch incision in my back. Hardware is in tact and in place and nothing shows anything has moved as far as that goes.

My pain "seems" to be from my sacroiliac joints, radiating pain that worsens when sitting and radiates around my hips, pelvis and down the front of my legs.

I recently received a pain shot in each si joint, and that seemed to have stopped the lightning bolt pain thru my butt, but i still have the radiating pain.

...trying to give you as much info as possible...

I have 3 doctors telling me 3 different problems so I am just gathering as much as I can so that I can help them figure it out.

I was hopsitalized on Monday for acute pain and was administered high doses of anti-inflamatory for 36 hours and released....yes, this has helped too....but tonight by the end of the day, I cant hardly move.

Thank you so much..you have so much knowledge on this!!

Donna

 
Old 03-08-2012, 04:56 PM  
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Re: Interpret MRI results

One more thing I thought of....have had hips xrayed twice in about 4 years looking for arthritus there because my hip pain is so severe and so consistant. My gp has been giving me cortizone shots in each hip 4x/year. No arthurities shows up in x ray, and we know that si joint issues dont show up.

I just want to be better.

Thanks again!
Donna

 
Old 03-08-2012, 06:49 PM  
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Re: Interpret MRI results

I'm willing to bet your pain is coming from your issues at L3-L4 and the pain in your hips is coming from the L5-S1 being fused....and perhaps issues you still seem to have there. You apparently still have a disc at L5-S1 (meaning it was not taken out during the fusion and replaced with a cage or some type of spacer) since the report indicates that that disc is bulging. That is also the disc where there is a mild spondylolisthesis, which, if you didn't have it prior to surgery, could indicate a little bit of slippage, or even instability.

Are you seeing the same surgeon who did the fusion surgery? Is he a neuro or ortho spine surgeon?

What we perceive as hip pain very often is a combination of a lower lumbar problem, sometimes SI joint issues and also a taut piriformis. The piriformis is very affected by lower lumbar fusion. It runs across the buttock from the SI joint over to the outside of the body where it attaches to the hip. I remember after my last fusion, I thought I was having a hip problem when I first began walking more than a block or two, but it was piriformis. You can read about "piriformis syndrome" to see what it is all about. The sciatic nerve runs right underneath the piriformis. In some cases the nerve runs through the sciatic nerve. Any time the piriformis is irritated, it can become taut, or inflamed, either can cause sciatic nerve irritation + pain.

 
Old 03-08-2012, 06:52 PM  
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Re: Interpret MRI results

Your knowledge is amazing, thank you!

 
Old 03-08-2012, 10:33 PM  
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Re: Interpret MRI results

Hi there, long day at work for me. I suppose I am as stumped as Teri re: your disc desiccation and biforaminal stenosis at L5-S1. It seems that the surgeon anchored these vertabrae without removing the disc? Maybe to keep your spondyolisthesis from getting worse?

As to your hip injections -- did they provide any relief? And, were they done under X-ray? If not done under X-ray, then the injections were not likely into the hip joint, but may have been targeted toward bursitis or inflammation around the hip joint. If the pain feels like it is in your groin, then it is more likely to originate from the hip joint. If it in the buttock-area, then probably bursitis, sciatica, piriformis, SI joint, etc. But, you could well have a combination of issues.

If you are very much concerned about the hip joints themselves, an MRI with arthrogram will usually include an injection of marcaine and cortisone. The marcaine provides 12 hours of numbing in the joint and allows for differentiation among pain generators. (After my last injection, I said to the surgeon -- oh, that's the sciatica pain, because the intra-hip joint pain overshadowed the sciatica.) The marcaine is as important for diagnosis as the imaging.

 
Old 03-08-2012, 10:41 PM  
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Re: Interpret MRI results

No, I just had similar issues. My doctors couldn't figure out why I was still in pain after my fusion...and I did tons of research, reading, visiting and questioning various professionals, traditional western medicine, alternative, and Chinese medicine.....

I know nothing about cervical issues except for the most basic stuff.

Regarding the pain in your thigh...the day after my first fusion which was at L4-L5, I developing the most excruciating pain I'd ever had on the front side of my right thigh. I went into the hospital with one type of pain, and after surgery developed this. Luckily it eased off a bit a couple weeks later...but during that time I was so drugged, I was almost comatose....No one could figure out this pain. My surgeon sent me for a new MRI at about two weeks post surgery, which is quite unusual. The techs. didn't want to do it. I was given a bunch of reasons as to what was wrong -- femoral nerve damage from the positioning on the O.R. table, but usually I got the "it's early in your recovery...the nerves are angry...the usual stuff doctors tell patients when they don't have an answer.

So for more than two years, and a second smaller surgery, I kept trying to find an answer. Because no nerve compression showed on any imaging, my doctors kept telling me they didn't see anything wrong...they never quite implied it was in my head, but one told me I needed to accept the fact that this might be "as good as it is going to get."

But I persevered and eventually I chipped away at my surgeon to the point that he started paying more attention to what I was saying...we did a whole series of nerve blocks, repeated all of them, and he finally started to believe that there was still some instability in my lumbar spine. All along, everyone kept saying my L3-L4 segment was not causing pain. There was a very small bulge, but that it wasn't the problem.

Cut to the chase: eventually I had another surgery. he went in thinking the L5-S1 was what was causing my problems, and was shocked to discover that the facets at L3 were almost non-existent. This had not shown up on a normal MRI, a sitting and standing MRI, x-ray. He ended up having to reconstruct those two facets, and then fused me from L3 to S1...when I woke up I still had the thigh pain, but it went away 4 days later and, knock wood, it is still gone (although I am still holding my breath in fear it will return, 22 months later!)

So that's why I am so convinced your thigh pain is connected to the damage at that segment that is reported in your radiology report!

 
Old 03-09-2012, 05:35 AM  
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Re: Interpret MRI results

Here are the surgery notes on L5-S1:
Attention was then turned to L5-S1. In a similar fashhion, extraforaminal lateral approach was made and the nerve root decompressed followed by extenive disectomy and placement of a 10 x 10x26mm cage. Vitoss was also packed into the disk space along with the cage. When these were both in place and had checked acceptability, local subeu fat was harvested and applied over thge nerve roots and minimally expose dura for protection. Serial irrigation had been used at both these sites so no bony fragments were left behind. Posterolateral decortication was performed, both right and left, and Vitoss and local bone graft placed. Pedicle screw were then placed on theleft using 6.5 x 50 at L4 and L4 and 45mm length at S1. All 3 crews tested and rod stock was then cut to length and secured with lociing caps which were all torqued to at least 2 clicks to inclue the right side. Final grafting was placed posterolaterally after decorticating the facet joint and packing them with the pixie dust local harvest material.

 
Old 03-09-2012, 05:43 AM  
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Re: Interpret MRI results

Comparison: 12/19/2007 exam
Impression: New postop changes at L4-5 and L5-S1 were not evident on the prior exam. No change in spondylolisthesis at L5-S1 is noted. Central canal is adequate at this level.

 
Old 03-09-2012, 06:40 AM  
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Re: Interpret MRI results

OK, so the spine appears stable, but there are other issues going on where the discs are supposedly fused. Be sure to ask the doctor about this. Sometimes people think the disc has to be removed in a fusion surgery, but this is not always the case. I have had it done both ways.

The bone graft is laid in along either side, when the disc is left in, with the idea being that the new bone cells will grow and eventually the disc will calcify and there will be a bone mass connecting one vertebra to another.

So, in my layman's mind, I do not quite understand how you can have a disc bulge if you are completely fused. But, again I stress that I am not a medical professional and this may be perfectly ordinary and I am just not aware of it.

What do the surgical notes at L4-L5 say?

I didn't get pixie dust with my fusion. I'm envious.

 
Old 03-09-2012, 06:54 AM  
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Re: Interpret MRI results

more --
new MRI states:

L5-S1 Disc desiccation. Grade I spondyolisthesis. Probably dorsal laminectomies. Central canal is adequate. Mild biforminal stenosis crowds exiting nerve roots.

But, the surgical notes say: ...the nerve root decompressed followed by extenive disectomy and placement of a 10 x 10x26mm cage...
Now I suppose that "extensive" discectomy could mean that most of the disc was removed...but I was under the impression that the disc was removed before a cage is inserted.

New MRI reports disc dessication at L5-S1. I would think with a cage in place, you could not see a disc even if parts of the disc were still present. I know with my MRIs since fusion, the "disc space" just looks kind of like a blob -- the only reason you know the cage is there is because they paint a dot on it that will show up with MRI or CT scan....but there is no "disc space" to see. The two vertebrae and the cage just run together.

How long ago was your fusion surgery? It is odd that the foramen would already have filled in to some extent...but enough to be mentioned on the new MRI.

 
Old 03-09-2012, 07:14 AM  
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Re: Interpret MRI results

Haha! What is pixie dust?

l4-5 Exposure obtained at L4-l5 and sacral area bilaterally using electrocautery subperiosteaLLY opps along with Cobb elevators. Fluorscopy was used to verify levels and then the Globus Revere screws placed using 6.5 x 45 mmat the right L4 and L5 and a 40 mm at S1. A 65 mm x 5.5 rod was contoured with the Freedom bender and then secured with locking caps. L4 cap was torque secure but the others left open for motion when doing her TLIFs as we expected increase in height. No direct distraction was applied.

Attention was now turned to the left side becuase it is more symptomatic for TLIF approaches to decompress and place cages. Midas Rex along Leksells were used to initiate reduction of the L4-L5 and L5-S1 facets. Bone was saved. Midas Rex was next used to create the extraforaminal approach at L4-5 followed by Kerrison rongeurs. The hemostasis was obtained with biipolar electrocautery, powdered Gelfoam mixed with thrombin (grits) and cottonoids. Nerve root was thoroghly decompressed and then the disc space visualized using a D"Errico retracor. Annulotomy was created in the far lateral approach and disc material removed with ppituitaqry rongeurs followed by rotating paddle system of the SustainO. Sizing show a 12 x 26 mm cage would have the best fit. It was packed with Vitoss on the back table . Vitoss had been coated with heme aspirate. Approximately 2mL of Vitoss was also packed into the disc space. We then extensively debrded a dis using ringed curettes, pituitary rongeurs and serial irrigation with an Angiocath on a syring. The cage was then tapped in place and check with AP and lateral fluroscopy. Monitoring remained stable.

Whew!

 
Old 03-09-2012, 07:17 AM  
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Re: Interpret MRI results

Surgery was 03/08/2010

 
 



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