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MRI results 3.5 years post op!! Opinions?


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Old 06-07-2017, 09:12 AM   #1
crazylisa
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Question MRI results 3.5 years post op!! Opinions?

Rt leg numb from knee down front side, knee and ankle pain same side thoughts on findings?


FINDINGS:
There is dorsal subluxation of L5 on S1 of 6.6 mm at midline. AP diameter of the dural
sac measures 10.1 mm at midline. Intervertebral foramen are patent.

There is minimal broad-based disc bulging at L4-5. AP diameter of the dural sac
measures 12.1 mm at midline. Degenerative changes are noted at the right facet with
mild intervertebral foramen encroachment on the right. The left is patent.

Minimal central disc bulge is noted at L3-4. AP diameter of the dural sac measures 10.1
mm at midline. Intervertebral foramen are patent. Degenerative changes are noted at
the left facet.

Minimal broad-based disc bulging is noted at L2-3. AP diameter of the dural sac
measures 10.1 mm at midline. Intravertebral foramen are patent. Degenerative changes
are noted at the left facet.

Minimal broad-based disc bulging is noted at L1-2. AP diameter of the dural sac
measures 12.8 mm at midline. Intravertebral foramen are patent.

Negative for intradural lesion. Following gadolinium administration no abnormal
enhancement is noted. No intradural lesion noted. Conus is noted at the level of T12.

IMPRESSION:
Resolved disc herniation at L4-5 since August 30, 2013.

Degenerative changes at the left L2-3 facet, left L3-4 facet and right L4-5 facet.

 
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Old 06-11-2017, 03:04 PM   #2
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Re: MRI results 3.5 years post op!! Opinions?

I am not looking for diagnosis just thoughts on findings....

 
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Old 08-01-2017, 08:45 AM   #3
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Re: MRI results 3.5 years post op!! Opinions?

saw my nero for follow up! He is suggesting surgery to clean out the path for the nerves in the l-5-s-1 region as it is narrow and compressing my nerves. I however do not want to have surgery so he said we can wait now we know what this issue is you can go on as is until such time I can no longer tolerate the pain in my right leg. He said to call his office and he would order steriod pack then steroid injection then surgery. I thought I would update you all as I see no one replied to the thread im assuming due to no one having an opinion based off the MRI results posted. He showed me the images of my spine and showed me the spot that is being compromised from the narrowing. My Nero is a top neurosurgeon from San Francisco spinal specialist institute I trust his opinion. Any thoughts on waiting this out from anyone? He did not seem to concerned but I know when dealing with nerves you can cause more damage by waiting?

Thank you!

 
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Old 08-01-2017, 11:34 AM   #4
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Re: MRI results 3.5 years post op!! Opinions?

Hello, Welcome back to the board. I'm sorry I didn't respond. I must not have noticed your original post back in June. Is this the same surgeon that did your discectomy?

Had I responded back in June, I would have said that I find the Impressions comments interesting as stenosis is not mentioned. To me that appears to be the significant finding! The spinal canal is more narrow than normal. A dimension of 12mm is kind of the cut-off point between being OK, but narrow and too narrow! When it is smaller than 12mm, the person usually feels pain coming from the nerves of the cauda equina being squished or squeezed. They cannot function normally with that amount of compression...and thus, the symptoms.

You can wait until you can't stand it any more, but what does that accomplish? It simply postpones the inevitable, and increases the odds that the damage to nerves will be permanent.

The surgeon isn't concerned because he doesn't have to live with it. The situation is not going to kill you if you wait...so there is no immediacy to the surgery!

You can look online for a dermatome map to which which area of the body is innervate s by which nerve.

 
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Old 08-01-2017, 12:39 PM   #5
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Re: MRI results 3.5 years post op!! Opinions?

Thank you! Yes same doc he is a great surgeon. What prompted the revisit was numbness getting higher up on right leg knee and ankle pain. I know im prolonging the inevitable.

 
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Old 08-01-2017, 06:56 PM   #6
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Re: MRI results 3.5 years post op!! Opinions?

I'm surprised he only wants to operate on L5-S1, given the location of your symptoms! The canal is just as small further up...but there is no spondylolisthesis.

 
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Old 08-01-2017, 07:31 PM   #7
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Re: MRI results 3.5 years post op!! Opinions?

[QUOTE=teteri66;5465232]I'm surprised he only wants to operate on L5-S1, given the location of your symptoms! The canal is just as small further up...but there is no spondylolisthesis.[/QUOTE]



He did not say only that portion he showed me the slides and i could see were it is narrowing and he said I can go in there and rotter that out to alleviate the issues with you nerves. Since I was like can I wait he did not go any further with where and what all he would do.

 
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Old 11-12-2017, 08:24 AM   #8
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Re: MRI results 3.5 years post op!! Opinions?

surgery was scheduled for the 9th but my insurance would not cover the hospital where it was to be done at... Now I have to go to a new Nero who has rights at the hospital they do cover for spine surgery! UGH! the pain has gotten worse not only my leg but three to four times a day I feel like my disc ruptures and I can not move for 20 min after i apply ice... I am sure it is all nerve related but can no longer live like this. Driving any distance kills me. ANNOYED!!!! Ill update once I see the new nero praying this week some time.

 
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Old 11-12-2017, 01:27 PM   #9
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Re: MRI results 3.5 years post op!! Opinions?

I hope you can get it taken care of soon. I recently had a similar surgery. The central canal was just about closed at L2-3. (The level above my fusion). The surgeon was able to do it microscopically -- went in, cleaned it all out. I was in hospital one night and pain has been minimal.

 
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Old 11-12-2017, 03:46 PM   #10
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Re: MRI results 3.5 years post op!! Opinions?

Thank you!!! Me to this is stopping me from living life I pray I can get this taken care of quickly! And I pray you remain pain free and healthy.

 
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Old 11-13-2017, 06:56 AM   #11
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Re: MRI results 3.5 years post op!! Opinions?

Please keep us informed of your progress.

 
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Old 12-19-2017, 10:38 AM   #12
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Re: MRI results 3.5 years post op!! Opinions?

Saw a new neurosurgeon yesterday he wants to do nerve block to make sure that the L4-L5 is causing the symptoms then do a fission and remove the bone that is crushing my nerves. I spoke to my other nero and he said he does not disagree with this nero but said he wanted to do least invasive surgery to try to relive my symptoms? I have no knee jerk on right side and positive nerve stretch findings. I was also told I have scoliosis in L1-L2 region he did state I would most likely not have to do anything with this in my life time... He also stated he could do a fusion at L-5-s1 but he likes to be conservative and stated there was still a little bit of room in that are but was bad enough to warrant a fusion there also... I am scared and concerned but am over this leg pain any thoughts?

 
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Old 12-20-2017, 07:44 AM   #13
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Re: MRI results 3.5 years post op!! Opinions?

I am confused. One surgeon wants to do a fusion at L4-5 and your other surgeon, who is more conservative, wants to treat L5-S1. Did I get that right?

 
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Old 12-20-2017, 07:48 AM   #14
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Re: MRI results 3.5 years post op!! Opinions?

no no they both wanted to address L4-L5 one wants to do a partial facetectomy/foraminotomy The 2nd opinion wants to do a fusion and remove the bone to free the nerves as they a completely crushed at the 4th nerve root. the 2nd openion stated L5-S1 still has some room but is bad enough to warrant a fusion there also he stated he does not want to do L5-S1 at the same time as he think I have enough room to hold off on that area until the other heals.

 
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Old 12-24-2017, 08:08 AM   #15
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Re: MRI results 3.5 years post op!! Opinions?

I generally agree with the philosophy of doing as little surgery as you can get by with...but I know from personal experience and the experience of others, that that usually leads to people having a series of spine surgeries. I do not know anyone who has just had one spine surgery.

Knowing what I know now, it makes sense to have L4-5 and L5-S1 done at the same time IF both levels are showing signs of degeneration and instability. When surgeons don't share the same opinion, it makes it difficult.
Then it becomes your decision, sometimes coming down to which surgeon you prefer, etc.

Usually when multi level fusion are done, the levels are tied together with rods. When a level is added on, it often requires removal of the hardware from the first level done, and then new, longer rods to tie the levels together. But, apparently your surgeon does one at a time...but you might ask him if the levels are tied together with rods.

Personally I believe the fewer general anesthetic we experience in a lifetime, the better...so that is something else to consider. Every time the surgeon goes into the spine, the risk of infection goes up.

Have you consulted with an orthopedic spine surgeon?

 
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