It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Back Problems Message Board

Need help on MRI Report at 1 year TLIF L4-5 Post-Op


Post New Thread   Reply Reply
LinkBack Thread Tools Search this Thread
Old 11-05-2018, 09:21 PM   #1
gabrialo
Junior Member
(female)
 
Join Date: Apr 2012
Location: CA USA
Posts: 49
gabrialo HB User
Need help on MRI Report at 1 year TLIF L4-5 Post-Op

Hello Everyone,

I've been posting here for a while and need help on my new MRI report taken 10 days ago.

Iím 12 months post-op with minimum invasive TLIF on L4-L5 due to unstable Grade 1+ spondy.
I woke up with numbness from left knee down to toes and nerve pain from left thigh down to toes. It has not improved since surgery and I just had CT and MRI done last week for my 12 months post op with neurosurgeon.
The below is the MRI report and I need help to understand the issues sites under the IMPRESSION section as it mentioned severe stenosis, nerve compression and grade 2 or higher spondy but did not indicate which level(s) in the detail section above!?
Any help or insights would be greatly appreciated
thanks so much!

FINDINGS:
Osseous and Disc Structures: Anterior posterior spinal fusion L4-5.
Stable grade 1 anterolisthesis L4-5. Vertebral body height well-maintained. Mild disc space narrowing L5-S1.
Spinal Canal: Visualized conus medullaris is normal in signal and position.
Paraspinal Soft Tissues: Unremarkable.
Findings at individual levels are as follows:
L1-2: No significant canal or foraminal stenosis.
L2-3: No significant canal or foraminal stenosis.
L3-4: Mild facet arthropathy. Mild right foraminal disc bulge with annular tear with mild inferior right foraminal narrowing.
L4-5: Circumferential disc bulge and moderate facet arthropathy without significant canal narrowing. Left foraminotomy changes. There does appear to be at least moderate left foraminal narrowing. Mild right foraminal narrowing.
L5-S1: Mild circumferential disc bulge and mild facet arthropathy without canal narrowing. Mild bilateral foraminal narrowing.
IMPRESSION:
Anterior posterior spinal fusion and left foraminotomy L4-5. No significant canal narrowing.
There does appear to be at least moderate left foraminal narrowing at L4-5. Mild foraminal narrowing elsewhere as detailed above. Lumbar spine MR epidemiology
The following findings are more likely to be clinically significant:
* Moderate or severe stenosis
* Disc extrusion
* Nerve root displacement or compression
* Grade 2 or higher listhesis
The following findings are less likely to be clinically significant:
* Annular Fissure
* Disc height loss
* Mild stenosis
* Nerve root contact without displacement/compression
* Grade 1 listhesis
* Disc dessication
* Disc bulge
* Disc protrusion
* Facet degeneration (any severity)

 
Reply With Quote
Sponsors Lightbulb
   
Old 11-06-2018, 06:46 PM   #2
teteri66
Senior Veteran
(female)
 
Join Date: Nov 2010
Location: USA
Posts: 9,063
teteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB User
Re: Need help on MRI Report at 1 year TLIF L4-5 Post-Op

Did they do a nerve conduction study? If not, was it mentioned? I would think they would like to know to what extent the nerve is damaged.

Iíve never seen a report written quite like this one but I take everything below the Impression part of the report (where it begins...ĒThe following findings...Ē) to be generalized comments designed to help the lay person understand the language of the MRI report. It isnít anything pertaining to your specifics...it is saying IF you see on the report that you have a Grade 2 spondylolisthesis, it would be significant. It is NOT saying you have Grade 2 spondy.

I can go through this line by line if you want...but bottom line, it doesnít reveal anything that explains your continued symptoms.

 
Reply With Quote
Old 11-06-2018, 07:23 PM   #3
gabrialo
Junior Member
(female)
 
Join Date: Apr 2012
Location: CA USA
Posts: 49
gabrialo HB User
Re: Need help on MRI Report at 1 year TLIF L4-5 Post-Op

Hello teteri66,

thanks for your reply. Yes the NS ordered a re-test of EMG/NCS for late November.
My first EMG/NCS was 2 months before surgery and was normal. 2nd one was done 6 mos post-op and was abnormal: chronic radiculopathy on L4 and sub-acute radiculopathy on L5. The sub-acute radi on L5 matched to the locations of my numbness and pain. At that time, he asked me to try spinal stimulator inplant which I declined as it only work on pain, not weakness or numbness. Not sure what else I can try.... or accept the fact that the nerve damage during surgery is permanent! Do you see anything stand out from the MRI and CT reports that can caused my symptoms? Any advices could be greatly appreciated.

thanks,
Gabriela

 
Reply With Quote
Old 11-09-2018, 10:13 PM   #4
teteri66
Senior Veteran
(female)
 
Join Date: Nov 2010
Location: USA
Posts: 9,063
teteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB User
Re: Need help on MRI Report at 1 year TLIF L4-5 Post-Op

Sorry about not getting back to you sooner. I havenít been on the board as much as I did in the past.

I definitely agree with you on the spinal cord stimulator. You want to know what is causing your radiculopathy, numbness, etc. not just attempt to cover up pain. ( too many doctors downplay the potential for serious consequences and side effects of the neurotransmitter as well).

Iíve forgotten the details of your post surgery issues. You woke up from surgery with drop foot?

 
Reply With Quote
Old 11-09-2018, 10:31 PM   #5
teteri66
Senior Veteran
(female)
 
Join Date: Nov 2010
Location: USA
Posts: 9,063
teteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB User
Re: Need help on MRI Report at 1 year TLIF L4-5 Post-Op

Iím going back to reread your earlier posts so you donít need to update all that. What is going on now?

You know, I had surgery a year ago but I am still dealing with some stuff from my big surgery in 2010! As far as I can tell, the body is capable of change way beyond that one year mark the doctors talk about!

Also, in my case, prior to my 2010 fusion from L3 to S1, multiple specialists all concurred that my symptoms were consistent with a L5 radiculopathy. When my surgeon went in to operate, he was stunned to see that my facet joints at L3 were almost nonexistent ó worn down to tiny little nubs which was creating a good deal of instability.

This was not apparent on any imaging that had been done. I had no symptoms that indicated L3 was even involved! My point is that things are not always as they seem ... and, things donít always add up the way they ďshould.Ē It took me two years to even find a surgeon and convince him he should go in to operate because there just wasnít anything showing on imaging.

 
Reply With Quote
Old 11-10-2018, 09:44 AM   #6
gabrialo
Junior Member
(female)
 
Join Date: Apr 2012
Location: CA USA
Posts: 49
gabrialo HB User
Re: Need help on MRI Report at 1 year TLIF L4-5 Post-Op

Hello teteri66,

Thanks for your reply. Here is my history:

I woke up with numbness of left knee to toes matching the dermatone of L5 radiculopathy. EMG before surgery was normal, EMG 6 mos post-op was abnormal with chronic radiculopathy on L4 and sub-acute radi on L5.

3 months post op started having nerve pain on knee to toes and they come and go but are pretty intense. It went on for 4-6 months and then started CONSTANT intense spasm, pin/needle, and burning about 2-3 months ago, worst in the evening and night after a day of moving around. Worse is sitting and standing with calf burning within 20 minutes. It helps to elevate the left leg up when sitting. The only way to lessen the pain is lay down flat in bed.

I also have VERY SORE THIGH SINCE DAY 1 and was getting worse. My NS said it might relates to L1-L3???? When I squeezed my thigh, it will trigger strong pin/needles from knee->toes. Also my left sit bone and illac-crest bone start to ache and not sure why? That is why he ordered a re-test EMG. What do you think these might be?

I saw my NS's professor at 6 most post-op and he told me I will get better as nerves take time to heal. I saw him for follow-up yesterday and he told me I have permanent nerve damage that was done during surgery as i WOKE UP WITH NUMBNESS! He said my options are pain med or spinal simulator and wrote a referral to see Stanford pain clinic. I was disappointed with him as he was so confident last time but totally changed at 12 months. He doesn't recommend another EMG or other tests as he thinks the result will be the same-permanent nerve damage! He said there are nothing surgically he would recommend as my fusion looks good and no nerve compression there.

Do you have any recommendations? Please share and advice.

thanks,
gabriela

Last edited by Administrator; 11-10-2018 at 10:27 AM.

 
Reply With Quote
Old 11-10-2018, 05:32 PM   #7
teteri66
Senior Veteran
(female)
 
Join Date: Nov 2010
Location: USA
Posts: 9,063
teteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB User
Re: Need help on MRI Report at 1 year TLIF L4-5 Post-Op

By NSís professor, you literally mean a surgeon who taught your neurosurgeon?

 
Reply With Quote
Old 11-10-2018, 05:58 PM   #8
teteri66
Senior Veteran
(female)
 
Join Date: Nov 2010
Location: USA
Posts: 9,063
teteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB User
Re: Need help on MRI Report at 1 year TLIF L4-5 Post-Op

My guess regarding the pain in left iliac crest, etc. is part of the whole left leg injury...it may be a compensatory issue caused by muscle imbalances, structural alignment, etc.

As I recall there were issues that came up during the surgery...like a Dural tear or something, and then the surgery too, MUCH longer than anticipated. I think it is not a long shot to assume there was nerve damage done at this time.

I have an area over the right side of sacrum on buttocks that sends shooting electrical zaps down to my foot when touched. It is a residual nerve thing left over from one or more of my surgeries...probably involving scar tissue.

If I were in your shoes I would go to an orthopedic spine surgeon for an evaluation. I would want to rule out anything that could be addressed...then, I would try some body work type therapy, perhaps acupuncture along with work to achieve proper structural alignment, addressing focal adhesions etc. I would give myself several more years before even thinking about some sort of long term pain management. Try to keep active...walking in a pool is one activity that is pretty well tolerated among many of us with less than stellar spinal surgery outcomes.

Obviously I am not a doctor but there doesnít appear to be anything at L1-2 or L2-3 that would be causing symptoms. At L3-4 there are minor issues but, again, I wouldnít think anything that is causing current symptoms.

What does your surgeon think is going on?

 
Reply With Quote
Reply Reply




Thread Tools Search this Thread
Search this Thread:

Advanced Search

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is Off
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Sign Up Today!

Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

I want my free account

All times are GMT -7. The time now is 08:34 AM.





© 2018 MH Sub I, LLC dba Internet Brands. All rights reserved.
Do not copy or redistribute in any form!