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    Old 06-28-2022, 09:30 PM   #1
    Booksellergirl
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    Lumbar stenosis- MRI help

    Can y’all help me know how serious this MRI is?
    An ortho spine surgeon told me I needed lumbar fusion. My primary doc advised against this and sent me to pain management. I got an ESI, but now I have tingling and pain in my legs, which I never had before the ESI.


    TECHNIQUE: Routine multiplanar MRI of the lumbar spine was performed without IV contrast.
    FINDINGS: Lumbar spine radiographs demonstrate the presence of a transitional L5 segment. There is a rudimentary disc space between L5 and S1. This differs from the nomenclature used on the radiographs. For purposes of the lumbar spine dictation, there are 5 lumbar segments.
    Mild reversal of normal lumbar lordosis. Minimal lumbar dextroscoliosis. Multilevel degenerative disc desiccation, loss of disc space height and diffuse disc bulging. Superimposed disc protrusion at T12- L1. Degenerative endplate changes about the L3-4 disc space. No abnormal signal in an intradural or paraspinous position.
    T12-L1: Diffuse disc bulge with superimposed 5 mm right paracentral disc protrusion. This impinges upon the thecal sac producing mild canal stenosis. No foraminal stenosis.
    L1-2: Mild disc bulge. Mild facet arthropathy. No canal stenosis. No foraminal stenosis.
    L2-3: Moderate disc bulge. Mild facet arthropathy. Mild canal stenosis. Mild foraminal stenoses.
    L3-4: Prominent disc bulge, somewhat more prominent to the left of midline. Moderate facet arthropathy. Bilateral facet joint effusions. Moderate canal stenosis. Moderate left foraminal stenosis and mild right foraminal stenosis.
    L4-5: Moderate disc bulge. Moderate facet arthropathy. Mild canal stenosis. Mild foraminal stenoses.

    L5-S1: Rudimentary disc space. No canal stenosis. No foraminal stenosis.
    1. Mild lumbar dextroscoliosis with associated multilevel degenerative disc disease and facet arthropathy. Degenerative changes combine to produce multilevel canal and foraminal stenoses. Most notably, moderate canal stenosis, moderate left foraminal stenosis and mild right foraminal stenosis at L3-4.
    2. 5 mm right paracentral disc protrusion T12-L1 producing mild canal stenosis.

    X-rays:

    Radiographs:
    Patient had 5 views of the lumbar sacral spine in the office today. Radiographs demonstrate minimal lumbar dextroscoliosis, 5 nonrib-bearing vertebrae noted with a rudimentary/transitional vertebrae sacralized to the sacrum. On the AP view patient is noted to have multilevel spondylosis, with bridging osteophyte of L3 over L4. Fractureno high-grade canal stenosis or foraminal narrowing. Trace retrolisthesis of L3 over L4. Facet arthropathy, SI joints appear patent.

    The ortho spine surgeon recommended this:

    Based off of patient's MRI, goal instability and handicapping pain we recommend namely, subtotal L3 laminectomy, radical L3 discoidectomy, transforaminal lumbar interbody fusion at L3, internal fixation with peek cage, L3-L4 posterior lateral fusion with local and iliac autograft, allograft, graft substitute and posterior nonsegmental spinal instrumentation from L3-L4 with intraoperative neuro monitoring



    Patient inquired about interventional pain management injections-which at this time will not be beneficial due to the severity of her stenosis and her clinical instability and handicapping pain.



    A note, I am not in HANDICAPPING pain. I can still walk and workout, but the pain is bothersome. The new addition of tingling and pain my legs is very worrisome.

    Thanks for any help and advice!

    Last edited by Booksellergirl; 06-28-2022 at 09:40 PM. Reason: Forgot to add X-rays

     
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    Old 06-29-2022, 03:30 AM   #2
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    Re: Lumbar stenosis- MRI help

    That is a lot of damage and very concerning. My first suggestion is to see a neurosurgeon. I've got several spine issues going on as well and would not even consider an ortho for this kind of work. Next, have you done PT? Been to a chiro? Are you doing any stretching exercises targeting the lumbar area? All could be very beneficial.

     
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    Old 06-29-2022, 06:31 AM   #3
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    Re: Lumbar stenosis- MRI help

    I have done PT, as much as insurance would allow, 12 sessions. Have not been to a chiro. I have been doing ďat homeĒ lumbar stretching and core work that the PT sent home with me.
    Would a neurosurgeon also want to do fusion or is the some type of minimally invasive procedure that could help?
    Thank you so much for your reply. I appreciate your insights.

     
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    Old 06-29-2022, 01:55 PM   #4
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    Re: Lumbar stenosis- MRI help

    Personally, since the spine is where all the nerves start, I'd want a Neuro...not a bone doc. And there are some minimally invasive procedures out there for the spine. Whether you are a candidate, I can't say...but a neuro is an excellent resource. Do you live in or near a city with a teaching hospital? I'd start there if you do. if you can find one who studied at Barrow Neuro in Phoenix, s/he would be a starting point.

     
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    Old 06-30-2022, 06:03 AM   #5
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    Re: Lumbar stenosis- MRI help

    Thank you for your wise words. Iím set up for another ESI, this time as a foraminal injection. They gave me a toradol and kenalog injection in the office yesterday to try to calm down the current pain my legs. The NP thinks that since the pain receptors for my back pain were taken care of the brain is now picking up the leg pain. Does that make sense or seem true? Was also prescribed 100mg gabapentin to take at nightÖ.hoping I donít have to rely on it. I just want to get back to being active and working out without worrying. Hoping this next ESI will hit the right nerves. If I have to see another surgeon itíll definitely be a neuro. Iíd hope to seek one out in Dallas or Houston if possible as I am in Texas. I donít live in those cities, but I want to be choosy about who I see, granting that insurance allows it!
    Thank you again-

    Last edited by Booksellergirl; 06-30-2022 at 06:04 AM.

     
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    Old 06-30-2022, 03:02 PM   #6
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    Re: Lumbar stenosis- MRI help

    Sounds like a good track to try at this point. Something may help. Keep me posted.

     
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