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    Old 09-16-2014, 10:53 PM   #1
    WayneB
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    MRI understand the reading

    3 back surgerys still in great pain, a resent mri

    Examination: Lumbar spine MRI with and without contrast

    Comparison: 10/21/2010 and 9/29/2010

    Additional clinical data: Post laminectomy syndrome, back pain, 722.83

    Technique: Axial and sagittal T1 and T2; Axial and sagittal T1 with and without fat-sat postcontrast

    Contrast: 11 cc Gadavist intravenous contrast agent

    Findings:

    The last well-formed disk is designated as L5-S1 for the purpose of this report, and vertebral bodies were numbered using this convention.

    L3-S1 posterior decompression and with instrumented fusion. Ghost tracks from prior hardware demonstrated in the right upper sacrum and right L5 with pedicle. Interbody spacer L5-S1. Further interbody spacer along the left anterior margin of the L3-L4 disc space, series 8 image 20 and series 9 image 12, which has settled into the L4 superior endplate. Unchanged grade 1 anterolisthesis L5 in relation to S1. There are multiple screws through the left sacroiliac joint. Degenerative changes of the right sacroiliac joint are noted. The left sacral screw comes into close proximity with the left S1 nerve root, difficult to localize. If localization of the screws in the left sacrum is desired given approximation to the S1 nerve and neural foramen then CT could be utilized. Metallic susceptibility artifact is generated which obscures fine details.

    Conus terminates at approximately the L1 vertebral body. There is normal cauda equina nerve root separation without evidence of clumping or nodularity.

    Axial imaging begins at L1-L2.

    T11-T12: Sagittal imaging demonstrates no evidence of spinal canal or foraminal stenosis.

    T12-L1: Sagittal imaging reveals no evidence of spinal canal or foraminal stenosis.

    L1-L2: Mild facet arthropathy without spinal canal or foraminal stenosis.

    L2-L3: Mild disc bulge with left extraforaminal components partially encroaching on the exiting left L2 nerve root however no significant spinal canal stenosis. Mild bilateral foraminal stenosis.

    L3-L4: Postoperative level with posterior decompression and fusion. Diffuse disc bulge and without significant spinal canal or foraminal stenosis.

    L4-L5: Operative level with posterior decompression. Spinal canal is patent. There is mild disc bulge and bilateral facet arthropathy. Mild to moderate left foraminal stenosis.

    L5-S1: Operative level with posterior decompression. No significant spinal canal stenosis. The left neural foramen is partially obscured by metallic susceptibility artifact. Difficult to exclude underlying degree of left foraminal stenosis. Right neural foramen appears patent.

    There is epidural scar tissue which enhances surrounding the S1 nerve roots bilaterally, best appreciated on series 6 and series 8 images 29-31.

     
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    Old 09-19-2014, 05:55 PM   #2
    teteri66
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    Re: MRI understand the reading

    When did you have the last surgery? Was it the three level fusion?

    The MRI report suggests there may be an issue with the hardware at the L5-S1 segment, with a screw appearing to be tangling with the S1 nerve. It indicates there are a number of pedicle screws through the left sacroiliac joint...I would want to know about that...the writer indicates a CT may be needed to get a better sense of what is going on with the screws.

    The other issue that is probably causing you pain is the finding of scar tissue surrounding the S1 spinal nerves on both sides.

    Hopefully your surgeon will have some suggestions for you. If not, get an appointment with a different spine surgeon.

     
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    WayneB (09-20-2014)
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