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  • glassman19
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    Post count: 1

    MRI Lumbar Spine with and without Contrast Material, 06/05/2017

    INDICATION: Chronic low back pain in patient with history of spinal fusion surgery.

    COMPARISON: None.

    TECHNIQUE: Sagittal T1, T2, and T1 post-contrast with fat saturation. Axial T1, T2, fat sat and
    T1 post-contrast with fat sat.

    FINDINGS: The alignment of the lumbar spine is notable for 5 mm anterolisthesis of L5 on S1 and 5
    mm retrolisthesis of L3 on L4. There is normal alignment of the remaining levels. Vertebral body
    height is maintained. Marrow signal is notable for edema which appear to be related to endplate
    disc degenerative changes at the inferior endplate of T12 and the superior endplate of L3.

    At T12-L1, there is a broad disc bulge with a small focal central protrusion, but no significant
    central canal or neural foraminal narrowing.

    At T12-L2, there is minimal disc bulge without significant central canal or neural foraminal
    narrowing. There is some loss of normal disc water content and associated endplate disc
    degenerative changes, especially anteriorly at the T12 inferior endplate.

    At L1-2, the disc appears normal with no central canal or neural foraminal narrowing.

    At L2-3, the disc is also unremarkable with no central canal or neural foraminal narrowing.

    At L3-L4, adjacent to the fused L4-4/S1 segment, there is 5 mm degenerative retrolisthesis of L3
    on L4, combining with facet arthropathy, to produce moderate to severe bottle lateral or foraminal
    narrowing, and mild central stenosis. There is endplate edema as well as some edema associated
    with the left-sided L3-4 facet.

    The L4-5 and L5-S1 segments show a solid bony fusion with no hardware present at this time. There
    is no central canal or neural foraminal stenosis at these levels. There is a 5 mm anterolisthesis
    of L5 on S1, but this is in a solidly fused position and is not associated with significant
    narrowing or impingement.

    IMPRESSION: Chronic L4-5 and L5-S1 fusion. L3-4 disc disease likely related to adjacent segment
    physiology because of the fused lower lumbar region putting greater stress on this level. There is
    facet arthropathy, endplate disc degenerative change, and 5 mm degenerative retrolisthesis of L3 on
    L4. There is associated moderate to severe bilateral neural foraminal narrowing.

    At the L3-4 level, the moderately severe neural foraminal stenosis does appear to be associated
    with impingement of the bilateral exiting nerve roots, which are directly effaced against the
    degenerative facets without clear surrounding fat.
    MR Lumbar Spine wo Contrast, 2/22/2019 15:15 PST

    COMPARISONS: 01/08/2018

    TECHNIQUE: Multisequence multiplanar imaging without intravenous contrast, by standard department
    protocol.

    FINDINGS:
    Visualized kidneys: Normal

    Curvature: Normal
    Spondylolisthesis: L5-S1 anterolisthesis is unchanged as is L3-4 retrolisthesis.
    Marrow: No marrow edema. Degenerative endplate changes at multiple levels most prominently at L3-4
    with a large Schmorl’s nodes involving the inferior endplate of L3.
    Conus: Normal

    Near osseous fusion across the L4-5 and L5-S1 disc spaces is unchanged. Posterior decompression at
    these levels is again seen.

    T11-12 and T12 S1 disc bulges are partially profiled.

    L1/2: Normal
    L2/3: Mild facet hypertrophy without central canal or neuroforaminal stenosis.
    L3/4: Disc osteophyte complex with facet hypertrophy and ligamentum flavum thickening result in
    moderate central canal and likely severe bilateral neuroforaminal stenosis.
    L4/5: Central canal is widely patent. No neuroforaminal stenosis is seen.
    L5/S1: Central canal is widely patent. No neuroforaminal stenosis is seen.

    IMPRESSION:
    Multilevel degenerative changes in the lumbar spine, most prominent at L3-4 and minimally changed
    from the prior MRI.
    MR Lumbar Spine wo Contrast, 8/10/2020 14:32 PDT

    COMPARISONS: MRI lumbar spine, 02/22/2019

    FINDINGS:
    Visualized kidneys: Normal
    Curvature: Normal
    Spondylolisthesis: 6 mm of retrolisthesis of L3 on L4 and 8 mm of anterolisthesis of L5 on S1,
    unchanged.

    Marrow: Multilevel degenerative endplate changes.
    Conus: Normal, terminating at the lower T12 vertebral body level.
    Visualized pelvis: Postsurgical change at the left iliac bone from prior bone graft harvest,
    unchanged.

    T11/12: Unchanged small disc bulge causing mild spinal canal stenosis.
    T12/L1: Tiny disc bulge without spinal canal or neuroforaminal stenosis.
    L1/2: Normal
    L2/3: Minimal facet joint hypertrophy but no spinal canal or neuroforaminal stenosis, unchanged.

    L3/4: Grade 1 listhesis with mild to moderate bilateral facet joint and ligamentum flavum
    hypertrophy causing mild to moderate spinal canal stenosis and severe bilateral neuroforaminal
    stenosis, unchanged.

    L4/5: Postsurgical change of posterior decompression with disc fusion with mature osseous fusion
    across this disc space level. No spinal canal or neuroforaminal stenosis.

    L5/S1: Postsurgical change with anterior osseous fusion across the disc space level. Grade 1
    listhesis is unchanged. No spinal canal or neuroforaminal stenosis.

    IMPRESSION:
    Unchanged exam with postsurgical changes L4 on L5 and multilevel degenerative changes. Up to mild
    to moderate spinal canal stenosis at L3-4 with severe bilateral neuroforaminal stenosis, similar to
    the prior exam.
    Question is .How can these results be compared to each other yet none of them even resemble the other in how they are worded. Which makes it more than difficult to get any 2 neurosurgeon’s to give comparable recommendations .First one said nothing he could do because of potentially doing more harm. Second said he recommends surgery if other options failed IE , PT, acupuncture ,aqua therapy, prescription meds. Third one said ,not a problem recommended surgery as soon as he could get approved. decompression surgery.6-8 week recovery with 50-75 percent improvement.
    IN 2000 I had a 2 level fusion l4-5-s1 which resulted in the anterolisthesis of l5 on s1 which to me is not how that was supposed to be right? If it was then why wouldn’t L4 be on L5 also. How can i get reports that are accurate and consistent ?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    These MRI findings have to be compared to your current symptoms and impairment. See this section and describe your symptoms: https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-pain/

    Dr. Corenman

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