Continuing Back Pain after surgery (MRI REVIEW)

///Continuing Back Pain after surgery (MRI REVIEW)
Continuing Back Pain after surgery (MRI REVIEW)

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  • Avatarhhidden92
    Participant
    Post count: 2

    Hello Dr. Corenman,
    My name is Heather and I am a 26 year old who has already had a back surgery, due to a disc hernia toon the was pinching off my Sciatic nerve. I was told by my first surgeon that I had DDD and will need a partial spinal fusion in the future, do my mri results indicate the need for this? I am having more back pain located in the same area as the pervious back pain was located as well as it radiating down the leg. I was wondering if you could review my MRI that was done with contrast and help me to better understand what these results mean, as well as maybe suggest a good course of action.

    Impression
    Stable postoperative changes following right L4-L5 hemilaminectomy and microdiscectomy.
    No evidence of recurrent disc herniation. Stable minimal enhancing granulation tissue in the right ventral epidural space at the L4-L5 level abutting the transiting right L5 nerve root.
    Unchanged circumferential disc bulge, superimposed central disc protrusion at L5-S1 resulting in moderate left and mild right foraminal stenosis.
    No significant spinal canal stenosis

    Narrative
    PROCEDURE: MRI LUMBAR SPINE W/WO IV CONTRAST

    COMPARISON: MRI lumbar spine 11/15/2017

    INDICATION: Lumbar back pain with radiculopathy affecting right lower extremity

    TECHNIQUE: Multiplanar, multisequence MR imaging of the lumbar spine without and subsequently with intravenous contrast administration was obtained on a 1.5 Tesla magnet utilizing standard protocol.

    IV CONTRAST: MultiHance 14 mL

    FINDINGS:

    Postoperative changes following right L4-L5 hemilaminectomy and microdiscectomy are noted. Alignment is normal. The bone marrow signal is within normal limits. Multilevel degenerative changes are present as described below. The conus medullaris appears
    normal and ends at the L1-L2 level. The cauda equina nerve roots are normal in morphology and signal intensity without significant compression. The paraspinal soft tissues demonstrate no significant abnormality.

    Segmental analysis:
    T12-L1: Unremarkable.
    L1-L2: Unremarkable.
    L2-L3: Unremarkable.
    L3-L4: Mild circumferential disc bulge and annular fissure. No significant spinal canal or neural foraminal stenosis.
    L4-L5: Mild circumferential disc bulge. Stable right central microdiscectomy changes with minimal enhancement suggesting granulation tissue abutting the transiting right L5 nerve root. No significant spinal canal or neural foraminal stenosis.
    L5-S1: Mild circumferential disc bulge, superimposed small central disc protrusion and mild facet arthropathy. No significant spinal canal stenosis. Moderate left and mild right neural foraminal stenosis.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6831

    You unfortunately have the genetic version of degenerative disc disease and premature degeneration of the lowest 3 levels. What pain is worse and by what ratio, the back pain or the leg pain? Is it 75% back pain, 25% leg pain or?????

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    Avatarhhidden92
    Participant
    Post count: 2

    Dr. Corenman Thank you for reviewing this for me. I would say it’s probably 70 percent back pain and 30 percent leg pain but if I have a longer shift at work where I am standing all day then the ratio is close to 50/50. Are there things that you recommend to help with strengthening the spine? Was there anything that you read on this report that lead you to believe that I would need another spinal surgery in the near future or a spinal fusion at some point?

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6831

    There is nothing this radiologist thought would be “moderate” or “severe” so there are no focal findings that stand out. There is nothing that currently points to a need for future surgery. You need to rehab your spine. Maybe consider epidural steroid injections to calm down the inflammation.

    See https://neckandback.com/treatments/conservative-treatment-mechanical-lower-back-disorders/
    and
    https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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