Could you possibly give me a second opinion on this MRI scan?

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  • Alexhh
    Participant
    Post count: 6

    Hi,

    I posted on here around 2 months ago and since then have had an MRI due to symptoms not improving and wanting some clarity of my situation.

    I had a microdiscectomy august 2017 and was experiencing a good recovery until around the three month mark when I experienced main in my buttock area near the join between the leg and the buttock. I had an MRI about 2 months ago and was reccomended to continue PT and to take more rests at work.

    My symptoms have not really improved and I am feeling the pain move from the buttock to the groin, and increased numbness and pulling in my left foot and thigh. I am sure this is not normal nearly 5 months post operation.

    Would you mind having a look at my MRI scan to just check if any other measures should be taken? I am worried PT is aggravating it, as over xmas i did less stretching and also took several muscle relaxants left over from a previous prescription and found my pain was much improved until returning to work last week and having it return.

    Here are my results:

    Technique: Sagittal and axial T1, T2, post contrast T1w sequences of the lumbar spine
    Findings:
    No prior comparable imaging available. The last unfused vertebral segment is designated as L5.
    The imaged lower cord is normal in signal intensity and the conus ends normally at L1/2 level.
    The lumbar vertebral alignment is maintained. There are type II degenerative fat marrow changes
    at L5 superior end plate with schmorl’s node. Vertebral bodies are otherwise normal in signal
    intensity.
    L1-2, L2-3, L3-4 levels: Preserved disc signal intensity. No significant disc bulge or protrusion is
    seen.
    The L4-5 and L5-S1 lumbar intervertebral discs are desiccated with mild relative reduction in
    disc height.
    L4-5: Mild posterior disc bulge in contact with the thecal sac. No overt neurological
    impingement.
    L5-S1: Mild focal left posterior disc protrusion indents with the thecal sac and mildly narrows
    the left lateral recess. There is focal high T2 signal involving the left descending S1 nerve root in
    the lateral recess reflective of oedema with nerve root thickening and perineural enhancement
    suggestive of inflammation.

    here is the link for my actual scan:
    http://118.200.117.177:8080/PhysicianAccess/Viewer/ViewNormal/Default.aspx?serverName=CLARITY777&studyUID=1.2.826.0.1.3680043.8.852.35001811100006.4811

    Thanks

    Alex

    Dr. Corenman
    Moderator
    Post count: 6163

    You seem to have a recurrent herniation superimposed upon scar around the nerve root. Since scar can prevent root motion, sometimes a small herniation can compress the root since it is “trapped” by the scar from being able to “move out of the way”.

    There is a possibility that you have a chronic radiculopathy. See https://neckandback.com/conditions/chronic-radiculopathy/.

    The next step would be a TFESI to see if steroid application will help the nerve root recover. See 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.
    If this forum has helped you, please let Dr. Corenman know!

    Alexhh
    Participant
    Post count: 6

    THANk you so much for having a look at my scan!

    WHat is the outlook after having steroid treatment. Should I be doing anything else while doing this? I am currently doing a series of stretches and excercises given to me by a physio. Should I carry on doing these or should I seek some more help?

    Are steroids likely to help/ be effective? I am only 21 so I can’t imagine not being able to recover from this. Would it be worth taking some serious time off work to fully recover and is there anything I can do to ensure a more effective recovery?

    Thanks and sorry for all the questions.

    Dr. Corenman
    Moderator
    Post count: 6163

    Root stretches can be very helpful if performed properly and cause flair-ups if performed too vigorously. If work is continually aggravating the pain and you can take some time off without jeopardizing your job, that might be helpful. Steroid injections by themselves can significantly reduce the inflammation but like anything, can work only temporarily. As I like to say, time is the best remedy for root inflammation that is not dangerous.

    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.
    If this forum has helped you, please let Dr. Corenman know!

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