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  • Abbeygirl
    Member
    Post count: 40

    Hi Dr thank you for the great service you provide Ihave had a spinal fusion at the L5 S1 level appox 6 months ago and also I have had two previous surgeries prior to that which were laminectomy at the same level I am still in a bit of pain right thigh numbness lower back aches get pain in both calfs get pins and needles in my two big toes more so on my right foot now I had a ct scan the other day to see if everthing is healing alright I have the report but do not understand it so I was wondering if you could explain it to me please because I do not know why I am still in pain
    EXAM CT LUMBAR SPINE
    CLINICAL HISTORY L5-S1 FOLLOW UP
    TECHNIQUE
    Noncontrast CT lumbar spine performed with multiplanar reconstructions
    FINDINGS
    Comparison is made to 11/12/2012
    There is dorsal decompression and instrumentation of the L5/S1 with intervertebral disc spacer and bone graft material .No dislocation of intervertebral disc spacer. Bilateral L5 and S1 pedicles srcews are in satisfactory positions.
    Alignment of the lumber spine is unremarkable L1/2 discovertebral degenerative changes are noted.There is bilateral L5 pars defect. There is mild lumbar facet arthrosis.
    There has been removal of the surgical drain and reduction in the subcutaneous and paraspinal muscle oedema
    At L1/2and L2/3 there is no disc protrusionspinal canal or foraminal stenosis.
    At L3/4 there remains mild spinal canal stenosis from generalised disc bulge flavum and hypertrophy.
    At L4/5 there is generalised disc bulge flaum and facet hypertrophy also causing mild spinal canal stenious .No significant foraminal stenosis.
    At L5/S1 assessment of the central canal is diffcult due to the postoperative changes .There remains the effacement of epidural fat around the bilateral L5/S1 neural exit foramina suggestive of foraminal narrowing.
    CONCLUSION
    Status post L5/S1 dorsal decompression and instrumentation .interval removal of surgical drain and significant reduction in post operative oedema
    No evidence of hardware complication and the appearances are essentially stable since most recent examination
    Thank you Doctor

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    This CT scan reading is unusual in that this radiologist does not mention anything about the fusion mass at L5-S1. This is one of the reasons that a CT scan is performed so I cannot tell you why fusion mass discussion is omitted.

    The radiologist also does not mention how significant the foraminal stenosis is at L5-S1. Words like “mild/moderate/severe” are typically used to paint a picture of the severity of the narrowing. The “spacer”or cage is not discussed as to if it has settled into the endplates of the vertebral bodies or if it still creating distraction (which would mean that the foramen are probably still open as opposed to settling which would mean that the foramen are more closed).

    How has your pain changed from prior to surgery? Your statement; “still in a bit of pain right thigh numbness lower back aches get pain in both calfs get pins and needles in my two big toes more so on my right foot now” needs to be understood in light of your preoperative symptoms.

    Dr. Corenman

    Abbeygirl
    Member
    Post count: 40

    Hi Doctor
    I went to see my surgeon two days ago and she look at my ct scans and said that the bone has not grown at all and it has been six months since my surgery my symtoms seem worse than they were prior to surgery or should I say that I do not feel any better so I was wondering if you could tell me if the bone does not grow in the next three months what would be the next thing to do I dont think I could go through surgery again because that would mean 4 back surgeries and it would be three within 3 years your advice would be much appreciated

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Unfortunately, you have developed a pseudoarthrosis (lack of fusion) at the L5-S1 level. This is generally a rare event. A pseudoarthrosis is usually not dangerous but more likely than not-needs to be addressed surgically to give you some relief.

    There are external stimulators that generate an electrical or magnetic field that you wear around your waist for about three months. These stimulators purportedly increase the chance of fusion. I think they may not be as effective as the companies report but should cause no harm and will give the fusion another three months to see if it will fully fuse.

    If this does not work, then you will need a revision surgery.

    Dr. Corenman

    Abbeygirl
    Member
    Post count: 40

    Hi Doctor
    I say this all the time but thanks for the great service you provide you have been a great help to me that you explain things that i can understand if it was not for your help i do not think i would be hear now any way Doctor my question is when you say revision surgery what would that involve sorry for being a pain thanks again

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Revision surgery depends upon the original type of surgery, how well it was done and what type of failure you underwent. Most of the time, the revision can be performed from the back of the spine but occasionally needs to also be performed from the front of the spine.

    Dr. Corenman

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