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  • wmiller
    Participant
    Post count: 30

    Hi–if on MRI it is noted you have mild-moderate foraminal stenosis but “there is no nerve root impingement,” does this mean the foraminal stenosis is not responsible for sciatica symptoms? My MRI shows lateral recess stenosis and impingement at L4/L5, and foraminal stenosis without impingement at L5/S1.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    This is why I always like to read my own images as each radiologist has a different language and interpretation can be sketchy.

    To me, foraminal stenosis (FS) is the narrowing of the nerve hole seen on MRI or CT scan and is graded as to how potentially compressive the narrowing is to impinge the nerve root. Mild FS I generally don’t even read into a report as it generally is inconsequential. Moderate FS has the possibility of compressing the root and severe is definitely compressing the root.

    I would interpret “foraminal stenosis without impingement at L5/S1” as mild FS.

    Dr. Corenman

    wmiller
    Participant
    Post count: 30

    Thank you. My neurosurgeon looked at the images, and he doesn’t see any nerve impingement there. I have had multiple MRIs over the past two years and it always shows up at L5/S1 as either mild or moderate foraminal stenosis without impingement, and on my most recent “slightly worsened foraminal stenosis compared to prior study but there remains no nerve impingement.”

    A couple of follow ups (and thank you so much!!):
    -You can have stenosis read as “moderate” but it still not impinging? Is the most important thing not the “mild” or “moderate” but whether it’s impinging?

    -My surgeon told me that my disc is collapsing there at L5/S1, and it has been slightly worsening over time (I’m 37). Is it just a matter of time before it does impinge? He told me to avoid things I already am: don’t smoke, don’t be overweight, avoid high impact activities. Is there anything else to be done to prevent it?

    -I have had a Right L5/S1 emergent discectomy after a bad fall down stairs, and nine months later had a revision discectomy there due to moderate reherniation, plus Left L4/L5 laminectomy for lateral recess stenosis. If I should continue to have issues with stenosis, at what point do I need to consider fusion? Since my fall, I feel like I’m just going surgery to surgery.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    Your disc height at L5-S1 is probably very narrowed as with two prior microdiscectomies, there is not much “jelly in the donut”. The foraminal height (the up/down height) is made up from the height of the disc (from 1/2 to 3/4 of the total height).

    Losing this height compromises the foramen and can cause stenosis. Add to this, disc degeneration (which is present by definition) also causes bone spur formation which adds to the compression.

    An additional compromise is whether the disc is collapsed on an angulation (looking at the front to back film, the vertebra is tilted towards the side of pain).

    Add all these together and you could develop nerve pain from foraminal collapse. The symptoms would be buttocks and leg pain with standing and walking that disappears with sitting or leaning forward.

    Generally, multiple decompressions and continued nerve compression requires a fusion of the level.

    Dr. Corenman

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