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  • wmiller
    Participant
    Post count: 30

    I’m almost 8 months post L5/S1 fusion. I was doing great until about six weeks ago. I had return of back and leg pain, not as bad as pre surgery but definitely life disrupting. It is in back/glute, back of calf and lateral side of foot (S1). My x Ray looks fine.

    My surgeon sent me to pain management, who injected my SI joint (had no relief). They have now scheduled an MRI w/ contrast. The only etiology they’ve mentioned is scar tissue causing these new symptoms after a pain free period.

    -would the MRI show if it hasn’t fully fused? They say my x Ray looks good but I’ve read that it doesn’t always show up that way?

    -Would the mri show if hardware was impinging on S1?

    -I struggle to understand how I. Oils have a recurrence of symptoms that feel like when S1 was compressed before when I no longer have a disc?

    wmiller
    Participant
    Post count: 30

    Sorry that should say I struggle to understand how I *could have*

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Return of back and leg pain could indicate a pseudoarthrosis (lack of fusion), another level involvement or a stretch injury of the original nerve root. An MRI will assess the nerves and the nerve canal but won’t assess the fusion. X-rays can be helpful but a CT scan is the gold standard.

    Dr. Corenman

    wmiller
    Participant
    Post count: 30

    Thanks. Below is what my MRI shows. They have ordered an ESI for the pain I have in my leg (I also have back pain). I apparently had this scar tissue six months ago (2 months post op), and I did not have these symptoms then. They have only come up in the last six weeks. This has me worried about lack of fusion, but my surgeon’s PA has told me that my x rays look perfect and so I don’t need a CT scan?

    Report
    At L4-5, there is no change in a very small broad central disc
    protrusion, also associated with an annular fissure at the posterior
    midline. There is no nerve impingement or significant stenosis.
    At L5-S1, there is no change from prior, compatible with successful
    fusion surgery. Fairly extensive epidural enhancing scar tissue is
    again noted adjacent to the right S1 nerve sleeve with no change in
    its appearance.

    IMPRESSION:
    1. Stable findings from MRI six months ago with findings of prior
    anterior discectomy and fusion as well as posterior spinal fusion at
    L5-S1. There are no findings to suggest significant postoperative
    complications.
    2. No significant spinal stenosis or nerve impingement identified at
    other lumbar levels. Findings of mild disc degenerative change and
    small broad central protrusions again noted at L3-4 and L4-5.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    The radiologist’s statement; “Stable findings from MRI six months ago with findings of prior anterior discectomy and fusion as well as posterior spinal fusion at L5-S1. There are no findings to suggest significant postoperative complications” does not address the possibility of a pseudoarthrosis. X-rays can rule in or out a pseudoarthrosis but there are cases the can fool the observer in either direction. An ESI is a good next move.

    Dr. Corenman

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