sperryguyParticipantMarch 14, 2017 at 9:16 amPost count: 63
Hi Dr Corenman
This is the latest MRI report
MRI LUMBAR SPINE:
TECHNIQUE: Sagittal: T1, STIR, T2. Axial: T1, T2 (disc cuts L1-S1). Coronal: T2. Additional coronal STIR imaging of the sacrum was obtained.
CLINICAL HISTORY: Back pain, prior fusion surgery, assess interval change.
FINDINGS: Comparison prior lumbar MRI 09/27/16. The lumbar spinal canal is normal in size and configuration. No acute fracture is seen. No intradural abnormalities, bony destructive lesions or paraspinal masses are noted. The distal thoracic spinal cord and conus are normal. No bony or neural anomalies are identified. A small right renal cyst is partially visualized. Coronal imaging of the sacrum and sacroiliac joints is unremarkable.
L1-2, L2-3: Negative.
L3-4: Minimal posterior bulging of the disc annulus and mild facet arthropathy is noted. A small left foraminal disc herniation is causing very mild compression of the exiting left L3 root. No significant thecal sac deformity is seen..
L4-5: The patient has undergone laminectomy, posterior instrumented fusion and interbody fusion. Posterior metallic rods/screws and an anterior disc graft are noted. No herniated disc, spinal stenosis or postop collection is seen.
L5-S1: A small central and slightly more left-sided broad-based disc herniation is noted, causing mild midline thecal sac compression. Mild foraminal deformity of the exiting left L5 root is also noted.
1. NO SIGNIFICANT CHANGE SINCE THE PRIOR LUMBAR MRI DATED 09/27/16.
2. SMALL LEFT FORAMINAL DISC HERNIATION, L3-4, CAUSING VERY MILD DEFORMITY OF THE EXITING LEFT L3 ROOT.
3. PREVIOUS LAMINECTOMY, POSTERIOR INSTRUMENTED FUSION AND INTERBODY FUSION, L4-5, AS SIMILARLY NOTED ON EARLIER IMAGING. POSTERIOR METALLIC RODS/SCREWS AND AN ANTERIOR DISC GRAFT ARE AGAIN DEMONSTRATED. THERE IS EXCELLENT DECOMPRESSION OF THE SPINAL CANAL, WITHOUT NEURAL COMPRESSION OR COLLECTION.
4. SMALL CENTRAL AND SLIGHTLY MORE LEFT-SIDED DISC HERNIATION, L5-S1, CAUSING MILD MIDLINE THECAL SAC DEFORMITY. MILD FORAMINAL DEFORMITY OF THE EXITING LEFT L5 ROOT IS AGAIN NOTED.
This is the XRAY of my hip:
History: Bilateral groin pain for 4 weeks, left more than right, no trauma
Technique: XR HIP AP AND FROG BILATERAL
The right and left hip joint are congruent. The joint spaces are preserved. The cortical margins are normal.
There is mild prominence of the anterior femoral head neck junction bilaterally. There is fibrocystic change at the anterior right femoral neck. The acetabular morphology is normal bilaterally.
There are no osteophytes or erosions. There are no aggressive appearing lytic or blastic lesions. The pubic rami, ilioischial and iliopectineal lines appear normal. The bilateral sacral foraminal lines and sacroiliac joints appear normal.
There is no evidence of fracture or dislocation or arthritic change in the hips.
I believe that this will be the last MRI prior to revision surgery. The groin pain continues, Motrin 400MG appears to help along with 1/2 tablet of percoset(lowest dose).Dr. CorenmanModeratorMarch 15, 2017 at 10:32 amPost count: 5105
OK-your groin pain could possibly be from the foraminal disc herniation on the left at L3-4 (“A small left foraminal disc herniation is causing very mild compression of the exiting left L3 root”).
The L5_S1 disc is still an unknown in my mind. It does have degenerative changes (“L5-S1: A small central and slightly more left-sided broad-based disc herniation is noted, causing mild midline thecal sac compression. Mild foraminal deformity of the exiting left L5 root is also noted”) but I cannot tell from this reading if I would recommend fusion. Probably fusion will be helpful but the L3-4 disc has some degenerative changes which will increase stress on this level.
The hip might have femoral-acetabular impingement (FAI-see https://neckandback.com/conditions/femoral-acetabular-impingement-syndrome-fai-hip-impingement-syndrome/). That can be diagnosed with an intraarticular hip injection (see pain diary; https://neckandback.com/conditions/femoral-acetabular-impingement-syndrome-fai-hip-impingement-syndrome/.
Dr. CorenmanPLEASE 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!sperryguyParticipantMarch 16, 2017 at 11:43 amPost count: 63
Hi Dr. Corenman
Thank you so much for your findings. I will relate this information to my surgeon. He did mention the L3 could be causing the groin pain. He was equally suspicious that the hip is also the culprit. The surgeon did explain to me why the L5 must be fused, though I dot recall all the details. Only that he saw on the imaging that I am very unstable and he found nerve compression. If L5 must be addressed and fused, what would you suggest to do with the L3?
StevenDr. CorenmanModeratorMarch 19, 2017 at 7:54 amPost count: 5105
First, I would find the source of the groin/thigh pain. This would be an intraarticular hip block and then a selective nerve block of L3 keeping a pain diary (https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/, https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/).
If the hip is the pain generator (thigh pain relief from the hip injection), leave the L3-4 level alone. If the L3-4 level is causing pain, there is a decision to be made. If L5-S1 has to be added (and at this point, I still need some more convincing), the L3-4 will be further loaded and has a higher chance of wearing out. You can have a microdiscectomy at this level but that will further weaken this level with a somewhat higher chance of recurrent herniation due to the two level fusion below. You can fuse this level as well as L5-S1 leaving you with a three level fusion and the necessary further activity restrictions that a three level fusion requires.
If your L5-S1 level can be left alone, leave it alone. If not, use the algorithm above.
Dr. CorenmanPLEASE 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!sperryguyParticipantMarch 19, 2017 at 11:07 amPost count: 63
Hi Dr. Corenman
I just had a l3 l4 block. In addition, I will be meeting with my new surgeon this coming Friday. I will communicate all your advice to him. I’m very concerned at this juncture. My thought process is as you are communicating. The need to address all the issue’s and best outcomes are to me critical. Another symptom that is becoming more prevalent is urination issues. The constant feeling to go has been getting worse. Don’t have prostate issues, stones etc… Initially I attributed to my age (60). I will communicate to you the surgeon’s thinking on the l5 and thoughts on l3 issues.
All The Best and thank you. SteveDr. CorenmanModeratorMarch 20, 2017 at 7:53 amPost count: 5105
Did you keep a pain diary for the first three hours after the block? If so, what were the results?
Urination problems rarely are caused by compression of the nerves in the lower spinal canal (cauda equina syndrome). In your case, the MRI report does not substantiate compression of the cauda equina necessary for urinary dysfunction. At age 60, the problems certainly could originate from the prostate even though undiagnosed. Pain can also cause urinary dysfunction.
Dr. CorenmanPLEASE 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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