Viewing 6 posts - 103 through 108 (of 108 total)
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  • Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Sounds like you are having the typical good recovery from your revision surgery. It should take some further time for full fusion unless BMP was used (in which case you might be solidly fused now). Once you get better strength and range of motion, you will continue to improve.

    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.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    sperryguy
    Participant
    Post count: 68

    Hi Dr Corenman

    Been awhile since I posted my recovery. Been almost a year since my revision L4/S1 surgery. Some issues, nothing horrific. slow recovery but still way better than before the procedure. This is the latest MRI. Any suggestions or questions when I meet with the surgeon in May? Thank you so much for all the help! Steven
    Impression

    IMPRESSION:

    Prior laminectomy at the L4 and L5 levels. Prior anterior and posterior fusion at the L4-L5 and L5-S1 levels. No evidence of loosening of the hardware.

    L3-4: Circumferential bulging of the disc annulus, facet arthropathy, and ligamentum flavum prominence causing mild to moderate canal and bilateral lateral recess stenosis. Stable superimposed small left intraforaminal disc herniation causing flattening of the exiting left L3 nerve root.

    L5-S1: Postoperative changes are noted. Prominent left paracentral and left intraforaminal soft tissue density, the extent of which has increased compared with the soft tissue intensity on the MRI lumbar spine dated March 8, 2017. If clinically indicated, contrast-enhanced CT or contrast-enhanced MR imaging with attention to the L5-S1 level is recommended for further evaluation.
    Narrative

    CLINICAL INDICATION: Low back pain. Prior lumbar spine fusion surgery.

    TECHNIQUE: CT of the lumbar spine was performed without the administration of intravenous contrast, according to standard protocol using multidetector helical technique. Sagittal and coronal reformations were obtained.

    COMPARISON: MRI lumbar spine dated March 8, 2017.

    FINDINGS:
    The lumbar lordosis is maintained. There is a mild levoscoliosis. There is no fracture or cortical destruction. No focal suspicious osseous lesions are noted. No prevertebral mass is seen.

    Prior anterior and posterior fusion at the L4-L5 and L5-S1 levels is seen. Prior laminectomy at the L4 and L5 levels is seen. Transpedicle screws in L4, L5, and S1 are noted. The left-sided screw in S1 extends 2 mm beyond the anterior cortical margin of S1. Paravertebral rods are noted. Interbody cage placement at the L4-L5 and L5-S1 levels is noted. Dorsolateral bone graft at the L4-L5 level bilaterally is seen. There is no evidence of loosening of the hardware. Partial osseous integration is seen. Postoperative granulation tissue is seen. Postoperative changes in the left iliac bone are noted. There is a focus of increased CT density in the left iliac bone without cortical destruction or pathologic soft tissue mass; differential diagnosis includes, among others, focal fibrous dysplasia and Paget disease.

    EVALUATION OF INDIVIDUAL LEVELS DEMONSTRATES:
    L1-2: No significant canal or neural foraminal stenosis.

    L2-3: No significant canal or neural foraminal stenosis.

    L3-4: Circumferential bulging of the disc annulus, facet arthropathy, and ligamentum flavum prominence causing mild to moderate canal and bilateral lateral recess stenosis. Stable superimposed small left intraforaminal disc herniation causing flattening of the exiting left L3 nerve root.

    L4-5: Postoperative changes are noted. No significant canal or neural foraminal stenosis.

    L5-S1: Postoperative changes are noted. Prominent left paracentral and left intraforaminal soft tissue density, the extent of which has increased compared with the soft tissue intensity on the MRI lumbar spine dated March 8, 2017. If clinically indicated, contrast-enhanced CT or contrast-enhanced MR imaging with attention to the L5-S1 level is recommended for further evaluation.

    sperryguy
    Participant
    Post count: 68

    Correction, this is a CATSCAN.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    OK. This is a better report than the pseudoarthrosis that you originally had however this radiologist did not comment on fusion status which is generally why a CT scan is ordered.

    You are developing breakdown of the level above the fusion at L3-4 (“Circumferential bulging of the disc annulus, facet arthropathy, and ligamentum flavum prominence causing mild to moderate canal and bilateral lateral recess stenosis”). This level may become a problem in the future.

    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.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    sperryguy
    Participant
    Post count: 68

    Hi Dr Corenman

    My PT had the same question, why no mention of a fusion? That is concerning. My Pain management doctor was concerned and unclear as to the mention of “soft tissue intensity” issues. He doesn’t understand what the radiologist is trying to communicate. The past few weeks the lower back from left to right is quite painful and stiff, despite being quite active. I have been experiencing way more issues with leg pain. to fill in some blanks, I have had 2 RFA’s L4-L5, and L3-L4, both of which helped. Logic would dictate that these procedures would no longer be required after this surgery. I was warned that the L3-L4 may have issues. I simply had no options due to being in so much pain and couldnt function. Is it possible the scar tissue is an issue? Do I have options having that removed? If i need an additional surgery on L3-L4 what should I expect considering the revisions? Thanks again….!!

    Steve

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    The radiologist really did not feel comfortable (or was lazy) in his/her interpretation of the images. I would call him and request a comment on the fusion status. The “soft tissue intensity” is really “soft tissue density” and this is smaller than before which is good.

    Why you would have RFAs (radio frequency ablations) at L4-5 is a mystery as this level should have been fused and an RFA here would have been less than worthless.

    Is the leg pain the same side as the “density”? Does it seem to follow the L5 or S1 nerves as these would be affected by the “density” at L5-S1. See https://neckandback.com/conditions/symptoms-of-lumbar-nerve-injuries/ to see what nerve could be involved.

    As I noted before, L3-4 could become an issue or already is an issue now. If you would need surgery for this level, I would strongly advise the use of BMP (bone morphogenic protein) and only a posterior surgery (TLIF) if you need future surgery.

    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.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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