joseamaya4ParticipantNovember 1, 2019 at 3:35 pmPost count: 2
Dear Dr. Corenman,
I am a 67 year old male who recently had a spinal fusion. Pre surgery I had numbness on my right foot for a year, a couple of months ago I fell down the stairs and had an Xray. Results showed a fracture on my L4 although the Dr. told me it wasn’t a result of that fall but it was an old fracture. An MRI showed severe compression of vertebral foramen between L5/S1 and he recommended L5/S1 Spine fusion as well as laminectomy. During surgery he decided to fuse L4 as well. Post surgery my recovery was going well, the numbness was completely gone and I could slowly walk without pain or anything. 15 day after the surgery I started to have pain on the outter side of my right leg near my calf. The pain subsequently got so bad that I was unable to walk sit or even be in bed without pain. My dr prescribed Lyrica at the beginning, but as the pain got worse he prescribed oral steroids. Although the steroid did relieve the pain for a while it came back even stronger so much so that I ended up in the hospital 5 weeks post surgery because of the pain, I wasn’t able to walk or sit. My Dr. then recommended to have an MRI which showed (Translation Spanish to english):
Findings: Accentuation of physiological lordosis of lumbar spine. Artifacts on the vertebral image can be identified on L4-L5-S1 in relationship with recent spinal fusion. Transpendicular rods can be identified in adequate position. Lumbar vertebral bodies have adequate height, form, alignment, with small changes in lipid composition and without evidence of fractures, neoplastic or infectious lesions.
Elements of the posterior arch show a slight facet hyperthrophy, from L1-L2 until L3-L4. L4-L5 and L5-S1 can’t be evaluated because of the surgical material. Intervertebral discs L1-L2, L2-L3 and L4-L5, bulged.
Small protrusion in L3-L4 disc. L5-S1 disc can’t be evaluated because of the surgical material. The average diameter of the medular canal is 18 mm, left intersomatic space has good amplitude. Right intersomatic space can’t be evaluated due to surgical material. Medullary cone, dural sac, cauda equina and filum terminale are normal. No epidural collection can be observed. After administration of contraste material, no abnormal vascular reinforcement can be observed. Paraspinal soft tissue with residual post surgical edema, no collections or evidence of fistula.
Conclusion: Spinal Fusion hardware with transpendicular rods in L4-L5-S1 in adequate position. Surgical material limits evaluation of space, disc and canal in L5-S1. No observed intradural, epidural or soft tissue collections.
My Dr. couldn’t make an assesment because of the surgical material so he ordered a CT scan which showed (translation spanish to english):
Findings: Lumbar vertebrae have conserved height. Spinal fusion hardware with transpendicular rods and bone graft between L4-L5-S1. In L5 the rods are placed adjacent to the lateral corticospinal tract and have small protrusions in the anterior corticospinal tract, 4 mm to the right and 3.5 mm to the left. In S1 the right rod has a protrusion on the anterior corticospinal tract of 8 mm with adjacent small bone fragments. No hernias in discs from T12-L1 to L3-L4 can be observed. Limited evaluation of the canal and discs in L4-L5 and L5-S1 due to reflection of hardware. Paravertebral muscluar plains are conserved.
Conclusion: Hardware, transpendicular rods and intertransverse bone graft in L4-L5-S1. Ventral protrusion of transpendicular right rod in S1 with small adjacent bone fragments. Limited evaluation due to reflection of hardware.
After the MRI and CT scan, I had an epidural steroid injection. The next day I was still feeling lots of pain even in bed. Two days later my pain stopped and I was able to walk and sit using help of course. I was discharged from the hospital a week and a half ago and have been indicated physical therapy. Although I no longer have continuous pain, I am still unable to walk or sit by myself without having pain. I was wondering if the physical therapy is supposed to hurt this bad? I’m also starting to have symmetrical pain in my left leg and my right toe is starting to hurt as well. I called my Dr. today and told him my symptoms, he is recommending the removal of one of the S1 rods. Do you think this is a good option to aleviate pain? Thank you so much.
JoseAjoseamaya4ParticipantNovember 8, 2019 at 9:23 amPost count: 2
Quick Update: I have been in the hospital for the past 5 days. I am on IV Prednisone (4mg) and a higher dose of lyrica and pain killers. My pain is virtually gone when in bed and when sitting (I couldn’t even sit). Today my Dr. told me to try and stand but I couldn’t handle the pain, it was too much. Again, when sitting or in bed there is no pain. He is thinking of surgery again. Help.Donald Corenman, MD, DCModeratorNovember 8, 2019 at 8:30 pmPost count: 8455
It is hard to understand the translation from Spanish to English as there are terms that don’t make sense. I’m sure this is a maltranslation as there is no corticospinal tract in the lumbar spine. This tract is part of the spinal cord and disappears below T12. “L5 the rods are placed adjacent to the lateral corticospinal tract and have small protrusions in the anterior corticospinal tract, 4 mm to the right and 3.5 mm to the left. In S1 the right rod has a protrusion on the anterior corticospinal tract of 8 mm with adjacent small bone fragments”.
A very liberal translation might indicate compression from one or more of the screws placed in the pedicles which could have breached the bone and are compressing a neve root. This would make sense if your pain is now worse than before. Can you obtain a better translation of the CT scan?
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