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  • NIKKID17
    Participant
    Post count: 4

    I have a lengthy & complicated situation. JAN. 2019 I had a microdiscectomy at L3-L4. 3 days later I reherniated. MARCH 2019 I had a revision. I woke up from surgery with no feeling, use, or movement in my left leg along with foot drop. None of which I had before surgery. I ended up also having a CSF leak which required an additional surgery,ICU stay & 2 weeks in the hospital. The surgeon will not give me any straight answers as to what, why, possibilities. All he done was turnt me away & sent me elsewhere. Where I am going now said I have complete nerve root damage from my L1-S1 on that same side. I have not made any progress with my leg working & am wheelchair bound at 36. The new place is recommending a Fusion but at this point I don’t want anyone touching me not even to draw blood. The pain is constant in my back. I have no feeling in my leg so im unsure what it feels like. Any advice or recommendations.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    You first need a dialog with your surgeon as to what happened and why you present with what your deficit is now. If he caused significant injury, he probably won’t talk to you even though he should describe everything that occurred for your best interest as he took an oath.

    My suspicion is that you had adhesions and the dural leak/paralysis is due to multiple nerve root injuries. Since the level of surgery is high (L3-4) injury here can cause damage to nerve roots from L3 down to S1. This means weakness of quad muscles (keeping the knee from buckling) and weakness of foot muscles (drop foot and loss of heel push off). Does this fit with your current symptoms? You should be able to lift your thigh even in the wheelchair as you should have intact hip flexion. The psoas muscle should be working. You should also have feeling in the front of the thigh right below your hip above your knee.

    What does a new MRI indicate? Damage to the roots should be apparent on a new MRI with gadolinium.

    Dr. Corenman

    NIKKID17
    Participant
    Post count: 4

    Everything you replied is exactly what I am experiencing. The original surgeon has blatantly refused to even communicate with me on ANYTHING. I do believe in some fashion there may be surgical error & this could be potentially why he has refused to give me any advice or answers.
    MRI—-
    I am pending a new one from the new surgeon.

    EMG —
    Muscle bulk is reduced in the left leg with mild quadriceps, tibialis anterior and gastrocnemius atrophy. Fasciculations and abnormal movements are absent. There is no pronator drift. Tone is normal. Neck extensors were 5/5 and flexors were 5/5. Upper extremity power, when graded out of 5, revealed:

    Lower extremity strength, when reported the same way, showed:

    Right
    Left

    hip flexion
    5
    4

    hip extension
    5
    4

    hip abduction
    5
    4-

    knee flexion
    5
    4-

    knee extension
    5
    3-

    ankle dorsiflexion
    5
    0

    plantar flexion
    5
    2

    foot inversion
    5
    0

    foot eversion
    5
    0

    toe extension
    5
    0

    toe flexion
    5
    1

    MUSCLE STRETCH REFLEXES:
    Comparing right to left and utilizing the NINDS scale (0 = absent; 1+ = less than normal, including a trace response or a response brought out only by reinforcement; 2+ = lower half of normal range, +3 upper half of normal range; 4+ = enhanced, more than normal, includes clonus if present) reflexes are:

    Biceps brachii
    2+/2+

    Brachioradialis
    2+/2+

    Triceps
    2+/2+

    Long finger flexors
    present/present

    Quadriceps
    3+/2+

    Semitendinosus/
    Semimembranosus
    present/absent

    Gastrocnemius/ soleus
    2+/2+
    slightly lower on the left

    Mild spread in synergistic muscle groups. Vendorovich signs are present, bilaterally. Mild crossed adduction in the lower extremities. Plantar responses are mute, bilaterally. Clonus is absent.

    SENSORY: Left L5 >> L4/3 sensory loss. Otherwise normal and symmetric perception of pinprick, vibration. Romberg’s sign absent.

    COORDINATION/GAIT: Unable to rise from a chair without using arms.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Yes. You have multiple unilateral root involvement after your surgery. You need a new MRI to start. Please copy the report and paste it here when you get it.

    Dr. Corenman

    NIKKID17
    Participant
    Post count: 4

    I have attached the last MRI I had done. However, I am awaiting insurance to approve the new one with the new surgeon. There were so many different findings on the EMG the old & new surgeon done that the new surgeon doesn’t feel comfortable not doing a new one. I guess mainly I am wondering if any of this is normal from such a “minor surgery”

    RESULT:

    Indication for the Request / Reason for Overread: Previous report is

    inadequate.

    Specific Issue(s) Discussed: ? epidural hematoma ? arachnoiditis. ?

    evidence of ongoing root compression and/or surgically amenable pathology

    ? lumbosacral plexitis

    Counting reference: Lumbosacral junction. For the purposes of this

    report, L4-5 is considered the level of the iliac crest.

    Postoperative change: There are postoperative findings related to L3-4

    microdiscectomy.

    Alignment: Alignment is anatomic.

    Bone marrow signal/fracture: No evidence of pathologic marrow

    infiltration. No evidence of prior fracture.

    Conus: The conus is within normal limits of signal intensity and

    morphology. The conus medullaris terminates at L1.

    Paraspinal soft tissues: There is a 12 mm T2 hyperintense and T1

    hypointense peripherally enhancing fluid collection in the deep soft

    tissues adjacent to the posterior inferior aspect of the left L3-4 facet

    joint, which were present a postoperative fluid collection. There is

    mild surrounding edema and enhancement around the collection. Paraspinal

    soft tissues are otherwise within normal limits.

    Lower thoracic spine: Visualized lower thoracic canal and foramina are

    patent.

    T12-L1: Canal and foramina are patent.

    L1-L2: Canal and foramina are patent.

    L2-L3: Canal and foramina are patent

    L3-L4: There are postoperative findings on the left related to the prior

    discectomy and fluid collection resulting in mild left neural foraminal

    narrowing. There is mild clumping of the nerve roots at the posterior

    left aspect of the thecal sac at the level of L3-4. Canal and right

    foramina are patent

    L4-L5: Canal and foramina are patent

    L5-S1: There is mild bilateral facet arthropathy and mild diffuse disc

    bulge resulting in partial effacement of the bilateral subarticular zones

    and mild contact of the right greater than left bilateral S1 descending

    nerve roots. Canal and foramina are patent

    Sacrum and iliac wings: The visualized sacrum and iliac wings are

    within normal limits.

    IMPRESSION:

    Postoperative findings related to L3-4 microdiscectomy with a small 12 mm

    peripheral enhancing fluid collection in the deep soft tissues adjacent

    to the posterior inferior aspect of the L3-4 facet joint, likely

    postoperative. Associated adjacent mild surrounding enhancement and

    edema. Associated mild narrowing of the left neural foramina. Mild

    clumping of the nerve roots at the posterior left aspect of the thecal

    sac at the level of L3-4, suggestive of arachnoiditis.

    Mild degenerative changes at L5-S1 with mild diffuse disc bulge and

    contact of the right greater than left bilateral S1 descending nerve

    roots.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Your MRI is not too helpful for a diagnosis of “what really happened”. There is probably a pseudo-meningocele (a collection of CSF due to the tear of the dura) and “arachnoiditis” which is a clumping of the nerve roots, none of which gives any indication of what happened. Unfortunately, there does not seem to be anything surgically to do to reverse or ameliorate the injury but this imaging series needs to be seriously looked at by a surgeon for clarification. Why the collection of fluid enhances with gadolinium makes no sense as a simple pseudo-meningocele should not enhance.

    Dr. Corenman

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