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  • Abbeygirl
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    Post count: 40

    Hi Doctor i am writing again i was wondering if you could please explain my mri results to me please findings in the supline scanning position alignment is anatomic the tip of the conus lies at L1 and has normal morphology and signal intensity. L5/S1 laminectomy noted. NO pseudomeningocoele or changes to suggest infectious discitis. The lumbar nerve roots at the L4/5 level appear more clumped than on the previous scan raising the possibility of developing adhesive arachnoiditis. no generalised nerve root enhancement to support this
    At L5/S1 there is disc degeneration with loss of disc height and hydration. the previously documented asymmetric posterior disc/ridge complex more pronounced on the left is again noted this with the epidural and perineural enhancing granulation tissue combines to displace and slightly compress the left s1 nerve root as it crosses the disc the left s1 nerve root is swollen and shows asymmetric enhancement.there is only minimal right s1 lateral recess compromise. no significant L5 foraminal stenosis seen mild L5/S1 facet joint degenerative change noted.
    no other potential compresive neural lesion seen in the lumbar or lower thoracic spine the prominent schmorls node at the inferior endplate of l1 is noted no para vertaebral abnomality seen.
    comment
    the subtle clumping of the lumbar nerve roots at L4/5 and L5 levels may reflect mild adhesive arachnoiditas.? time since previous surgery asymmetric osteophytic disc/ridge complex compounded by post- operative epidural and perineural enhancing granulation tissue compromises the left S1 nerve root as it crosses the disc and there is left S1 enhancement on the post contrast scans consistent with nerve root inflammation.thanks doctor for the great service you provide i wish you worked in australia thanks again

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    Interpretation

    tip of the conus lies at L1 and has normal morphology and signal intensity-

    NORMAL

    L5/S1 laminectomy noted. NO pseudomeningocoele or changes to suggest infectious discitis.

    NOTES NO EVIDENCE OF INFECTION AT SURGICAL SITE

    The lumbar nerve roots at the L4/5 level appear more clumped than on the previous scan raising the possibility of developing adhesive arachnoiditis. no generalized nerve root enhancement to support this

    POSSIBLE ARACHNOIDITIS (SEE WEBSITE FOR EXPLANATION) NO ENHANCEMENT MEANS ROOTS DO NOT HAVE INCREASED VASCULARIZATION- PRESENCE WHICH COULD INDICATE INFLAMMATION- ENHANCEMENT PRESSENCE OR ABSENCE DOESN’T HELP WITH DIAGNOSIS ONE WAY OR THE OTHER.

    At L5/S1 there is disc degeneration with loss of disc height and hydration. the previously documented asymmetric posterior disc/ridge complex more pronounced on the left is again noted this with the epidural and perineural enhancing granulation tissue combines to displace and slightly compress the left s1 nerve root as it crosses the disc the left s1 nerve root is swollen and shows asymmetric enhancement.

    THE DISC AT L5-S1 IS DEGENERATIVE (AS WOULD BE EXPECTED AFTER 2 HERNIATIONS AND 2 SURGERIES) THERE IS A BONE SPUR PROTRUDING FROM THE DISC SPACE AT L5-S1 WHICH CONTINUES TO COMPRESS THE NERVE ROOT SOMEWHAT. THERE IS GRANULATION TISSUE (COMMON AFTER SURGERY) PRESENT. THE NERVE ROOT IS STILL SLIGHTLY COMPRESSED. THE MODIFIER “SLIGHTLY” IS HARD TO INTERPRET. COULD COMPRESSION BE SIGNIFICANT OR MILD? THE LEFT NERVE ROOT IS SWOLLEN- EXPECTED AFTER 2 HERNIATIONS AND 2 SURGERIES. NO SIGNIFICANT FORAMINAL STENOSIS AT L5 (THIS WAS ONE OF THE POSSIBLE DIAGNOSES AND IS NOT PRESENT ACCORDING TO THE RADIOLOGIST).

    ACCORDING TO THE REPORT, THE NERVE IS SWOLLEN AND STILL COMPRESSED BUT BY HOW MUCH IS NOT DETERMINED. YOU COULD HAVE ROOT IRRITATION (SEE CHRONIC RADICULOPATHY ON WEBSITE) OR CONTINUED COMPRESSION WHICH MAY IMPROVE BY A THIRD DECOMPRESSION SURGERY. ANOTHER SET OF EYES (A SECOND OPINION) MAY BE HELPFUL TO UNDERSTAND WHAT IS GOING ON

    Dr. Corenman

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