[Mikec]

#25629

June 7, 2017 I had Micro- at L4. I asked and received a copy of the operative report and I have a question about one subject on the report.

The report states as follows: “Patient had neuro monitoring and there was diminished sensory over the L5 nerve root at the beginning of the case and this did not seem to improve with surgery, was same as baseline”

Can you break this down in laymen term for me? I’ve googled this and can’t fin anything that addresses this topic.

I am about 1-1/2 months post-op and have substantially more pain and I have a different kind of leg pain than prior to surgery. At my last follow up I requested and received a order form for post-op imaging. The order includes MRI & MRI with dye. X-ray exam of lower back- complete ap/lat flex ext obliques.

I am hopeful these images will reveal the new pain generators.

Thank for you your time answering questions on your forum.

Warmest regards,

Mike

[Donald Corenman, MD, DC]

#25636

This report refers to neuro-monitoring performed during the surgery. Why this monitoring was done during a microdiscectomy is unusual as neuro-monitoring is typically performed in cervical surgery or if implants are utilized (screws) in the lumbar spine.

Nonetheless, the monitoring is performed with SSEPs (somatosensory evoked potentials). This means an electrical signal is generated in the leg and “read” by electrodes placed on the skin of the head. The signal is not specific to the L5 nerve but does read the time and intensity it takes to communicate with the brain. If the signal is delayed or of decreased intensity, that is noted as a possible conduction block. This means the nerve is not working normally and the signal could be delayed from a disc herniation.

Are you the individual who also supplied the operative report that I read on another thread?

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.

[Mikec]

#25644

Yes…. that was my operative report on the other post. I was attempting to tell you about the MRI order but I could not “reply” or update my post. Technical error, user error or computer error…. but for whatever reason I could not updat my previous post.

I’m also concerned about the MRI’s as it appears some most are minimally read and the reports seem to be a “fill in the blank” reports. My desire is to get a fair review of my MRI and an accurate diagnosis. I’ve had the same radiologist read one MRI and mention a annualar tear and then on the next MRI there was no mention of the annular tear. And to the best of my knowledge there is little hope of disc healing as there is no blood supply to disc.

[Donald Corenman, MD, DC]

#25645

I am concerned that you had the entire facet removed during surgery and that could be the cause of your current symptoms. Yes, a new MRI with contrast (gadolinium) would be helpful but also a CT scan would be very valuable.

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.

[Mikec]

#25650

All I can find in my area is a Toshiba 1.5 Short Bore Vantage MRI system. This is a a free standing imaging facility. I don’t want to go to he radiology department at my local hospital as they have a local radiologist that I don’t trust.

Do you feel this 1.5 MRI machine would provide me with the quality images I need?

Thank you,

Mike

[Mikec]

#25716

MRI report

Clinical indication: Low back pain. Poslaminectomy syndrome. Status post microdiscectomy on June 7, 2017 at the L4-4 level.

Multiecho multiplanar MR imaging of the more spine was performed. Images were obtained before and after intravenous initiation 17 cc of ProHance. No prior exam available for comparison.

The study assumes 5 lumbar type segments. The conus terminates in a normal fashion near the L1-2 level. There is straightening of the upper lumbar lordosis.

At L1-2, L2-3 and L3-4, no significant abnormality is seen.

At L4-5, the patient appears be status post left hemilaminectomy and factectomy. There is a moderate amount of the fluid along the surgical defect and the left ligamentum flavum appears slightly thickened and along the anterior lateral most aspect of the canal, there is thin linear focus of contrast enhancement which measures approximately 5mm in length by 2mm in diameter presumably related to small focus of scar formation with mild encroachment of the left lateral recess. There is no collection which appears consistent with abscess formation. Also noted is prominent diffuse enhancement along the left neural foramen which involves the L4 nerve root consistent with scarring and presumed focal neuritis. There is mild disc space narrowing at the L4-5 level with generalized annular bulge identified as well.

At L5-S1, there is mild disc space narrowing with minimal annular disc bulge.

Impression: Status post left hemilaminectomy at L4-5 and facetectomy with moderate amount of fluid as described above within the surgical defect and scar tissue type enhancement along the anterior lateral aspect of the canal with mild encroachment of the left lateral recess and moderate diffuse left foraminal encroachment and involvement of the exiting left L4 nerve root. No well-defined access formation. Also noted is mild disc space narrowing L4-5 and L5-S1 with shallow annular disc bulge and probable spasm with straightening of lumbar lordosis.

X-ray:

Exam Description: SPINE LUMBAR WITH FLEXION AND OR EXTENSION.

Clinical indication: Status post microdiscectomy at L4-5. Back pain. Radiculopathy

There is disc space narrowing at L4-5 and L5-S1. There is straightening of lumbar lordosis suggestive of spasm. The vertebral body heights are well-maintained. There is minimal retrolisthesis of L4-5. Flexion and extension views show no interval change.

Impression: Slight straightening of lordosis suggestive of spasm. Mild degenerative disc disease at L4-5 and L5-S1. Minimal retrolisthesis of L4 and L5.

What does all this mean?

Thank you so much for your dedication and time reviewing all the post.

Warmest regards,

Mike

[Author]

Posts