please help****POST OP Microdiscetomy on L4-L5 L5-S1

///please help****POST OP Microdiscetomy on L4-L5 L5-S1
please help****POST OP Microdiscetomy on L4-L5 L5-S1
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  • Avatarjd559
    Participant
    Post count: 1

    This is my Post op MRI. I am still having a tremendous amount of leg pain as well as other symptoms. Surgery was done on the 4th of April

    Result Code: ABNORMALITY, ATTN. NEEDED

    Report:

    MRI of lumbar with and without contrast

    Comparison: MRI of the lumbar spine dated 02 JAN 19

    Findings:
    L2-L3: Disc Desiccation and mild height loss. Small broad-based disc bulge. No significant facet arthropathy. No spinal canal or significant neural foraminal narrowing.

    L4-L5: Mild disc desiccation and height loss. Broad-based disc bulge with central, left paracentral disc protrusion. The disc touches the left L5 nerve root in the lateral recess. Overall, no significant spinal canal narrowing. Mild bilateral left greater than right neural foraminal narrowing. Left laminotomy site changes. Post Contrast enhancement is noted within the laminotomy site and posterior soft tissues as well as surrounding the left :5 nerve root in the lateral recess. There is also enhancement of the L5 nerve root above this level.

    L5-S1: Disc desiccation and height loss with small broad-based disc bulge. Central, left paracentral disc protrusion which touches the left S1 nerve root in the lateral recess without significant impingement. Overall, no significant spinal canal with mild caudal neural foraminal narrowing, left greater than right. Left laminotomy changes with enhancement within the surgical bed. There is some enhancement around the left S1 nerve root in the lateral recess.

    IMPRESSION:
    1. Interval new left L4-L5 and L5-S1 laminotomy changes with postcontrast enhancement within the surgical site and extending to the lateral recesses. This is most significant at the L4-L-5 surrounding the L5 nerve root consistent with granulation tissue. There is also abnormal enhancement of the L5 nerve root above this level suggestive of nerve root inflammation.

    2. Residual central, left paracentral disc protrusions at L4-L5 and L5-S1 with some impingement upon the left L5 and S1 Nerve roots. No significant spinal canal narrowing.

    ***I don’t really understand what all this means, am I going to get better? Did I reherniate a disc? What is the next course of action? and is Foraminal narrowing a form of stenosis?****

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6907

    Without knowing how significant was your initial nerve root compression, I cannot determine how significant this MRI report is. The L5-S1 level does not sound to be so bad (“Residual central, left paracentral disc protrusions at L4-L5 and L5-S1 with some impingement upon the left L5 and S1 Nerve roots. No significant spinal canal narrowing”). Normally the adjective “some’ means minimal.

    However, your level at L4-5 has more inflammation including the nerve itself (“Post Contrast enhancement is noted within the laminotomy site and posterior soft tissues as well as surrounding the left :5 nerve root in the lateral recess. There is also enhancement of the L5 nerve root above this level”). The enhancement of the L5 root above the surgery site indicates inflammation of the nerve itself called a radiculitis (not a radiculopathy which is probably what you had prior to surgery). There is no implication of further compression as the modifier words are “Mild bilateral left greater than right neural foraminal narrowing”).

    You most likely have a radiculitis and in my opinion, need an oral steroid for a period of time. You might have an infection but that would be unlikely. The way to check for infection is with serial lab tests over time and generally, how you feel. IF you feel “crummy” in general and not just in your back and leg, that might be a clue.

    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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