[Travis21]

#35799

Here are MRI results. Sounds like contrast would have been helpful, which I suggested but was told not necessary:

“Persistent left paracentral disc eccentricity at L4-L5 level likely represents the discectomy site. There appears to be residual central disc extrusion at L4-L5 level. In addition soft tissue attenuation at the left lateral recess cannot be fully characterized without postcontrast imaging. As mentioned above could represent evolving granulation tissue versus residual/recurrent migrated disc fragment.

Left laminotomy at the L4-L5 level is present. There is a residual central left paracentral disc eccentricity which could represent the discectomy site. Intermediate signal in the left lateral recess is of unclear etiology. Postcontrast images would be helpful to distinguish between postsurgical changes/evolving granulation tissue versus recurrent or residual migrated disc fragment.

Moderate disc space narrowing at L4-L5 level is stable. The remainder of the discs preserved at height. The vertebral bodies appear normal in height and marrow signal characteristics.

At T12-L1, L1-L2, L2-L3 level the central canal and the neural foramina are patent.

At L3-L4 level the central canal and the neural foramina are patent.

At L5-S1 level there is suggestion of bilateral L5 pars defect and stable mild anterolisthesis of L5 on S1. The central canal and the neural foramina are patent.

The conus medullaris appears normal in signal intensity and morphology. It terminates at upper L1 level.”

Does residual mean something left behind from the original surgery or does it refer to new herniation?

Any questions you would suggest for my neurosurgeon?

[Donald Corenman, MD, DC]

#35800

This very reading is why having Gadolinium administered is important on a post-op MRI. I can’t see through the radiologist’s eyes but he is insinuating of the presence of a residual or recurrent HNP. Have the MRI over-read by a partner of the radiologist (or even two).

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.

[Travis21]

#35801

Thank you for your replies. I look forward to the explanation from my surgeon why contrast was deemed unnecessary.

Is it safe to assume that, given my surgery was on 8/14, that it is unlikely that the areas of suspicion are scar tissue?

[Donald Corenman, MD, DC]

#35802

The mass in the surgical area could be hematoma/seroma and not herniation. That is why having other radiologists read this film would be helpful.

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.

[Travis21]

#35821

I insisted on MRI with contrast and the radiologist interpretation states I have a herniated disc at L4-L5. Unclear if this is residual or a recurrence.

I am open to a revision discectomy but am curious as to why I reherniated so quickly (9 days). The onset of pain was slow and gradual, no acute injury experienced.

I’m 40 y/o, non-smoker, non-diabetic, overweight but not obese. I do have an acquired leg length discrepancy due to advanced arthritis in right knee.

If there is a possibile underlying cause for the herniations, makes sense to address that prior to revision.

Any rule outs suggestions before proceeding with revision?

[Donald Corenman, MD, DC]

#35823

Recurrent herniations can originate from a free fragment inadvertently not removed from the disc space or a free intracanal fragment that was “hidden” but subsequently revealed (with relocation after motion) after some obvious fragments were removed surgically creating more space for migration. As you can understand, there is really no way to tell the origin of a recurrent herniation but a microdiscectomy, soon after previous surgery is generally easy to remove. Leg length discrepancy normally is not related.

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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