Post Fusion- Leg

Post Fusion- Leg
Viewing 6 posts - 13 through 18 (of 31 total)
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  • Avatarpec5002
    Participant
    Post count: 25

    Pain has continued to get more severe in the left leg, here is my MRI from yesterday, could you help with reading this and your thoughts?

    Exam: MRI Lumbar Spine Without and With Contrast
    History: Prior spinal surgery most recent fusion on 8/12/2019- radiating pain
    Technique: Coronal T2 weighted sagittal pre and post contrast T-1 weighted proton density and T2 weighted and axial pre and post contrast and T2 weighted images performed on a 1.5T unit
    Contrast: 16ML dotarem from a 20ml vial
    Comparison: Prior MRI exams most recent 6/4/2019

    Findings:
    Alignment
    Non specific straightening
    Mild grade 1 retrolisthesis L5-S1
    Vertebrae
    Hernatopoietic marrow
    No compression fracture deformity or pathological marrow infiltrative process
    Underlying bony canal is capacious
    Disc spaces:
    L1-2 throughout l4-5 no disc bulge, herniation spinal or foraminal stenosis. Disc space heights are maintained and there is preservation of the normal intervertebral disc signal

    L5-S1- spinal instrumentation post discectomy Left-sided surgery including facetectomy/foraminotomy/laminectomy with a central left sided interbody fusion device. Mild deformity of the L5 inferior endplate. Minimally enhanced material extending from the central left side of the disc space with minimal deformity of the thecal sac, this could represent a combination of postsurgical change and disc. There is diffuse enhancement of the epidural space most significantly surrounding the left descending S1 nerve root and extending to the posterior disc oriented in the same plane as the interbody device, compatible with postsurgical enhancement. Bilateral L5-S1 pedicle screws and interconnecting rods with artifact. No central spinal stenosis. Foramina free of significant compromise. Mildly narrowed disc space with desiccation.

    Intraspinal:
    Conus medullaris is normal in appearance and terminates normally at L1-2
    Subarachnoid space and cauda equina are unremarkable
    Paraspinal
    Aorta maintains its normal calber
    No evidence of an anterior paraspinal mass
    Non specific enhancement within the posterior paraspinal muscles at the surgical leve

    Impression:
    Interval additional surgery L5-S1, instrumented spinal fusion post discectomy. Minimally enhanced material extending from the central left side of the disc space with minimal thecal sac deformity, currently no compression of the descending S1 nerve root, this likely represents a combination of disc and post surgical enhancement within the disc. Compared to the preoperative study, improved mass effect. No interval disc hernations at other lumbar levels.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7005

    The radiologist notes; “There is diffuse enhancement of the epidural space most significantly surrounding the left descending S1 nerve root and extending to the posterior disc oriented in the same plane as the interbody device, compatible with postsurgical enhancement. Bilateral L5-S1 pedicle screws and interconnecting rods with artifact. No central spinal stenosis. Foramina free of significant compromise…..Compared to the preoperative study, improved mass effect”.

    He means that you have inflammatory material surrounding your left S1 nerve root. Nerves get “pissed off” if they are inflammed. It seems that your root is significantly inflamed. Did your surgeon use bone morphogenic protein (BMP)? I would consider an epidural steroid injection if your pain is as great as it was before surgery, especially if your surgeon used BMP to calm down the inflammation.

    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.
    Avatarpec5002
    Participant
    Post count: 25

    Thanks Dr. he did you BMO but doesn’t want me to do a steroid yet. In your experience is this something that will just take awhile to heal ?

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7005

    He used BMP (not BMO)? If so, BMP can be inflammatory to nerves and in my opinion, a steroid injection should be used early.

    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.
    Avatarpec5002
    Participant
    Post count: 25

    Yes , sorry – BMP and apologies for my spelling mistakes. They did give me a second medrol pack which I don’t want to take because of how it makes me feel. Hopefully this will go away over time and I think I am irritating it by sitting at work too long and getting up and down from lying on the couch. Thanks as always. If you have any other advice please let me know I appreciate what you do for everyone in confused and stressed out states.

    Avatarpec5002
    Participant
    Post count: 25

    Sorry doc last question, why do you think I still get pain down my leg (along the s1 nerve path, down the glute and back of hamstring) when I cough or sneeze. If there is no more disc and rods holding it in place shouldn’t this not happen? Or is the nerve so irritated that and sudden movement can make it angry .

    Thanks always in advance

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