[barney]

#31818

Hi
i had back surgery 6 months ago and just had a mri of the area . on the report it says facet arthorpathy at l4 l5 on right associated heterogeneous increased soft tissue signal abnormality surrounding the right facet joint which enfaces the forminal nerve root.Abnormal signal is inseperable from a likely thickening right l4 nerve root findings likely reflect a sequela of scarring with associated neuritis. sequestered disc fragment is also in the differential diagnosis
could someone please put this very simply

[Donald Corenman, MD, DC]

#31825

I assume that your surgery was a far lateral l4-l5 right discectomy due to a far-lateral disc herniation. I also assume that this MRI was not performed with gadolinium dye (which would have been helpful in your case). I further assume that you are not doing great after surgery or you would not have had a new MRI.

The statement “facet arthorpathy at l4 l5 on right associated heterogeneous increased soft tissue signal abnormality surrounding the right facet joint which enfaces the forminal nerve root.Abnormal signal is inseperable from a likely thickening right l4 nerve root findings likely reflect a sequela of scarring with associated neuritis. sequestered disc fragment is also in the differential diagnosis” is discussed below.

The approach to a far lateral disc herniation is performed on the side of the canal and not within the canal. You could have had a preexisting facet disorder or the facet could have been mildly “buggered up” by the surgery-not unusual. The “heterogeneous increased soft tissue signal” could simply be granulation tissue (scar) from the surgery and the aforementioned gadolinium would have lit up this tissue, solving the question of scar vs. residual or recurrent disc herniation (“sequestered disc fragment is also in the differential diagnosis”). It is possible that you still have some root compression and an MRI with gadolinium could be quite 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.

[barney]

#31830

Thank You for your kind and quick response
Yes I am having problems with my gait I’am going to have emg of both legs In a few weeks – both feet are pins and needles- I had c-5 c6 disconectomy from front about 20 years plate and bone graft – both hands have been pins and needles since injury/surgery .I also have mild to moderate spinal canal stenosis and moderate to severe bilateral femoral stenosis right greater than left

[Donald Corenman, MD, DC]

#31833

A thorough examination should have revealed any motor weakness that would be an important finding. Sometimes, EMGs are not too helpful for the lower extremities. Lumbar spinal canal stenosis generally does not show up on EMGs and cervical stenosis will not be demonstrated on EMGs.

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.

[barney]

#31838

what would the best way to test to find out if there is any spinal canal stenosis
or if the spinal cord was injured – in the neck or back . Iam seeing a neurologist
post surgery

[Donald Corenman, MD, DC]

#31839

Appropriate diagnosis is made by a careful history, physical examination and review of imaging studies. Spinal canal stenosis is an imaging diagnosis, neurogenic claudication is the symptom presentation. If stenosis is only of one nerve root, there would be only unilateral leg pain in one dermatome. A neurologist should be able to help you.

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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