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  • barney
    Participant
    Post count: 5

    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
    Moderator
    Post count: 8459

    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

    barney
    Participant
    Post count: 5

    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
    Moderator
    Post count: 8459

    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

    barney
    Participant
    Post count: 5

    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
    Moderator
    Post count: 8459

    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

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