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  • jayd10033
    Participant
    Post count: 69

    Hi doctor, here is the new MRI, any idea based on this what might be causing the back/nerve pain down my leg?

    EXAM: MRI LUMBAR SPINE WITHOUT AND WITH CONTRAST

    HISTORY: Acute onset low back pain with left lower extremity radiculopathy.

    TECHNIQUE: Multiplanar, multi-sequential MRI of the lumbar spine was obtained on a 3T scanner using a standard protocol.

    Contrast: 15 mL gadoterate meglumine from a 15 mL vial.

    COMPARISON: MRI lumbar spine 1/18/2022.

    FINDINGS:

    For purposes of this dictation, the last well-formed disc space will be labeled L5-S1.

    OSSEOUS STRUCTURES: Patient is status post interval L3-4 discectomy, placement of intervening L3-4 metallic artificial disc and posterior instrumented metallic spinal fusion via left-sided interlocking metallic rod transfixed by left-sided L3 and L4 pedicle fixation screws.

    There are no compression fractures.
    Redemonstrated, small chronic T11-12 through L2-3 endplate Schmorl’s nodes.
    No marrow edema or destructive marrow process.

    ALIGNMENT: Redemonstrated, anterior grade 1 retrolisthesis L2-3.

    SPINAL CORD, CONUS MEDULLARIS AND SPINAL CANAL: Conus medullaris is at T12-L1.
    There are no enhancing mass lesion, abnormal signal or abnormal enhancement involving the distal thoracic spinal cord, conus medullaris or cauda equina nerve root sheaths.
    There are no intraspinal masses.

    PARASPINAL AND INTRA-ABDOMINAL SOFT TISSUES: No paraspinal masses.

    INCLUDED THORACIC SPINE AND SACRUM: Unremarkable.

    DISCS: Mild L2-3 disc space narrowing is redemonstrated.

    The following axial levels are imaged and detailed below:

    L1-L2: No disc bulging or herniation. No spinal canal or neuroforaminal stenosis.

    L2-L3: Uncovering of the disc by spondylolisthesis.
    Mild enhancing disc bulging. No spinal stenosis or foraminal narrowing. Stable findings.

    L3-L4: No disc bulging or herniation. No spinal canal or neuroforaminal stenosis.

    L4-L5: No disc bulging or herniation. No spinal canal or neuroforaminal stenosis.

    L5-S1: No disc bulging or herniation. No spinal canal or neuroforaminal stenosis.

    IMPRESSION:
    1. Status post interval L3-4 discectomy, L3-4 metallic artificial disc and left-sided posterior instrumented metallic spinal fusion L3-4.
    2. No new disc herniations or spinal stenosis.
    3. Degenerative grade 1 retrolisthesis L2-3 with mild disc bulging. Stable.
    4. Otherwise no significant interval change.

    Thank you for the opportunity to participate in the care of this patient.

    jayd10033
    Participant
    Post count: 69

    Followed up with my surgeon after he read the above results. He basically said there was nothing on the MRI that would be related to an ache or radiculopathy in the low back down to the lower part of my right leg. He said this MRI was probably my best ever. I agree it does sound pretty good. So now I don’t know what to do/think. He said to make an appointment so he could see me in person to help further diagnose.

    Could anything obscured by the cage / hardware be causing this?

    Otherwise, I guess I have to chalk it up to an irritated and angry nerve unrelated to herniation or compression?

    Thank you,
    Joshua

    Donald Corenman, MD, DC
    Moderator
    Post count: 8427

    I would agree with your surgeon that there is no evidence of mechanical root compression. This is probably a stretch radiculopathy. If you are uncomfortable, you could consider a transforaminal epidural steroid at the surgical level. History and careful examination might be helpful to point to the exact level but generally, the suspected root likely was near the surgical level.

    Dr. Corenman

    jayd10033
    Participant
    Post count: 69

    Thank you! I will follow up in a few weeks after seeing my surgeon for a physical exam.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8427

    Please keep in touch.

    Dr. Corenman

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