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  • jayd10033
    Participant
    Post count: 69

    Hello Doctor,

    I had a far-lateral lumbar micro-discectomy earlier in 2021. As a result of that surgery I got discitis (you were very helpful on here!) and have since recovered. The low back was largely OK following that recovery, but for the past month has re-presented with both low back pain + occasional sciatic-ish pain. A new MRI was ordered, below are the results. Based on those, is an additional discectomy something I should consider or does the below not appear severe enough in your opinion? Perhaps a steroid injection first? I am unsure if steroids will do anything for impinging scar tissue. What are your thoughts? MRI results below.

    Date of Exam: 01-18-2022
    EXAM: MRI LUMBAR SPINE WITHOUT AND WITH CONTRAST
    HISTORY: Status post lumbar discectomy 2021. Low back pain since November 2020. History of discitis.
    TECHNIQUE: Magnetic resonance imaging was performed with pre and post contrast sagittal and axial Tl -weighted images, fast spin-echo proton density sagittal and axial images and fast spin-echo T2-weighted sagittal images on a 3T MRI unit.
    Contrast: 15 ml- gadoterate meglumine from a 15 ml- vial.
    COMPARISON: Prior MRI lumbar spine 8/24/2021
    FINDINGS: Redemonstrated, moderate 1.3-4 spondylosis with disc space narrowing, chronic appearing endplate Schmorl l s nodes with nearly completely resolved, prior 1.3-4 marrow edema with minimal residual marrow edema/moderate type I degenerative endplate marrow change the posterior inferior 1.3-4 endplates.
    There is enhancing fibrosis involving the anterior portion of the right 1.3-4 neural foramen and mild enhancing fibrosis within the anterior 1.3-4 epidural space.
    Degree of foraminal enhancement is slightly decreased in degree.
    Redemonstrated enhancing fibrosis within the right 1.3-4 neural foramen impinging upon exiting right 1.3 nerve root sheath.
    Tiny, nonenhancing, inferior right foraminal 1.3-4 disc herniation is present (sagittal post gadolinium enhanced Tlweighted image 10, series 801). Stable from prior exam.
    There is mild thecal sac flattening with mild bilateral facet arthropathy.
    Prior, left foraminal 1.3-4 enhancing fibrosis is improved. There is mild left-sided foraminal narrowing without significant change.
    There is no spinal stenosis.
    Redemonstrated, 0.3 cm, grade 1 retrolisthesis 1.2-3 and 0.2 cm grade 1 retrolisthesis 1.3-4.
    There are no compression fractures.
    Mild, chronic, Tl 1-12 through 1.2-3 endplate Schmorl’s nodes are redemonstrated. There are no destructive marrow processes.
    Conus medullaris is at T 12-1.1
    There are no enhancing mass lesions, abnormal signal or abnormal enhancement involving the distal thoracic spinal cord, conus medullaris or cauda equina nerve root sheaths. There are no intraspinal or paraspinal masses.
    Partially included, at Tl 2-1.1 , very small central superiorly extruded disc herniation. There is mild thecal sac flattening. There is no spinal stenosis. Stable.
    At Ll -2, there are no disc herniations, significant disc bulge, spinal stenosis or foraminal narrowing.
    At 1.2-3, there is uncovering of the disc by spondylolisthesis.
    There is mild 1.2-3 disc bulging. There is no spinal stenosis or foraminal narrowing. There is no significant change.
    At 1.4-5 and 1.5-SI, there are no disc herniations, significant disc bulge, spinal stenosis or foraminal narrowing. Stable findings.

    IMPRESSION
    1 . Moderate 1.3-4 spondylosis, chronic, 1.3-4 endplate Schmorl l s nodes with near complete resolution of prior 1.3-4 vertebral marrow edema, as above.
    2. Slight decrease enhancing fibrosis within the right 1.3-4 neural foramen with tiny, nonenhancing, disc herniation in combination with postoperative fibrosis impinging upon the exiting right 1.3 nerve root sheath.
    3. Improved, left foraminal 1.3-4 enhancing fibrosis with mild left-sided foraminal narrowing.
    4. 0.3 cm, degenerative grade 1 retrolisthesis L2-3 and 0.2 cm, degenerative grade 1 retrolisthesis L3-4 without significant change.
    5. Partially included, very small central Tl 2-1.1 superiorly extruded disc herniation with mild thecal sac flattening. 5 othenNise no significant interval change.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    We have to differentiate your symptoms. Are they more central lower back pain or more one-sided back pain that radiates to the hip or buttocks?

    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.
    jayd10033
    Participant
    Post count: 69

    Thanks for looking.

    Lower back, right side. Tingling / ache behind leg, hamstring/calf. Nothing of note on the front. Dull / persistent ache is in the same spot as pre original surgery, low back, right side.

    jayd10033
    Participant
    Post count: 69

    Just to clarify, MOST of the discomfort is confined to the lower right side of my back. I don’t have painful electric shooting pains, just occasional tingling or ache behind the right leg. The focal point remains the L3-4 area on the right.

    jayd10033
    Participant
    Post count: 69

    Just to clarify, MOST of the discomfort is confined to the lower right side of my back. I don’t have painful electric shooting pains, just occasional tingling or ache behind the right leg. The focal point remains the L3-4 area on the right.

    jayd10033
    Participant
    Post count: 69

    UPDATE: Surgeon recommended waiting if possible, but noted there is almost no good disc there following a previous microdiscectomy + discitis. The levels were almost bone on bone. He said I was a good candidate for a “spacer” + small fusion/rod. When asked why not an ADR, he said he didn’t want to perform an ADR at a level where there was an infection, especially recently as there was higher risk of uncovering/activating dormant bacterium with ADR than fusion.

    What are your thoughts?

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