Thanks Dr. Corenman,
After reviewing the forum more thorougly, I should also add:
1. I was fairly pain free prior to this event in January 2022. After my initial bracing as an 18 year old, I went on to play 6 years of collegiate and amateur rugby (maybe not the best choice). For most of my adult life, I’ve been very active; triathalons, century bike rides, mountain biking. Last fall, I was hiking up and down the mountains of the Rockies backpacking and hunting with no problems.
2. I have a fairly significant sitting intolerance. Where initially pain was felt in the gluteal region and R hip. I had difficulty with sit to stand. This gradually went away. Now, my foot issues appear to be amplified with prolong sitting.
3. Standing Lumbar flexion/extension x-rays showed no instability. “no evidence of instability during flexion and extension.”
4. MRI report:
a. L4 pars defect with at most minimal anterolisthesis. Some chronic, mechanical fatty marrow changes are present in the L4 pars interacriculari bilaterally. No bone marrow edema.
b. L4-L5: Diffuse disc bulge with questionable mild superimposed, broad-based central protrusion. No spinal canal or lateral recess stensosis. No formainal stensois. Mild facet arthropathy with trace effusions.
c. L5-S1; Small right central disc extrusion/protrusion abutting the traversing right S1 nerve root in the lateral recess without nerve displacement or lateral recess stensosis. No spinal canal or formainal stenosis. Mild facet arthropathy.
a. Surgeon A plan (more specifically): “think the L5-S1 disc his main pain generator. Based on the central location and what appears to be conjoined nerve roots, I would likely do a laminectomy to see if we can unroof this and give him as nerves more space with a foraminotomy and medial facetectomy on the right side. If this did not help him, we would need did do more aggressive things and consideration for a fusion”
b. Radiology/pain management note: ” Imaging shows bilateral S1 nerve root contact and bilateral L5 nerve root contact as well as bilateral pars defect at L4″
Sorry, a couple more followup questions.
1. Would the conjoined nerve roots have a clinical significance.”
2. It seems to be there is some ambiguity in reading my imaging regarding nerve contact, is this normal?