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.
5.
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?