Dr,
1) I have a spot to the left of my incision site that hurts badly when pressed with even a little bit of force (not a skin pain, a deep pain). When getting a massage when that spot is hit it sends a shock wave of pain into my tailbone and the surrounding incision tissue. At first I thought it may be seroma related and it was somehow pressing on my nerve but after going over my 2nd MRI report it mentions at the very bottom “There is a soft tissue enhancement predominantly in the left lateral aspect of the posterior paraspinal soft tissues at L4-5 and L5-S1.”
Do you think that could be causing the problem?
2) I received my surgery report and found some things that my Dr never told me about, I was wondering if you could tell me if its important or not. Part of report shown below.
“There was erosive facet pathology also noted with synovial facet cyst formation across this zone, which was resected and removed using microdissection technique, releasing some tethering around the S1 nerve root.”
This sounds to me like I had a cyst & nerve tethering? I would assume nerve tethering would be scar tissue possible from the original herniation? Will the cyst grow back?
3) One more thing that strikes me off is in the MRI report shown below.
Is it common for the surgeon to make two cuts into the disc. The wording to me sounds like there were two different tears in the disc.
1st MRI after surgery, no contrast.
[L4-5] 4.5 mm disk bulge with posterocentral and left paracentral annular tear and 7.6 mm caudal soft tissue intensity, extruded disc versed post-operative granulation effacing left lateral recess with possible indentation on the descending left L5 nerve root. Mild right and moderate left neural foraminal stenosis due to disc osteophyte
complex. The midline AP dimension of the thecal sac measures 11.4mm.
[L5-S1] Disc desiccation with moderately reduced height. 4mm disc bulge with posterocentral and left paracentral annular tear and 5 mm disc protrusion along with marginal ostephyte and facet arthrosis producing moderate bilateral neural foraminal stenosis. The midline AP dimension of the thecal sac measures 10.3.
2nd MRI after surgery, with contrast
[L4-5] The previously described 7.5mm soft tissue density is again noted in the left lateral aspect abutting the left L5 nerve root. It shows rim enhancement in the post contrast images and likely represents and extruded disc and recurrent disc herniation. It appears to be contiguous with the L4-5 disk. There is a focal fluid collection at the laminectomy site measuring approximately 1.5 x 2 cm without significant enhancement in the post contrast images. This likely represents a seroma. There is a disc osteophyte complex with ligamentum flavum and facet joint hypertrophic changes causing moderate right and severe left neuaral forminal narrowing. The Ap diameter of the spinal canal is 1.3 cm.
[L5-S1] There is a stable broad-based posterior disc osteophte complex with ligamentum flavum and facet joing hypertrophic changes acsuing moderate bilateral neural forminal narrowing. The AP diameter of the spinal canal is 1.3 cm. There is a soft tissue enhancement predominantly in the left lateral aspect of the posterior paraspinal soft tissues at L4-5 and L5-S1.
Thank you for your wisdom and knowledge.
Bird