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I have attached the last MRI I had done. However, I am awaiting insurance to approve the new one with the new surgeon. There were so many different findings on the EMG the old & new surgeon done that the new surgeon doesn’t feel comfortable not doing a new one. I guess mainly I am wondering if any of this is normal from such a “minor surgery”

RESULT:

Indication for the Request / Reason for Overread: Previous report is

inadequate.

Specific Issue(s) Discussed: ? epidural hematoma ? arachnoiditis. ?

evidence of ongoing root compression and/or surgically amenable pathology

? lumbosacral plexitis

Counting reference: Lumbosacral junction. For the purposes of this

report, L4-5 is considered the level of the iliac crest.

Postoperative change: There are postoperative findings related to L3-4

microdiscectomy.

Alignment: Alignment is anatomic.

Bone marrow signal/fracture: No evidence of pathologic marrow

infiltration. No evidence of prior fracture.

Conus: The conus is within normal limits of signal intensity and

morphology. The conus medullaris terminates at L1.

Paraspinal soft tissues: There is a 12 mm T2 hyperintense and T1

hypointense peripherally enhancing fluid collection in the deep soft

tissues adjacent to the posterior inferior aspect of the left L3-4 facet

joint, which were present a postoperative fluid collection. There is

mild surrounding edema and enhancement around the collection. Paraspinal

soft tissues are otherwise within normal limits.

Lower thoracic spine: Visualized lower thoracic canal and foramina are

patent.

T12-L1: Canal and foramina are patent.

L1-L2: Canal and foramina are patent.

L2-L3: Canal and foramina are patent

L3-L4: There are postoperative findings on the left related to the prior

discectomy and fluid collection resulting in mild left neural foraminal

narrowing. There is mild clumping of the nerve roots at the posterior

left aspect of the thecal sac at the level of L3-4. Canal and right

foramina are patent

L4-L5: Canal and foramina are patent

L5-S1: There is mild bilateral facet arthropathy and mild diffuse disc

bulge resulting in partial effacement of the bilateral subarticular zones

and mild contact of the right greater than left bilateral S1 descending

nerve roots. Canal and foramina are patent

Sacrum and iliac wings: The visualized sacrum and iliac wings are

within normal limits.

IMPRESSION:

Postoperative findings related to L3-4 microdiscectomy with a small 12 mm

peripheral enhancing fluid collection in the deep soft tissues adjacent

to the posterior inferior aspect of the L3-4 facet joint, likely

postoperative. Associated adjacent mild surrounding enhancement and

edema. Associated mild narrowing of the left neural foramina. Mild

clumping of the nerve roots at the posterior left aspect of the thecal

sac at the level of L3-4, suggestive of arachnoiditis.

Mild degenerative changes at L5-S1 with mild diffuse disc bulge and

contact of the right greater than left bilateral S1 descending nerve

roots.

Hello Dr. Corenman,

I am now roughly two years and two months post endoscopic discectomy for HNP at L5-S1 and severe radiculopathy on the left side. Progress has been slow as discussed earlier in this thread, and it seems over the past six months to have plateaued. I was aware before my surgery that given the nature of my injury that there could be some residual symptoms and almost certainly some limitations going forward. Nevertheless, I am optimistic for future progress and I solicit you opinion on some ongoing issues and how they may be ameliorated if not resolved.

Visits with physical therapists and chiropractors both before and after my surgery have identified a pelvic torsion that occurs and causes one leg to appear longer than the other. It results in added pain, and adjustment by a DC via clicker, or at home with a muscle energy technique taught me by a PT, bring relief. I have been working on strengthening my core for over a year and a half (McGill big three), yet moderate lifting, bending over improperly, or even sleeping wrong can cause my back/pelvis to “go out”. Any advice on what to anticipate with this? Is it prudent to avoid the things that cause this problem at all costs? I am willing to take my PT to the next level, but I fear no amount of muscle strengthening can offset the damage to the connective tissue between my vertebrae.

The second problem I am having is a persistent twitch my left calf in both the gastroc an soleus. It is fairly constant and is made worse when my knees and hips are flexed, as in sitting in the car and even when lying on my back, bending my knees with my feet on the floor. I cannot hold this last position due to the intensity of the twitching which also begins to become painful. Lately the twitching has seemed to become more frequent and occasionally spread further up the leg into the hamstring and hip, and to occur even in positions which normally relieved it some, like lying supine. I am curious if this could be from ongoing compression of the nerve root, or if it is more likely from nerve damage, either from the herniation, surgery or the two ESI’s I had. I first noticed it approximately seven to eight months after surgery and it has waxed and waned since then, becoming most prominent lately. Do you think another MRI is warranted at this point, in addition to a nerve conduction study? Though I am not eager to do things that may potentiate more surgical intervention, I am eager to understand how best to proceed to ensure the best quality of life I can going forward.

I thank you for taking the time to consider my questions and to reply at your convenience.