Lollipop

Second opinion helped me feel much more at ease going ahead with surgery. He said definite L4-5 fusion and felt including 3-4 may be more prophylactic in nature as some of the bone from L3 was removed during my decompression surgery on L4-5; also due to the fact I have osteoporosis. He never mentioned L5-S1. I did take my MRI disc and report. He feels my issues will only progress due to the scar tissue/inflammation from the L4-5 pars fracture.

Thanks again for your opinion and knowledge. I’m planning this for September.

Hi,
Perhaps due to the moderate bilateral stenosis? I did ask several questions but did not have the report in front of me. I took notes. I just know he said he would do L3-L4 and L4-L5. I am going to make an appointment to get a second opinion. Thank you so much!!

Hi Dr. Corenman,
I had an L4-5 partial discectomy with decompression in November 2012. I did well until developing lumbar tightness/intense burning with walking along with buttock pain radiating to L lateral thigh about a year later. I had an MRI w and w/o contrast in October 2013 which showed:

1. Laminectomy decompressing thecal sac L3 and L5 vertebral body levels with enhancement of postoperative bed and epidural enhancement extending to a portion of the right lateral recess and to a lesser extent left lateral recess L4/5 with component fibrosis. This is nonspecific, but may contribute to patient’s symptoms. No abnormal nerve root enhancement.
2. Interval development of left L4 pars defect.

Medrol dose pack and eventual steroid injection did help. Medrol dose pack helped for a week and injection for three days.

I have continued to deal with the discomfort, which now includes my R thigh. I have been weight training including core strengthening for years. I am a fit 57 y.o. female and do have osteoporosis for which I have had Reclast infusion the past two summers.

I have seen my surgeon a few times in the past two years and he has done x-rays which have shown a Grade 1 spondylolisthesis with stable spine. He suggested a fusion of L4-5 based on my symptoms, but I have been hesitant. My lumbar burning continues with intermittent pain down one or both lateral thighs and a clicking I feel in my lumbar region as I move my left leg forward as I walk any distance. My back discomfort is getting worse and my back is starting to feel fatigued/overloaded with ADL’s/cleaning/on my feet for long periods of time.

I was not comfortable doing surgery without an up to date MRI. My surgeon ordered one last week at my request showing:

L2-L3 There is disc space narrowing. There are discogenic changes in the adjacent endplates. There is posterior disc osteophyte complex. There are mild hypertrophic facet changes bilaterally. There is mild central canal stenosis. The neural foramina are patent.

L3-L4 The patient is s/p posterior laminectomy. There is granulation tissue posteriorly at the laminectomy site. There are discogenic changes in the adjacent endplates. There is mild diffuse disc bulge. There are mild hypertrophic facet changes bilaterally. There is no significant central canal stenosis. There is moderate bilateral neural foraminal stenosis.

L4-L5 The patient is s/p posterior laminectomy. There is circumferential granulation tissue within the epidural space. There is grade 1 spondylolisthesis. There is a medially projecting 3.3 mm left synovial cyst. This causes moderate impression on the subarachnoid space. There is a left lateral herniated disc. There are moderate hypertrophic facet changes bilaterally. There is severe left neural foraminal stenosis.

L5-S1 The patient is s/p posterior laminectomy. There is no significant granulation tissue. There is disc space narrowing. There are discogenic changes in the adjacent endplates. There is posterior disc osteophyte disc complex. There is no significant central canal or neural foraminal stenosis.

On a side note: I had to have a cervical laminoplasty C3-C6 in 2009 due to severe stenosis. I have done great since.

My surgeon is suggesting a L3-L4 TLIF with screws and rods, cadaver bone with bone morphogenic protein.
Your thoughts? Thanks so much!