amoresi

Thank you for your reply. It’s extremely frustrating. The staff asks if I’ve had previous spine surgery. When I tell them I had a recent decompression and hardware removal on 03/29/2017, I’m always told Dr. so and so doesn’t see patients so recently removed from surgery. And that they usually don’t see patients with previous surgery until after one year out. If I can’t get a physician to evaluate me, I may just proceed with the long distance consult with you. If refreshing that a surgeon is as accessible to patients through a medium like this.

Below is from the radiology report of the CT scan I had on 05/08/2017. This was after surgery but before the symptoms really started getting bad.

FINDINGS:

Patient has bridging osteophytes at the SI joints. Since 3/25/2017,
the fusion hardware has been removed at the L5-S1 level. Patient is
status post L5-S1 facetectomy. There is homogeneous soft tissue
density material at the site of the facet joint extending to the
dorsal margin of the vertebral body. This may all be fibrous tissue.
The L5 and S1 levels appear to be fused across the intervertebral disc
space. L5 level is normal in AP diameter. L4-5 has mild disc bulge. L4
level is normal in AP diameter. L3-4 is without disc herniation or
stenosis. L3 level is normal in AP diameter. L2-3 shows no disc
herniation or stenosis. L2 level canal is normal. L1-2 shows no disc
herniation or stenosis. L1 level is normal.

IMPRESSION
IMPRESSION:

Interval removal of fusion hardware from L5-S1 level. L5-S1 level
appears fused. For further evaluation of the right L5-S1 area, MR with
and without contrast might be considered. Plain CT cannot distinguish
between extensive fibrosis and intermixed disc herniation.

But a plain xray says the following (“without evidence of complete bridging osseous fusion”)

L5-S1 interbody fusion with associated laminectomy is again
appreciated without evidence of complete bridging osseous fusion.
There is no evidence of acute fracture or significant listhesis. Mild
osteoarthritis in the region of the thoracolumbar junction and at
L5-S1. Cholecystectomy clips. Pelvic phleboliths.

This is the most recent radiology report from an MRI my pain management physician ordered on 05/20/2017.

HISTORY: Back and left leg pain 6 weeks following hardware removal from
the lumbar spine.

Routine imaging was performed with and without 16 cc of gadavist.

COMPARISON: X-rays done March 15, 2017 and MRI January 2016.

There has been interval removal of the pedicle screws at the L5-S1
level. There are residual postoperative changes in the posterior aspect
of the lower lumbar spine and subcutaneous tissues. There is normal
alignment of the vertebral bodies. There is no fracture or bony
destructive change or significant marrow edema. Disc space narrowing
with disc desiccation is seen worse at L5-S1 and L4-5. The rest of the
vertebral bodies and disc spaces appear normal.

Axial imaging from T12 down to L4 are normal.

L4-5: Mild bulging and facet hypertrophy without canal compromise.

L5-S1: There appears to be a disc spacer to the right of midline. The
pedicle screws and been removed. There is a fluid collection projecting
over the right facets at L5-S1 with some surrounding enhancement but
the adjacent bone and bone marrow signal appears relatively normal.
There is also infiltration of the subcutaneous tissues bilaterally
following pedicle screw removal without any additional fluid collection
seen. There is a small amount of perineural fibrosis with enhancement
on the right with a right laminectomy defect. There is no recurrent
disc herniation significant spinal or foraminal stenosis at any level.
The epidural space on the left is entirely normal and there is no left
foraminal encroachment.

The sacroiliac joints appear to be normal and well preserved. There is
no edema present.

There is no epidural fluid collection hematoma or abscess suspected.

The conus is of normal caliber and signal intensity.

There is no other abnormal enhancement following gadolinium

I do recall before my most recent surgery the surgeon said that if when he got in there and if I wasn’t fused, he was going to do in-situ fusion by adding bone graph like a posterolateral fusion and replace the hardware with larger hardware. I read his post-op report. It has no mention of inspecting the fusion mass itself. Only that the hardware was not loose, and had excellent purchase when backed out. Given my condition after hardware removal, is it still possible to go back in and add additional bone graph to the outside of the posterior spine to augment the fusion, and re-instrument either unilaterally or bilaterally to add stability?