Calista

Hi, it’s Calista again.
I am 2.5yrs post XLIF, had CT and I did not achieve a solid fusion. The surgeon who viewed the CT said I have hollowing around the screws used for the lateral plate fixation. Have 2 screw plate by Nuvasive. I also had another MRI. Results are
Results are
The unfused disc spaces are intact
Straightening & reversal of the lumbar lordosis
3mm anterolisthesis of L5 on S1
L3-4 Large disc bulge Mild right and severe left foraminal stenosis
L4-5 Moderate disc bulge and severe facet hypertrophy. Mild right and severe left foraminal stenosis. No spinal stenosis
L5-S1 moderate disc bulge. Mild right & severe left foraminal stenosis. No spinal stenosis.
(Note surgeon confirmed that the herniations are residual disc, not cages ir scar tissue.)
Impression
1) Transitional anatomy
2) Status post L3-S1 fusion. Severe left foraminal stenosis at L3-L4 L4-L5 L5-S1

I cannot stand up straight long, need to lean on right leg, Have severe axial & radicular pain, mostly left side. However right side my leg goes pins & needs numb if sitting more than 5 min, plus pain to lateral side of foot. Unsure if due to pathology or overuse.
Also felt spine pop at likely L4/5, no sound, just internal snap & if f*ing hurts like hell.
I have bilateral groin pain, much worse on left side. I try not to stay in bed, cannot sit long..
New symptoms since XLIF – when standing get pins & needles numbness & pain creeping upwards to almost my rib cage, then it takes several hours at a minimum for pain to subside when laying down to sleep, often I cannot sleep at all, will go 36-48hrs before falling asleep, which is completely unhelpful for pain. Also my legs feel very heavy, feel as if someone us pulling me towards the ground. The symptoms are debilitating & scaring me.

I am at the end of my rope. I am scared of more surgery, but realize I have to get issues addressed. One surgeon recommended open decompression of L3-L5, plus add more BMP to cages and posterior cortical screws. L5/S1 I had posterior hardware removed 18 mos post original fusion, because one screw fractured plus I am very petite & pedicle screws were pressing into skin & formed bursa over all of them. So I realize I have L5/S1 left foraminal stenosis, but the level is fused, unsure about if the level is decompressed again if more screws needed.

I cannot visualize how the cortical screws will fit with lateral screws. Besides being 5ft tall, I have short pedicles for size, go figure? My brother has same issue, also fused at 3 levels, had ASD + XLIF & it was not a good outcome either.

I realize revision of XLIF is not common since new, plus using technique as a revision of choice for many. But since the fusion, I have had rashes & increased joint pain throughout body, and prefer to have XLIF hardware removed, since I have a nickel allergy & thought I was getting titanium hardware as I had previously. When web like rashes appeared on arms & legs, plus increased joint pain in hands, I looked up the Nuvasive Hardware & it contains nickel. I understand the jury is out on metal allergies, but if I have an allergy plus autoimmune disease, it seems dumb to have nickel within hardware since revision is required.

I am going for more consults, but what would you recommend for surgical approach to deal with my clusterF situation?

Note I do not receive pain mgmt because worried stigma if use of narcotics will label me a bad outcome waiting to happen, when already labeled due to amount of surgeries.

Your feedback would be greatly appreciated. Thank you!

Hi. My CT Myelogram was canceled due to COVID19, with 427 cases, mostly north of where I live. So rescheduled for 3wks later, with 50k reported cases…makes sense? So have CD, uploaded to my surgeon, but have not seen the report yet.

I have been trying to read it, however my eyes hurt, the resolution on preview is poor, had to use a very old laptop that had a CD drive to upload.

I may see report Monday, if not have call scheduled with the surgeon on Tuesday. I will add here the radiology report and surgeon’s opinion when available.

Thx!

I definitely will and update you too. Now that you have been ironically the most engaging and informative surgeon, I am compelled to keep you in the loop. I know nothing is better than visualizing, as almost all imaging I have had in the past missed pathology or it was grossly underestimated.

I have mixed feelings about L5/S1..certainly do not want to revise from short-term outlook, however if it has issues it would offer some hope to a solution. And answer some questions that I have not received – 2 radiologists thought the level was causing issues/pain, but my surgeon said they were wrong. So coin toss?

Then L3-5, I feel less clueless about, the pain correlates definitely axial and some direct to L3-5, but the groin pain may be from higher levels unless my nerves are not quite aligned normally due to LSTV, or just for me manifests lower, who knows?

The definite unknowns are the XLIF fusion status, and I think I know what nerves are damaged vs impinged by the, lack of a better word, “different” sensations – think the quad/knee is not reversible, praying hip, lateral thigh, groin and feet issues are to some extent.

Not sure how an EMG/NCS confirms if salvageable? It will be the test after the CT Myelogram. But prior test, the results did not differentiate between damage/impingement. So not really understandinghow they work.