Calista

I was fused 360 (anterior/posterior) at L5/S1. Pedicle screws were removed 18 mos post op. I had one screw fractured, and all 4 screws had bursa formed over them. Being petite,the hardware was hitting into skin vs fat. So still have cage at L5/S1, just peducle screws were removed.

Thank you.
I finally received approval for the CT myelogram yesterday for surgical planning purposes. I will have done hopefully next week.

On X-rays the fusion looks like it has fused, but the surgeon did allude to the CT being a better test to determine, plus confirm MRI findings, and now since MRI is not so recent (July 2019) new imaging will be helpful.

If fused, can a posterior decompression be done well without redoing fusion? I know my new surgeon will discuss options, but was curious, if there would be a need for posterior fixation, and since I have lateral screws/plates if it poses more issues. I realize scar tissue may too. Not an ideal situation now.

I had hemilaminectomies with diskectomy surgery. Since I had posterior scar tissue, I was advised to have an indirect decompression via XLIF.

Below are the MRI results, with comparative MRI obtained in between diskectomy and XLIF surgery. The MRI was performed approx. 8 months post XLIF

FULL RESULT: EXAM: MRI LUMBAR SPINE WITHOUT AND WITH CONTRAST CLINICAL INDICATION: spinal stenosis, lumbar region
TECHNIQUE: A variety of MR imaging pulse sequences were performed in the sagittal and axial planes before and after gadolinium administration for evaluation of the lumbar spine. COMPARISON: 6/22/2018.

FINDINGS: There is a dextroconvex scoliotic curvature of the spine.

Since previous examination there is been interval placement of hardware at L3-L4 and L4-L5 with intervertebral disk spacers.
There is persistent hardware and an intervertebral disk spacer at L5-S1.
There is a 3 mm retrolisthesis of L2 on L3 and a 3 mm anterolisthesis of L4 on L5. There is an 8mm anterolisthesis of L5 on S1. The vertebral body statures above the level of the hardware are maintained with normal marrow signal intensity. The disk heights are preserved. The conus terminates at L1-L2.
Sagittal images only through the disk space of T10-T11 through L1-L2 demonstrate no significant disk bulge or disk herniation.
At L2-L3, the disk space appears normal.
At L3-L4, there is mild to moderate bulging of the disk eccentric to the right and posterior endplate ridging. There is bilateral facet
degeneration and infolding of the ligamentum flavum. There is moderate
right and severe left neural foraminal narrowing. There is mild to moderate spinal stenosis eccentric to the right abutting the traversing nerve roots.
At L4-L5, the patient is status post left hemilaminotomy. There is mild bulging of the disk and posterior endplate ridging. There is bilateral facet degeneration and infolding of the ligamentum flavum. There is moderate bilateral neural foraminal narrowing. There is mild spinal stenosis. There is enhancing scar tissue adjacent to the thecal sac eccentric to the left of midline and surrounding the exiting left L5 nerve root.
At L5-S1, aside from the anterolisthesis, there is minimal bulging of the disk and posterior endplate ridging. There is bilateral facet degeneration. Patient is status post laminectomy. There is mild to moderate bilateral neural foraminal narrowing. The central canal is patent. There is enhancing scar tissue to the right of the thecal sac.

IMPRESSION: Multilevel spondylotic disk disease status post fixation of L3-S1 without significant interval change in appearance since previous exam noting multilevel neural foraminal narrowing and spinal stenosis as detailed above. Persistent postsurgical changes at the L4-L5 and L5-S1 levels.