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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 for your feedback. I am also out of curiousity interested in finding out if L5/S1 has issues. Apparently my slip at the old fusion level has progressed. It has left me confused because it makes sense regarding some of the pain I feel, not all..but the pain that started in 2014 that demonstrated much less severe ASD, but noted first change in slip. I had a grade 1 slip, and not sure how many milimeters my vertebrae are, but think I had progressed from 3mm, to 5mm antero slip 3 years post fusion via MRI, and now last MRI it is 8mm. But maybe the other levels are causing distortion since have both antero and retrololisthesis now? Will let you know what the findings show..wish I lived in Colorado. A girl can dream.
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.
Yes, it is post XLIF. The first sentence in the MRI report indicates there has been placement of hardware and intervertebral spacers at L3/4 L4/5. Thank you.
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.
I would like the posterior decompression surgery that was not fully performed. I prefer the pathology to be addressed versus implanting another device in my back, and given my size, allergy to nickel, which I had no idea was used for my two new implants, thought titanium would be used, as it was before, and the trial results that from my understanding are 50% of 50% who receive trial of devicd, receive, then 50% have some pain relief, but the timing of the outcomes reported, diminishing returns, and the trials exclude much of the population that actually receive the devices. In my brain having it in me is a risk, as devices are less stringently monitored, plus autoimmune disease..would like to give the compressed nerves a chance, vs them getting worse.
If a full decompression was performed and I did not still have severe stenosis at L3/4 and some at L4/5, retrolisthesis of L2/3 – but not sure if causing pain, as well as residual disc herniated behind both levels that were fused by XLIF -and then realizing each time I was operated on, pathology was missed on imaging.
I am hoping that when the CT finally is approved to confirm the MRI findings, plus MRI will be a year old in June, that I find an excellent surgeon that will do their best to address issues. I rather take the risk of a third surgery if there is a chance of a decreased level of axial back pain, and or decrease in radicular / spasm symptoms that are getting worse, not better. Also being able to regain some feeling in crotch and possibly reduced groin pain would definitely improve my QOL. Also at this point want a procedure that includes viewing the levels afflicted vs an approach that may miss pathology, A third surgery is far from ideal on same levels, so want the next one to be thorough.
Thank you again. Your replies with links validated the pain that had been previously dismissed. Even how I described to you before reading links, was so similar to what I communicated multiple times. Sadly the benchmark has been set low now, as obtaining relevant information related to my situation was more than I have received over in the past 23 months.
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