koobi336

Hello Dr. Corenman,
I had another MRI last week since my back pain is continuing. If you wouldn’t mind looking, do the results below tell you any clues about where this continuing pain could be coming from? Also, I believe it confirms that this is not arachnoiditis, correct? Thanks for your continued correspondence and help!

CLINICAL DATA: 58-year-old male with lumbar back pain radiating to
the buttock and foot. Left leg numbness. Lumbar surgery in December
2018 with subsequent surgical repair of pseudomeningocele on
02/07/2019.

EXAM:
MRI LUMBAR SPINE WITHOUT AND WITH CONTRAST

TECHNIQUE:
Multiplanar and multiecho pulse sequences of the lumbar spine were
obtained without and with intravenous contrast.

CONTRAST: 16mL MULTIHANCE GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN

COMPARISON: 03/06/2019 lumbar MRI, 01/24/2019, and earlier.

FINDINGS:
Segmentation: Normal lumbar segmentation designated as on the prior
studies.

Alignment: Stable vertebral height and alignment. Mild straightening
of lower lumbar lordosis. No significant spondylolisthesis.

Vertebrae: Small chronic endplate Schmorl’s nodes in the lower
thoracic spine and L1. Bone marrow signal remains normal. No marrow
edema or evidence of acute osseous abnormality. Intact visible
sacrum and SI joints.

Conus medullaris and cauda equina: Conus extends to the L1 level.
Conus and cauda equina appear normal. No abnormal intradural
enhancement. Mild posterior dural thickening and enhancement at
L4-L5 is described below.

Paraspinal and other soft tissues: Negative visible abdominal
viscera.

A quadrilateral shaped residual postoperative fluid collection in
the left laminectomy space at L4-L5 is further described below, and
is decreased since 03/06/2019 now encompassing 11 x 18 x 33
millimeters (AP by transverse by CC) versus 18 x 24 x 40 millimeters
previously.

Disc levels:

T11-T12 through L3-L4 are unchanged and largely unremarkable.

L4-L5: Sequelae of left laminectomy. The residual laminectomy space
fluid collection has decreased in size since March. The collection
appears simple but is mildly rim enhancing, and there is associated
mild left posterior dural convexity rim enhancement (series 9, image
34). However, there is no mass effect on the thecal sac, the
posterior contour which has mildly enlarged since March. No
surrounding soft tissue edema. A smaller subcutaneous fluid
collection at the skin incision site has also regressed with trace
residual (series 6, image 32). Stable other postoperative changes
tracking from this fluid collection to the skin surface.

Stable disc desiccation with minor circumferential disc bulge and
small broad-based central disc protrusion (series 6, image 31).
Stable mild facet hypertrophy. Capacious thecal sac now at this
level. No nerve root clumping or thickening. No convincing stenosis.

L5-S1: Stable and negative.

IMPRESSION:
1. Satisfactory postoperative appearance following repair of dural
leak in February. Decreasing residual small left L4-L5 laminectomy
space fluid collection with no mass effect on the thecal sac. Mild
postoperative dural thickening without adverse features; no nerve
root thickening, clumping, or enhancement.
2. Stable L4-L5 disc degeneration with small broad-based protrusion.
No convincing neural impingement.
3. Other lumbar levels are stable.

Hello Dr. Corenman,
Unfortunately, I do have unusual leg symptoms as well. Numb left rear and numb/tingly/burning in left foot. The left leg feels a bit weak too.

Dr. Corenman,
Thank you for such a quick reply! So is it very likely that this type of disc/facet inflammation and pain would be caused by the two back surgeries and all the spinal fluid/pseudomeningocele trauma in between two? And if so, not unusual that it would persist for 2 months without treatment? I am hopeful this was caused by the surgery and trauma and maybe I don’t have a disc/facet defect, and maybe could be cured by taming the inflammation with an injection. Does that sound plausible? Thanks.