Forum Replies Created
-
AuthorPosts
-
in reply to: weakness in levels above TLIF #34219
Would it be better to wait until the results of the EMG start the long distance consult with you? Also, if you have a chance would you share any thoughts on the CT i posted? I’m eager to hear your thoughts. The neurologist involved in my care says he is unsure of the fusion status based on that report and i’m having a very hard time getting any response from the neurosurgery team on their interpretation. I appreciate your time!
in reply to: weakness in levels above TLIF #34203This was the description of the fusion as of this months, about 3 weeks shy of the 1 year mark.
Intact L5-S1 fixation construct in place with bilateral pedicle screws, vertical rods, and interbody device. No significant periprosthetic lucency to indicate component loosening.
At the left L5-S1 facet joint, there is bony bridging that appears to be progressing towards osseous union. No joint gas to suggest excess motion. No posterolateral osseous union on the right.
At the L5-S1 disc space on the right, there is bony spicule formation that may span the entire height of the disc space. There also appears to be developing bony bridging at the site of the interbody device, although hardware related artifact precludes accurate assessment. No intervertebral disc gas to suggest excess motion.
Vertebral body heights are preserved.Symptoms: back pain and leg pain, right worse than left.
Back Pain-central, the return of a sharp “catching” feeling has come back when exercising. The pain is more intense with position changes, it aches after standing upright for longer than 45 minutes. Squatting and leaning very forward when sitting takes pressure off. Turning over in bed creates pain in my spine. Many of these issues got better at about the 4-6 month mark post fusion.
Leg pain/weakness. Right side has always been worse. The L5 S1 i’m sure has chronic damage but many of the intense nerve pain/nerve sensations in that dermatome had improved until about 1-2 months ago when i really increased my exercise/activity. I do now have pain and weakness in other areas of my right leg and i have an emg to look further into that in 1 month. Prior to surgery i had some neurogenic claudication in both legs, again this improved after recovering from the tlif but has returned. Also, when i stand up straight and still my right leg, under my knee all the way to my toes on the right side, goes numb and tingly, it happens often when sitting up right as well.
Many of these symptoms blend together when i compound activities (i.e cycling, running, swimming, strength training). At this point i’m trying to continue my current level of activity but its getting harder and harder, it seems like my back is just declining again and i’m paying for my activities with pain more and more.
Thank you
in reply to: weakness in levels above TLIF #34197Hello again,
I wanted to give an update; the MRI didn’t show any stenosis or compression, just further arthropathic changes on L4-L5 (right above the tlif) with new bilateral effusions. Unfortunately i have not been able to get an answer regarding the fusion status, the only answer i received was that the hardware shows no signs of loosening. I’m just a little concerned because based on my research there should be more of a solid fusion by the 1 year mark (BMP was used). I’m starting to think there may be some malalignment since so many of my symptoms are positional and activity related, prior to the TLIF i did have a slip with a pars fracture on the right side of L5. I do have mild levoscoliosis in the lumbar spine, have been told i only have 4 lumbar vertebrae, and immediate post op images from the tlif last year commented on stepwise lethisis of the L spine (particularly retro at L4-5) but again all this structural information has been brushed off as a reason for any symptoms since surgery. I have an EMG scheduled for next month. Please let me know your thoughts on this when you get a chance. I do think i would like to schedule a long distance consult/review with you in the near future once we get the EMG results and the neurologist’s thoughts. I’m wondering if ortho spine would have more of a focus on spinal structure vs only looks for for nerve compression. Thanks for your time!
in reply to: weakness in levels above TLIF #34192Hi,
Below are my ct results. Is this typical for 11 months post tlif? My pain continues to be an issue, most right leg pain and it is almost as bad as it was pre surgery. I also have more noticeable bilateral leg pain and numbness/tingling. It seems like as the weeks go on activities that were once tolerable are becoming more painful (swimming, biking, driving). I have an mri and emg next week. Thanks
Document: CT LUMBAR SPINE WITHOUT
PROCEDURE: CT 0054 CT LUMBAR SPINE WITHOUT CONTR Jul 9 2021 11:29AM
CLINICAL INDICATION: ENCOUNTER FOR FOLLOWUP DOSE: dlp; 768.87
CLINICAL INDICATION: Postoperative follow-up. Status post TLIF on 8/5/2020 with worsening back pain, right worse than left leg pain, bilateral leg numbness and tingling with standing, and worsening of symptoms with activity per the patient questionnaire.
TECHNIQUE: Helical CT of the lumbar spine without contrast was performed according to routine protocol. The helical data set was reformatted in the sagittal and coronal planes. Additionally a 3-D model of the data set was performed at an independent workstation. Dose reduction techniques were utilized including mA and/or kV adjustment.
COMPARISON: Lumbar spine radiographs from 8/7/2020 and 4/20/2021. Lumbar spine MR from 8/21/2020.
FINDINGS AND IMPRESSION:
Intact L5-S1 fixation construct in place with bilateral pedicle screws, vertical rods, and interbody device. No significant periprosthetic lucency to indicate component loosening.
At the left L5-S1 facet joint, there is bony bridging that appears to be progressing towards osseous union. No joint gas to suggest excess motion. No posterolateral osseous union on the right.
At the L5-S1 disc space on the right, there is bony spicule formation that may span the entire height of the disc space. There also appears to be developing bony bridging at the site of the interbody device, although hardware related artifact precludes accurate assessment. No intervertebral disc gas to suggest excess motion.
Vertebral body heights are preserved.
Alignment is maintained.
Disc heights are preserved at the noninstrumented levels.
T12-L1: No significant abnormality. Canal and foramina are patent.
L1-L2: No significant abnormality. Canal and foramina are patent.
L2-L3: Mild facet degenerative change bilaterally. Patent canal and foramina.
L3-L4: Mild right facet degenerative change. Patent canal and foramina. L4-L5: Shallow posterior disc bulge. Mild left facet degenerative change.
Patent canal and foramina. Page 1 of 2 L5-S1: Status post bilateral pedicle screw fixation and right-sided TLIF, Page 1 / 2
as detailed above. Canal and foramina are patent.L3-L4: Mild right facet degenerative change. Patent canal and foramina.
L4-L5: Shallow posterior disc bulge. Mild left facet degenerative
Patent canal and foramina.
L5-S1: Status post bilateral pedicle screw fixation and right-sided TLIF, as detailed above. Canal and foramina are patent.
Postoperative changes at the dorsal soft tissues. Imaged retroperitoneum is unremarkable.
NUMBER OF IMAGES: nin reply to: weakness in levels above TLIF #34172I actually have not have an imaging recently, the last MRI was about 11 months ago. I did see the neurologist today and he felt based on the exam there could be some adjacent segment issues. He is ordering an MRI and will do an EMG. Does ASD happen this quickly? I’m wondering now if another surgery is in the near future. Thanks
in reply to: S/p TLIF 8 weeks ago-new sx #33067Ok thank you. So do you think the degree of slippage on the xrays is so minimal that it shouldn’t be causing any symptoms?
-
AuthorPosts
