metallikat

Hello Dr. Corenman,

New MRI came back. It says among other things:
“Disc desiccation and mild loss of disc height ta L5-S1.” [Note the word “mild”]
“L4-L5: No evidence of […] neuroforaminal stenosis.”
“L5-S1: Broad-based disc protrusion measure 5mm without significant central canal stenosis. Previously seen right subarticular disc extrusion has resolved. No significant foraminal stenosis.”
“Impression: Broad-based disc protrusion measure 5mm without significant central canal stenosis. Previously seen right subarticular disc extrusion has resolved. No significant foraminal stenosis.”

Previous MRI before surgery said:
“Disc desiccation with loss of disc height.” [Note the absence of the word “mild”]
“L4-L5: […] Mild bilateral foraminal stenosis”
“L5-S1: Disc desiccation with loss of disc height. Large right subarticular disc extrusion measuring 11mm AP. Complete effacement of the right lateral recess with impingement on the traversing right S1 nerve root. Mild central spinal stenosis with AP thecal sac diameter of 8mm. No significant foraminal stenosis.”
“Impression:
1. At L5-S1, large right subarticular disc extrusion with impingement on the traversing right S1 nerve root.
2. Facet arthropathy at L4-L5 with mild bilateral foraminal stenosis.”

Comments/Questions:
1. I am getting referrals to a neurosurgeon and a neurologist
2. It is my hope that the surgeon might be able to see on the MRIs if the disc height increased slightly due to traction, etc that was done for some weeks prior to surgery.
3. The new MRI does not note the mild foraminal stenosis that the old MRI did at L4-L5. Is that something that could have gone away with traction and mobility exercises?
4. The new MRI did not note the mild central stenosis with AP sac diameter of 8mm. Nor did the old MRI clearly explain what the source of that stenosis was? Any clue? Was the “hose” just narrow for no reason? And could it really have resolved since the last MRI?
5. The new MRI says protrusion does not cause “significant” stenosis. I take it this is not the same thing as “zero” stenosis. And I read that even without actual contact with the dura, protrusions can cause inflammation in the area, causing nerve symptoms. Given my new bilateral symptoms including weakness, does this protrusion look like the probable cause?
6. Any chance a surgery would allow me to keep the spinous process, and just get away with maybe having another laminotomy on the other side as well?
7. Any chance of treating this with traction?
8. If hernia retracts with traction, would the annulus heal itself over?
9. Is there time to mess around with such alternatives, or given the weakness symptoms should I just get surgery in your opinion? No one would know I have weakness by looking at my gait.
10. Since right after the first surgery, extension of both legs would cause nerve symptoms. Does that make sense anatomically given I presumably did not have this protrusion at that time, but only had the extrusion on one side? What explains it? Inflammation/irritation in the general region caused by the surgery?

Thanks,
David