MidwestW

Thanks. I have my MRI results. Again, this is 8 weeks post left L4/L5 laminectomy for lateral recess stenosis and right L5/S1 revision discectomy. I had a return of symptoms at 7 weeks, hence the MRI.

FINDINGS: There is straightening of the lumbar lordosis. There is no
evidence of acute fracture or subluxation. Lumbar alignment is
satisfactory. There is disc space narrowing and disc dehydration
particularly at the lower lumbar levels with slight spurring at the
endplate margins. The vertebral body heights are maintained. A small
fluid collection in the deep subcutaneous tissues in the midline at
the L4-L5 levels likely represents a postoperative seroma. There is
residual edema in the paraspinal musculature on the left side as
well. The conus medullaris terminates normally at the L1 level.

L4-L5: There are postsurgical changes posteriorly on the left where
there has been partial hemilaminotomy. There is mild diffuse
posterior bulging of the disc with mild facet and ligamentum flavum
hypertrophy. There may be a small focus of granulation tissue or
inflammation in the left lateral recess. Absence of intravenous
contrast makes this distinction difficult. There is moderate left
lateral recess stenosis contacting and possibly slightly impinging on
the left L5 nerve root.

L5-S1: Disc space narrowing contributes to moderate bilateral
foraminal stenosis. There has been partial hemilaminotomy on the
right. There is mild diffuse posterior bulging of the disc and there
is a new herniated disc fragment in the right lateral recess. The
extruded fragment measures approximately 1.4 cm sagittal by 1.1 cm AP
by 1.5 cm transverse. It displaces and likely compresses the right S1
nerve root. The right L5 nerve root is contacted but not displaced or
compressed.

IMPRESSION
L4-L5: Small postoperative seroma in the posterior soft tissues and
edema in the left paraspinal musculature. Slight disc bulge with
facet arthropathy causing left lateral recess stenosis where there
may be residual or recurrent impingement on the left L5 nerve root.

L5-S1: Postsurgical changes on the right. There is a new 1.5 cm x 1.1
cm right lateral recess disc herniation. The right L5 nerve root is
contacted but not displaced or compressed. The right S1 nerve root
appears displaced and compressed.

Questions:
-Is this seroma causing nerve compression? Or is it just “there”?
-It appears the lateral recess decompression I had on the left has now been re-compressed, and the right side has reherniated for the second time. Is a fusion my best bet at this point? Or do I try another left laminectomy and right discectomy?

Thank you!

Okay–my surgeon has ordered a new MRI which will be done right at the 2 month mark. It is ordered without contrast. Is that okay..I remember reading on here about needing contrast if post op?

Thanks. Called and my surgeon ordered a Medrol pack and told me to rest. I mentioned your advice and was told they would recommend those tests if no relief from steroids.

I understand that inflammation can occur after discectomy due to the nerve handling (I have had one of those before), but can it also happen with laminectomy with no disc work? My symptoms are in the exact same pattern as pre op, and a little bit worse after having had a few days of relief post op.