professorW

Hi. I had a belly incision and also a back incision. They removed the disc through my abdomen and I believe put in the cage that way, then did decompression and fusion from my back. I have the burning pain in both feet, just worse on the right. My surgeon told me they “cleaned both sides out,” but the MRI did not note a hemilaminectomy defect on the left, only the right. Does that mean only the right side (where I had the herniation) was decompressed? If so, I’m not sure why I have the burning pain in both feet, in the same distribution, unless the left-sided nerve could be irritated from the fusion?

professorW wrote:

Thank you! All my pain is actually on the LEFT, and the MRI indicates the inflammation on the right. Is there anything explaining LBP (worse than leg pain but some leg pain) on the left? My surgeon wants me to have a diagnostic SIJ injection.

I should add that I don’t have back pain on the right. On the right, I do have annoying muscle fasciculations in my calf, as well as some fullness/numbness in my foot at times. This could be from the inflammation of the right S1 nerve?

My surgeon did order an MRI and below is the report. I continue to have almost constant LBP worse with sitting/lying/walking and it goes into buttocks and sometimes lower in leg. Particularly interested in what this means: “ There is also fairly strong postcontrast enhancement and high precontrast T2-weighted signal intensity around the disc space implant at L5-S1“

Report
Exam: MRI Lumbar Spine wo then w Contrast Date: 9/22/2020 8:35 AM
History: 38 years old patient with M54.5 Low back pain; Technologist reports: Low back pain with left leg pain x 3 weeks. History of surgery August 25. 2020. No injury.
COMPARISON: Lumbar spine July 23, 2020.
TECHNIQUE: Standard sagittal and axial sequences were performed before and after contrast including fat-saturated postcontrast
sagittal T1-weighted images. The patient received 15 ml of IV MultiHance. Exam is technically limited by susceptibility artifact
from metallic hardware in the lumbosacral area..
FINDINGS: There appears to be typical lumbosacral anatomy with five lumbar-type vertebrae, assuming T12 is the lowest rib-bearing vertebra. There are new metal artifacts from posterior spinal fusion
at L5-S1 as well as a disc space implant at the L5-S1 level, also
new. There is a small posterior midline incisional fluid collection
at the level of the L4 spinous process down to the L5 spinous process but not atypical given the short interval following surgery (four

weeks ago).There is no remarkable curvature on coronal images. There is been no change in alignment on sagittal images.
There is also fairly strong postcontrast enhancement and high precontrast T2-weighted signal intensity around the disc space implant at L5-S1 (sagittal series 9, image 4 through 11). However, there are no reactive marrow changes subjacent to the endplates and no suggestion of erosive or subsidence changes in the endplates. There is no apparent change in the other disks with only very mild disc space narrowing at L4-5 and relative disc dehydration at L4-5 and L3-4.
Vertebral body heights are well-maintained at all levels. Bone marrow is generally normal with no concerning bone marrow replacement or marrow edema at any level.
The conus and intradural lumbar nerve roots have a generally normal appearance. Specifically, there does not appear to be any contrast enhancement of the nerve roots or adherence between nerve roots or between the nerve roots and the meninges to suggest adhesive arachnoiditis. Conus termination is at L1-2, which is normal. There
is no evidence for epidural abscess, hematoma, or mass. On axial images:
At T11-12, there is mild bilateral facet hypertrophy with no disc abnormality or stenosis.
At T12-L1, there is no significant degenerative change or stenosis.
At L1-2, there are no significant degenerative changes and no significant stenosis.
At L2-3, there are no significant degenerative changes and no significant stenosis.
At L3-4, there is no change in very small but broad central disc protrusion associated with an annular fissure at the posterior midline. There is still no central stenosis or nerve impingement.
At L4-5, there is no change in very small broad central disc protrusion, also associated with an annular fissure in the posterior midline which has not changed. There is no nerve impingement nor significant central stenosis

At L5-S1, there is fairly prominent right anterior epidural enhancing scar tissue which extends around the right S1 nerve sleeve and into the new right hemilaminectomy defect. Again, however, there is no epidural fluid collection. The right S1 nerve sleeve is not significantly displaced or effaced.
IMPRESSION:
1. Compared to MRI two months ago, patient has undergone anterior discectomy and fusion as well as posterior spinal fusion with
hardware at L5-S1. Right hemilaminectomy also appears to have been performed. There is an enhancing tissue around the disc space implant at L5-S1, but the finding is of uncertain significance given the
short interval following surgery (about one month). There are no convincing findings of postsurgical infection and there is no epidural fluid collection.
2. Otherwise stable findings of mild disc degenerative change and very small broad central disc protrusions at L3-4 and L4-5. No lumbar nerve impingement or significant spinal stenosis demonstrated.