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So do you think it is a recurrent disc herniation because pre surgery it said left paracentral protrusion and post surgery it says central/left paracentral protrusion?

Hi Doctor. I have received my pre surgery and post surgery MRI reports. Can you please assist with interpreting these for me? The good news is my back is starting to settle back down. I’m not feeling 100% as I did before my fall 2 weeks ago but things are starting to normalize.

1. What is your overall takeaway from the pre and post surgery findings?

2. Does it appear I have reherniated?

3. I see that I still have a protrusion at L4/L5 post surgery. Is this normal? If so and if I practice proper spinal movements going forward, is it likely for the protrusion to shrink in size over the next few years?

4. The fall I had off the tree 2 weeks ago made me feel “sick in the back” along with over symptoms like numbness in the legs. You noted this might be due to annular torque that I caused when landing. Is this possibly the “annular fissure” noted on the post surgery report? If so will the annular fissure repair itself over time assuming I practice proper spine hygiene?

5. Should I be concerned regarding the thoracolumbar levoscoliosis?

PRE SURGERY

FINDINGS:

Mild partial disc desiccation from T10-T11 through L3-L4 and to a greater degree at L4-L5.

At the L4-L5 Leve mild posterior bulging and 4mm broad posterior left paracentral protrusion is seen. Moderate ligamentum flavum hypertrophy noted. Mild to moderate compression of the thecal sac to a more marked degree in the subarticular lateral recess on the left at the origin of the left L5 nerve root sleeve.

Slight annular bulging at L2-L3 and L3-L4

2mm left posterior protrusion mildly indents the anterior margin of the thecal sac at L1-L2

IMPRESSION:

At L4-5 minimal bulging and moderate broad left posterior protrusion as well as some ligamentum flavum hypertrophy bilaterally. Mild to moderate compression of the thecal sac to a more marked degree in the subarticular lateral recess on the left at the origin of the left L5 nerve root sleeve.

POST SURGERY

FINDINGS:

Mild long segment thoracolumbar levoscoliosis is seen with a Cobb angle at 10 degrees and leftward apex about L3-L4.
Straightening of the normal lumbar lordosis without significant listhesis.
No acute fracture, compression deformity, or frank aggressive osseous lesion.

The conus medullaris terminates normally at T12-L1.
A 5mm T2 hyperintensity in the right kidney is too small to characterize but generally lacks enhancement favors a small renal cyst.

Disc desiccation L4-L5 with mild disc height loss. Small Schmorl’s nodes are present centrally in the endplates throughout the lumbar region.
Evaluation of the individual lumbar demonstrates:
L1-L2 Left paracentral annular fissue up to 9mm with a left paracentral disc protrusion to 3.5mm. This encroaches on the left lateral recess without nerve root contact. No overall thecal sac stenosis. No neural foraminal stenosis.

L2-L3: Unremarkable

L3-L4: Unremarkable

L4-L5: Prior L4 hemilanminectomy since 4/3/2020 for disc resection L4-L5. Disc encroachment on the central zone and lateral recesses has significantly improved since the prior exam. There is a posterior central/left paracentral annular fissure identified up to 12mm in with associated with a 4.5mm posterior central/left paracentral disc protrusion. Disc material encroaches on the left greater than right subarticular zones near the descending L5 nerve roots but without clear contract or mass effect. The thecal sac is narrowed to 9mm at the AP midline with prior caliber 6mm. Mild bilateral foraminal stenosis without exiting nerve root contact.

L5-S1: Unremarkable.

IMPRESSION:

1. L4-L5: Interval L4 hemilaminectomy since 4/3/2020 for disc resection L4-L5. Disc encroachment on the central zone and lateral recesses has significantly improved since the prior exam.
There is a posterior central/left paracentral annular fissure identified up to 12mm in with associated with a 4.5mm posterior central/left paracentral disc protrusion. Disc material encroaches on the left greater than right subarticular zones near the descending L4 nerve roots but without clear contact or mass effect. The thecal sac is narrowed to 9mm at the AP midline with prior caliber 6mm.
Mild bilateral neural foraminal stenosis without exiting nerve root contact.
2. L1-L2: Left paracentral annular fissure up to 8.5-0mm with a left paracentral disc protrusion to 3.5mm. This encroaches on the left lateral recess without nerve root contact or thecal sac stenosis.
3. Mild thoracolumbar levoscoliosis with straightening of the normal lumbar lordosis noted.

Hi Doctor. I wanted to clarify the “atrophy” I mentioned above. Not sure if I am correctly using the term. Part of my gluteus minimus is being “sucked” into my body. Maybe this is something else? This started about 3 days ago. Sometimes it gets noticeably sucked in other times its only a little bit.