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Dr.Tiwari
Dr.Tiwari, Doctor.
Category: Health
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Experience:  M.D.
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After two-level lumbar discectomy/fusion(~6 months ago) pain

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After two-level lumbar discectomy/fusion(~6 months ago) pain has significantly increased.(from level 5-6 to level 6-8, one time level 10) Also, pattern of increased numbness from lower left back,lower left buttock, lateral left thigh,across all toes, and big toe back about half-way left foot.(before, numbness only lateral left calf, big toe and half-way back left foot) Had CT study done one week ago. Radiologist reported unable to see left l5 nerve(which was damaged in previous surgery) because of epidural scarring. Also reported evidence of screw loosening at both levels(l2-l3 and l3-l4) and that solid bony confluence across cages had not occured. l4-l5, which has not been fused(l5-s1 level also fused) indicated annular bulging without lateralization nor stenosis, and facet joint arthrosis with periarticular erosions present on right plus bilateral calcific flaval prominence at l4-l5.
I met with neurosurgeon today and expected he would want to go back in and work on some of these situations. Instead he said that I had already had all of these back fusions without significant pain relief. He didn't see any indication of any problems looking at CT films even though I informed him of significant change in pain levels experienced plus change in pattern of numbness experience. I'm concerned about his response in lieu of the pain levels and numbness I'm experiencing. He said to work with pain management on these issues. Should I be concerned about his response and get a second opinion or can you concur with him based upon the limited explanation that I've give you?
Charlie(I'm most concerned about the radiologist's finding of loose screws and the surgeon's dismissal of this as a cause for concern. It seems to me that when these screws were inserted, they were inserted into healthy bone tissue and should not be coming loose.)
Hello,
Welcome at JA.

I want to clear about some questions before answering you-

1.Was this MRI taken before or after surgery?


2.The MRI shows the presence of screw at l2,3 levels so did you also operated [previously?

3.What were your previous symptoms?
Please reply.
Customer: replied 6 years ago.
First, it wasn't an MRI, it was set of x-rays with extension/flexion views and series of CT scans from L1-L5-S1. The films were taken six months post surgery. The surgery this year was bi-level discectomy/fusion at l2-l3 and l3-l4. Previously in 2008 I had l5-s1 discectomy fusion.(l5 nerve on left side was originally damaged as result of l5-s1 surgery. It was decompressed again this year before bi-level d/f was done. I ended up with screws and rods at l2-l4 levels. screws and rods at l5-s1 were removed as fusion was complete and pain issues were at this level. My previous symptoms were low back pain, bi-laterally, left worse than right with pain moving into buttocks and back of thighs. I also had numbness and pain lateral left calf and inside of left foot from l5 nerve damage before this last bi-level surgery.
Hello Charlie,
I am very sorry that i have taken a long time in answering your question.


By looking at your history again & again i have found that your present CT report is very much informative.

Your reason of present numbness in lateral aspect of leg & inner aspect of foot is due to damage to your L5 nerve root.

The reporting of loosening of the screw & inability to see bony confluence across the age is not a normal one.You should really concerned about this .The loosening of the screw can be there only with either presence of infection or presence of delayed or non union of the bone.

In my opinion you should have a second opinion from an other neurosurgeon so that an active intervention can be taken at its earliest.The option which may be there with presence of delayed union or non union are -

-Restriction of activities with wearing of orthoses.

-Injection of bone marrow.

-Revision surgery & application of BMP,BONE GRAFT OR SYNTHETIC BONE GRAFT.

Hope this will help you.
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