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I am 10 months post-op from a one level fusion of the L4-5

with instrumentation. I have had...
I am 10 months post-op from a one level fusion of the L4-5 with instrumentation. I have had continued pain and unable to return to work yet. I have had pain injection in the lower back and in the SI Joints. I do go to physical therapy and have a bone stimulator at 6 months MRI and CT Scans showed there was a non-union and was told by pain management that this is a failed fusion. Since I have continued pain and drop foot with neropthy of both feet. I just had a CT Scan yesterday and it is saying: Any assistance would be most appreciated.
L2-3 annular bulging is seen. The exiting nerve roots still appear to be surrounded by fat. Mild thickening of ligamentum flavum is notes with very early facet degenerative change
L3-4 disc degeneration is seen with a vacuum disc phenomenon. Diffuse annular bulging is seen with flattening of the anterior aspect of the thecal sac. There is narrowing of the inferior aspect of the left neural foraman but existing nerve roots still appear to be surrounded by fat on the axial images. The sagittal remonstrations do demonstrate narrowing of the inferior aspect of the left neural foramen secondary to annular bulging plus a superimposed osteophyte.
L4-5 a disc insert is seen in good position. There is sclerosis of the adjacent endplate. Annular bulging and associated small endplate osteophytes are seen flattening the anterior aspect of the thecal sac. There does not appear to be spinal stenosis. Minimal narrowing of the right neural foramen is seen in the superior to inferior plane on the sagittal reconstructions. The axial images do demonstrate the neural foramen to be widened in the anterior to posterior direction. The pedical screws appear in good position.
L5-S1 the disc appear rudimentary. No disc herniation or spinal stenosis is seen and this does appear to represent a transitional level.
Impression Post--operative and degenerative changes are seen. The hardware appears in good position.
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Answered in 2 minutes by:
9/10/2013
Dr Basu
Dr Basu, Experienced Specialist
Category: Medical
Satisfied Customers: 29,282
Experience: MD
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Mysticdoc :

The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.

Mysticdoc :

Hi there,


I am Mysticdoc, experienced Internal Medicine Specialist.


I am here to help you with your concerns.

Mysticdoc :

Your current CT scan shows narrowing of the neural foramen ( the hole through which the nerve comes out) left worse then the right.

Mysticdoc :

However, your symptoms are more prominent on the right side.

Mysticdoc :

The neural foramen narrowing seen at L3-4 level.

Mysticdoc :

There is also osteophyte formation at that level commonly seen with degenerative disease.

Mysticdoc :

The disc insert and the screws seem to be in good position.

Mysticdoc :

There is no disc herniation or spinal canal narrowing.

Mysticdoc :

Also there is no mention of any change since the last MRI.

JACUSTOMER-uw5a7pdu- :

There is a lot more there written about L3-4

JACUSTOMER-uw5a7pdu- :

read the end statement it says there were changes since post-operative

JACUSTOMER-uw5a7pdu- :

The is a CT Scan NOT a MRI

Mysticdoc :

yes they talked about bulging of the annular ligament and thickening of the surrounding ligaments.

JACUSTOMER-uw5a7pdu- :

what does that all mean

Mysticdoc :

But the thickening of ligaments are seen with arthritis or degenerative changes of the spine.

Mysticdoc :

Postoperative changes refer to the changes seen after the surgery.

Mysticdoc :

But this is not at the level of L4-5 where you had disc insert.

Mysticdoc :

The hardwares are in good position.

JACUSTOMER-uw5a7pdu- :

I am a surgical technician so I have knowledge of anatomy this entire process I am going thru was a fluke thing I was drying my hair and got a sharp pain the next day saw the surgeon and sent for emergency MRI and in the hospital for surgery 5 days later

Mysticdoc :

However, there are significant degenerative changes at the L3-4 level.

JACUSTOMER-uw5a7pdu- :

Yes what does that mean

Mysticdoc :

Still, there i no disc herniation or spinal stenosis.

Mysticdoc :

that means, the neural foramen has been narrowed.

Mysticdoc :

the nerve roots come out through the foramen from the spinal canal.

JACUSTOMER-uw5a7pdu- :

I can read the CT report I need definitions and want to know what is going on with me.

Mysticdoc :

and also soteophyte formation and some thickening of the ligament.

JACUSTOMER-uw5a7pdu- :

Yes what does that mean

Mysticdoc :

best to see a picture of neural foramen.

Mysticdoc :

this means the nerve can be compressed due to the changes.

Mysticdoc :

and the compression can be worse with spinal movements.

JACUSTOMER-uw5a7pdu- :

so I have the disc and so does my surgeon who is in the OR the past 2 days and not calling me

Mysticdoc :

there is no emergent changes like say for example cord compression from spinal stenosis or disc herniation.

Mysticdoc :

However, you do have degenerative changes affecting the L3-4 level just above the surgical site.

Mysticdoc :

This can occur with chronic degenerative spine disease.

Mysticdoc :

Other levels get affected over time.

Mysticdoc :

Interesting thing is, the left side is worse, but your symptoms are in right side correct?

JACUSTOMER-uw5a7pdu- :

I know that I have been a scrub tech for 15 years and did many of these surgeries the different levels hold more weight

JACUSTOMER-uw5a7pdu- :

My symptoms last Oct were in the right side and now starting on the left side the past 3 months

Mysticdoc :

ok --

Mysticdoc :

that is more consistent with this report.

Mysticdoc :

they saw more worsening on left side.

Mysticdoc :

that can happen when you favor better side and that can get affected.

JACUSTOMER-uw5a7pdu- :

I have drop foot on the right foot so I am favoring the better side and I know I have DDD it is aging of the spine and I am 53

Mysticdoc :

ok

Mysticdoc :

L3-4 level is very much affected.

JACUSTOMER-uw5a7pdu- :

what do you mean

Mysticdoc :

So, you can discuss with your surgeon for possible surgical intervention.

Mysticdoc :

nerve compression

Mysticdoc :

so nerve decompression surgery.

JACUSTOMER-uw5a7pdu- :

Another nerve decompression surgery like I had?

JACUSTOMER-uw5a7pdu- :

I still don't know if I ever fused there was a non union at the last MRI last month

JACUSTOMER-uw5a7pdu- :

that's it?????

Mysticdoc :

another nerve decompression surgery if other approaches not helping.

Mysticdoc :

Like physical therapy or epidural steroid injection.

Mysticdoc :

please be patient--i do not get your replies right away sometimes due to the chat software problem.

Mysticdoc :

and you can continue chat till you get all your questions answered.

Mysticdoc :

They did not mention about the non union in the Ct scan.

JACUSTOMER-uw5a7pdu- :

I have been doing PT since 4 months post-op and as I said in my original form I had 1 set of pain injections in the SI Joint and then 2 weeks ago had epidural steroid injections. After meeting with pain management doctor he said he doesn't want to make me a human pin cushion if the SI Joint injections didn't help nor the 1st set of pain injecting in the lower lumbar didn't help. I see that they did not mention non union this is a pliminary report not the final report.

Mysticdoc :

I do not see any significant problem in the SI joint.

Mysticdoc :

The injection should be directed at L3-4

Mysticdoc :

So, the prior injections were not that helpful.

JACUSTOMER-uw5a7pdu- :

I have a lot of pain in that area but it is not uncommon after having a fusion. I think they have been trying everything possible to keep me comfortable. I did have 6 injections 2 weeks ago at L3, L4 L5

Mysticdoc :

ok --

Mysticdoc :

then you need another surgery --although that is not easy to accept sometimes

Mysticdoc :

if injections fail and Pt not helping, not much option available then besides surgery.

Mysticdoc :

and spinal stimulator also not helping you right?

JACUSTOMER-uw5a7pdu- :

No injections did not do one thing no relief. I was a 100% active person I ran 5 to 10 miles a day in the gym every day. Plus being a scrub tech I am on my feet all day and stretching bending twisting lifting none of what I can do today. I said I don't take pain meds I don't like them only when it is necessary I take Tylenol. Yes I do have the bone stimulator and it was not until 8 months post op damn insurance company keeps turing it down my surgeon got me a loaner one. I wear 30 mins a day

JACUSTOMER-uw5a7pdu- :

I think you can understand I am very afraid of surgery again to go through all of that again is horrible I don't think I will ever work again as a scrub tech especially with drop foot I feel like I am going to fall down all the time even with brace. It's the neropthay in the bottom of my right foot and now starting on left side

Mysticdoc :

This is a very challenging situation.

Mysticdoc :

I understand your fear, frustration and sufferings.

Mysticdoc :

This condition is not curable as you know.

Mysticdoc :

However, goal is to keep you active so that you can continue with your life with reasonably good quality.

Mysticdoc :

Now, you can see a different pain management specialist but outcome may not be much different.

Mysticdoc :

And you can see a different spine surgeon with more reputation which may make some difference.

Mysticdoc :

Regarding foot drop, did you have any nerve conduction study done to see if there is any other problem liek at the ankle level?

JACUSTOMER-uw5a7pdu- :

Yes had EMG 3 weeks ago and the nerve is alive in the leg good thing but it is not firing to the foot. I do not feel my foot at all this is what prompted me to go see the surgeon to start with. I have never had a backache in my life and got one and really thing it was scotia since the symptoms were the same once I started dragging my foot I got to the surgeon ASAP

Mysticdoc :

Ok

Mysticdoc :

now do you know where the compression of the nerve is as per the EMG?

JACUSTOMER-uw5a7pdu- :

Yes I agree I want to be active and 2 surgeons I saw said I was a perfect candidate for this surgery since I don't smoke in good physical condition. No I do not know where the compression of the nerve is as per the EMG. I am being told that nerve heals at 1ml per day so that it just may take me time to get the foot back. When I had my pre-op appt it was the first questions asked will I get my foot back it was a 50/50 is the best the surgeons could give me.

Mysticdoc :

ok

Mysticdoc :

see, if there is compression of the nerve, that is repairable by surgery since the nerve is good.

Mysticdoc :

So other causes are ruled out like autoimmune disorder.

Mysticdoc :

In this case, I think, you may need another surgery given the failure of the conventional treatment.

Mysticdoc :

Foot drop does improve with physical rehab over time.

Mysticdoc :

And waiting few more weeks will not be a problem if your foot drop is showing signs of improvement.

JACUSTOMER-uw5a7pdu- :

what kind of autoimmune disorder no never tested. I am the healthy person never sick with anything not even a cold

JACUSTOMER-uw5a7pdu- :

Foot drop not showing signs of any improvement since Oct I have moved my toes 5 times they just don't bend as hard as I try and also the foot won't move.

JACUSTOMER-uw5a7pdu- :

I am not rushing into surgery and will look into other options surgery is the last! The pain was so horrific last time that is why I did the surgery so quickly. I told my husband I'd take the pain over not being able to move now.

Mysticdoc :

ok

Mysticdoc :

there is no improvement in foot drop.

Mysticdoc :

Autoimmune disorders refer to the spondyloarthropathy, rheumatoid arthritis, peripheral neuropathy for example.

Mysticdoc :

Diabetes is another cause.

Mysticdoc :

Severe pain can be debilitating.

Mysticdoc :

And pain medications can give you some relief till the underlying cause has been addressed.

Mysticdoc :

I will also suggest checking for vitamin B12 deficiency.

JACUSTOMER-uw5a7pdu- :

I am not diabetic that I know. I will make a suggestion to my doctors about the autoimmune possibilities. Yes severe pain is debilitating I have been able to manage my pain with Tylenol and only when 100% need do I take a pain medication the addiction rate is too high and seen people go down the tubes with pain medication, The good thing about the practice I go to they are not pill poppers!

JACUSTOMER-uw5a7pdu- :

I am waiting for my surgeon to call he is in the OR today and haven't been able to talk to him but thank you for chatting it has been a help I was a nervous wreck reading this and I actually understood the report but needed to clarify somethings that you have.

Mysticdoc :

That is good to know.

Mysticdoc :

I already understood you are not seeking pain medication.

Mysticdoc :

Your problem is complex but can be adresed properly.

Mysticdoc :

I will suggest the autoimmune work up and also vitamin B12 level check.

Mysticdoc :

Discuss with your surgeon the CT results.

Mysticdoc :

You do not need to rush to the surgery.

JACUSTOMER-uw5a7pdu- :

I will thank you!

Mysticdoc :

It was my pleasure to help you today.
Best wishes,
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