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MRI findings re: Cauda equina..Confused?

hotcoffee29hhotcoffee29 Posts: 327
edited 06/11/2012 - 8:35 AM in Back Surgery and Neck Surgery
Hey everyone, Today I had my 6 week post op visit from laminectomy/discectomy at L5-S1. I had a new MRI last week due to continued nerve pain and numbness in leg below knee and on my foot. I have been back at work since 4 weeks post op and the surgeon said my MRI shows what he would expect this early on in recovery with scar tissue. He showed me the MRI and told me that there was some scar tissue around the right side of the nerve but my symptoms are on the left. He continued to say that until my back was fully healed by atleast a year he would not want to go in and do another surgery. I do have DDD at the L5-S1 level, he said its all black but I still have some height in the disc.

Ok, so he says I should continue to improve and he'll see me in 6 weeks......I get a copy of the report and I see that the report says I have a residual/resolving post surgical seroma that a follow up study should be done to assure complete resolution, but he didn't mention it or check my incision or feel the swelling still in my back

And, secondly the report also states that there is mild enhancement of some of the roots of Cauda Equina on the post infusion images within the left lateral aspect of the thecal sac...........I know we are not doctors here and I am just asking what anyone THINKS this might mean, the surgeon did not mention it but should I be concerned. He did ask how my urinary retention was (I had it bad in the hospital) I told him i think its ok but not sure.

If anyone can shed any light on this for me I'd sure appreciate it,


  • I would be interested to hear some responses to your question. I am confused, I though Cauda Equina is a syndrome, meaning that there is a loss of bladder control due to pressure on certain nerves. Anybody out there has a more thorough answer?

  • Hi everyone,
    Maybe I can help. An MRI 6 wks after surgery is very difficult to interpret because there is still so much swelling and inflammation at the surgery site.

    To have a "residual/resolving post surgical seroma" in there is normal. It just means that the wound is filled up with fluid that will get absorbed as it continues to heal.

    "mild enhancement of some of the roots of Cauda Equina"
    What I think that means is that some of the nerves are still inflamed after the surgery. Probably pretty normal.

    The cauda equina is part of the anatomy, it is really the tail of the spinal cord. At about the level of the L1 vertebra the spinal cord divides into many many many nerve roots that each exit at their own level further down the spine.

    Cauda equina syndrome is when one or more of these nerve roots are being squeezed and weakness or bowel and bladder problems can begin.

    The bottom line is, are you getting better? I wouldn't expect you to be painfree yet. But are you better than you were 2 weeks ago? Are you walking better? Getting around? Doing more?

    If your urinary retention doesn't resolve or gets worse, you do need to tell your surgeon about that. Even though this soon after surgery, there may not be very much that you can do except wait for it to improve.

    I hope this helped.
    Good Luck

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  • Dave explained your questions well.

    If you should develop bladder or bowel problems, be sure to call your surgeon. This can be retention or incontinence. Your nerves should continue to recover as the inflammation goes down...but, if you should suddenly develop a problem, call immediately. You do not want to end up with any kind of nerve damage at this level.

    It sounds like your MRI is fairly normal for a post surgical patient. Just remember that healing takes a long time and you will need to recognize that fact and be patient! Remember to keep walking, short distances several times each day. It is important to keep those spinal nerves stretched out to help with scar tissue issues.
  • I appreciate your responses and for making things clearer for me. I believe I still have trouble with urine retention but I don't think its too bad, my bowels have never worked properly since surgery, through the week I use a stool softner and by the weekend I usually have to use a supossitory, so embaressing, I guess thats why I didn't mention it in detail to the surgeon incase I am just severly constipated!!!

    In answer to your question Dave, I am finally in the last week seeing some improvement. The pain is not as severe as it was and of course there is still pain, I am starting to get a little tingling on my right side which is just beginning and a little bit of pain starting in my right butt.....but nothing too severe, and I hope it stays that way as the MRI does show scar tissiue, the report says central and right paracentral antetrior epidural scar at the L5-S1, partially encroaching upon the right S1 nerve root.

    I also had a cervical MRI which part of the impression read thay I have a loss of Lordosis, possibly a degree of muscle spasm.....any ideas??? I have disc bulges at C4-5 and C5-6 which also states canal diameter is 11mm, borderline narrow...........does that mean stenosis?

    This stuff gets so complicated but I guess if the doctor didn't make a big deal of it then neither should I.

    Thanks for everyone's input and help, I know we are all in this together.
  • Sandra,
    Your pain meds might be part of the problem. Many of us here have constipation that is aggravated by pain meds which tend to slow down - hang on to your hat, I'm going to impress you - peristalsis, the involuntary muscule contractions that move waste through the digestive system, as well as the lack of physical activity that usually stimulates your bowels. I've read many posts (including a few I have written myself) about post surgery needs for stool softeners and suppositories. Hopefully your bowel issues are not cauda equina related. I am sure your surgeon has heard it all so try not to be embarrassed about discussing this with him. I hope you continue to improve.
  • That unless your name has an MD (or other alphabet besides "Jr" or "Sr" or "IV") following your name, you really should not be attempting to interpret MRI results.

    I know how much we love helping each other. That's what makes this site as awesome as it is. BUT, there could be mistakes made in attempting MRI interpretation....

    This is something that is really best left to the Doctors.

    Thanks for understanding!
  • Be sure you are really watching your diet. Really push the fluids, and eat lots of things with lots of moisture in them -- watermelon is good, blueberries are a known laxative...anything with high fiber. Limit dairy, particularly cheese...and just keep drinking water, grape juice, prune juice, cranberry juice.

    And keep walking -- distance is less important than frequency. So, your assignment is to walk, rest, drink lots of fluids, and repeat.
  • I agree about my diet and increasing fiber. I have not been eating much atall lately as I have just been so busy with work and taking care of my kids and lots of back to school stuff and now my son has been hospitalized with a spider bite.

    Since I will be going back to the hospital in the morning with my son (I am home tonight with my other 2, dad will sleep on the couch in the hospital) I won't be on here much as I will be with my son and my stuff seems so irrelevant right now. I will take your advice though and it does mean alot.

    Please know that I do understand no one is a doctor and in regards to MRI results, I just needed help undetstanding some of the laymen terms, not looking for a diagnosis, I know only the doctors can do that. It is good to remind people that these responses are just peoples opinions, nothing more....I apologise if I asked too many questions regarding my confusing MRI reports, but like I mentioned in above post, if the doctor did not make a big deal out of it, then neither will I.

    Thanks everyone,
  • Wow -- when it rains, it pours. A spider bite?? How long does he have to stay in the hospital?

    If you don't have time to eat, just keep drinking tons of water!! That will help.
  • We believe it started as spider bite on Sunday, by Monday is was red and swollen and painful, Tuesday morning he was in more pain, knee swelling alot and more redness, sent him toschool, he came home Tuesday with 102 temp and barely able to walk, took him to Urgen care, they lanced it and opened the wound and wrapped it with gauze, antibiotics by injection, today the redness had gone p and down his leg, took him to pediatrician who hospitalized him, he has a staph infection that has led to cellulitis possible from this spider bit, we can't be sure, I don't know how long he will be in for, I just hope he is going to be ok.

    Thanks for all your concern, I will keep up drinking water and coffee!!!! LOL (My fav)
  • Sandra,

    So very sorry to hear about the spider bite.

    I sent you a PM in reply to yours.

    I am sure that everyone here on SH will be thinking of you and your little son at this time.

    We wish him well and a very speedy recovery.

    Best Wishes

    John B
  • I HATE 'EM!! My mom says I got bit by one when I was a baby, playing in my playpen, minding my own business when one snuck up on me and BIT me! How creepy is that - picking on a poor defenseless kid like that?

    Sandra - when it comes to interpreting MRIs, what I do is look up words I do not know (which in my case would be ALL of them!), and then do my own interpreting.

    Lastly, don't apologize for asking too many questions. THAT'S how we learn! Just realize the answers you receive may not be more than opinion... Well, maybe some experience in there too, but definitely leave the final say to the MDs. It's not insulting to ask for a second opinion from another doctor - don't forget that!

    Have a great day everyone!
  • Thanks JEAUX,
    Spiders are nasty things, I hate em, especially now! At this point we don't even know if a spider is the culprit. They have made my son's room an Isolation station because they say its probably MRSA and we are waiting on an MRI of his knee and an orthopedic consult because they fear the infection has spread to his joint and bone.....once we have those tests and consult we go from there, but until he can walk and bend his knee he will remain in the hospital. He is a special needs little boy and this is all so over whelming and confusing to him, but thank you so much to everyone for the kind words of hope, it does mean alot to me. I'll keep you posted and JEAUX no hard feelings, I get it and good friend explained it all to me.....snd you had good reason to tell me what you did and I appreciate it.
    Got lap top in hospital so I will post regular updates as we get them.
  • Sorry to hear that things are not looking any better this morning. Really glad to hear that they are looking after your son so well. Please keep us up to date on his prognosis and progress.

    Will be waiting to hear from you.

  • I'm sorry to hear about your son. I'm saying a prayer for your family and am anxious to hear he's improving.

  • Thank you so much for the well wishes for my son Tyler. Its been a bit of a roller coaster today. Bad news is that he has MRSA and we have discovered another lesion on his back. Good news is that it has not affected his joint and he will not have to have surgery. Infection is stubborn, its still spreading although very minimally and he is still running a low grade fever but they have him on lots of antibiotics so hopefully he will continue to get better.

    I'll keep you updated and I wish everyone well,
  • Thanks for the update. Glad to hear your son will be OK.

    Take good care,
  • Jeaux, I am sorry you saw the need to delete the link to my website. My post was intended to help a member of your forum understand her MRI. My website has more information for people that suffer with back pain. Without any advertising or commercial content of any kind. Why would you not want the members of your forum to have access to this information? I have some experience treating and dealing with this kind of stuff. I live with chronic back pain and I started my website to help people that suffer with back pain. Please contact me at noway.com so we can discuss this.

    Let me explain that Spine-Health is a privately owned company and has a set of forum rules that everyone must adhere to. We do not allow posting of private web sites for anyone.
    If you feel your information is important, then I suggest you contact people using private messages or emails. We will not allow public announcements such as yours

    Ron DiLauro , Spine-Health Administrator 09/04/09
  • My son will be here for a few more days, he has avoided surgery so that is good news and he is healing.

    I have really irritated my back, sleeping on a fold out chair and I haven't left the hospital in 2 days, Today as the day has wore on I am in lots of pain and my left foot is completely numb!!! Dad will stay here tonight and I will go home to get a good nights rest and a well needed shower!!
  • Hospitals are the worst. I was doing really well after my last surgery when my elderly mom who has Alzheimer's ended up in the ER three times in one week. I never recovered from the experience and it ruined whatever success my surgery might have had.

    I know you are worried about your son, and not worrying about yourself, but do try to be as careful as you can.

    Hopefully you can take it easy tonight.
  • I will include your son in my nightly prayers. How old is he? I used to be a pediatric nurse. One of my sons was a very ill child. My heart goes out to you. Having your child be so sick is so hard. And my goodness how do you sleep on those cots! Glad to hear you'll get a more comfortable rest tonight.

    Best to you,

  • I will add you and your little boy to my prayers. I know how hard it is for us moms when our babies are sick or hurting!
  • I'm new to all this, so hya.

    I have had back problems over the last 12 years. Two slipped discs treated by GP with drugs and physio. So bad at the time physio had to come out to me.
    In June this year (2009) I began to have sciatica, which within a week became a medical emergancy -Cauda Equina. I was unable to walk, or pass urine and in the most awful pain. Following surgery I was home within a week. I was then rushed back in with days with the same symptoms. Within a two week period I had three opperations. Cauda equina, Laminectomy, L5-S1 Microdisectomy and Laminectomy.Due to the Cauda Equina symptoms I was sent for urodynamics for bladder function testing. (all is now well) I have also been told that I need a fusion. My surgeon has been on sick leave, I should have had a spine support to return to work with- surgeon off - no support. I was to book the date with his secretary - no surgeon - no date !!!

    I can just about put up with the pain during the day, but sleeping is a problem. I have no idea what I should or should not be doing work or daily routin wise and can't get any answers.

    If I were you I would request another MRI and a referal to Urodynamics.
    I am due to have the fusion in October but no deffinate date which is worrying.
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