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Need Advice As soon As possible

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:39 AM in Back Surgery and Neck Surgery
I have a history of low back issues including l5 S1 microdicectomy 7 years ago. I am currently 36 years old now and have done farily well, iam very active, my life revolves around physical fitness and work. I had a car accident 4 weeks ago and have had 9 out of 10 pain in the low back with pain in the left leg under the ball of my foor and the right side feels like there is a lighter on my little toe. The pain is so bad with bending forward or backward i cant barly move. I will include the mri, iam scheduled for a ct mylegram tommorow. Any advice would be welcomed, scared to death of a fusion, i life to workout, compete, and be active. thanks for any advice


CLINICAL INFORMATION: 36-year-old patient with chronic back pain and acute onset radicular pain. History of MVA in November 2009 and microdiscectomy at L5-S1 in 2002.

INTERPRETATION: Normal lordotic curvature of the lumbar spine. Alignment of the vertebral bodies is grossly normal. Conus ends normally at the level of T12 L1. Vertebral body height is normal without evidence of an acute-subacute compression fracture or deformity. Marrow shows normal signal intensity and enhancement on all pulsing sequences. Unilateral right-sided chronic L5 pars fracture with suggestion of pseudoarthrosis and osteophyte formation.

L5-S1 intervertebral disc is decreased in height and hydration status with a posterior central, right paracentral annular tear. Right L5 hemilaminectomy without postoperative fluid collection or enhancing soft tissue at the surgical site. Minimal peridural fibrosis around the thecal sac and surrounding the preganglionic right S1 nerve (axial images 5). No evidence of residual or recurrent central canal stenosis. Hypertrophic facet joint arthrosis, right worse than left with capsular hypertrophy, chronic pars defect and pseudoarthrosis in conjunction with foraminal extension of disc herniation and osteophytes resulting in moderate up-down and front-back right and moderate up-down left neural foraminal narrowing without significant neural impingement. No evidence of perifacetal edema or abnormal enhancement.

L4-L5 intervertebral disc is decreased in height and hydration status with a posterior central, right paracentral and subarticular recess annular tear. Associated broad-based disc protrusion measuring 3-4 mm AP, 5 mm SI contacting and flattening the thecal sac and in conjunction with facet joint arthrosis and ligamentum flavum hypertrophy resulting in mild to moderate central canal stenosis. Subarticular recess narrowing with impingement of the preganglionic L5 nerves bilaterally. Foraminal extension of disc bulge results in moderate bilateral up-down neural foraminal narrowing with the disc margin contacting the undersurface of L5 ganglia without ganglionic impingement.

L3-L4 intervertebral disc is normal in height and hydration status with a diffuse disc bulge flattening the thecal sac without significant central canal stenosis. No neural foraminal narrowing and no ganglionic impingement.

L2-L3, and L1-L2 intervertebral discs are normal in height and hydration status with a diffuse annular bulge without central canal stenosis or neural foraminal narrowing. No neural or ganglionic impingement at either level.

T12-L1 intervertebral disc is normal in height and hydration status without a focal disc herniation. No significant central canal stenosis or neural foraminal narrowing and no neural impingement.

Images through the sacrum and iliac bones chronic degenerative changes of the anterosuperior sacroiliac joints. Pre- and paravertebral soft tissues are normal. Aorta demonstrates a normal flow-void.

1. Summary:
a. Right L5 hemilaminectomy and discectomy with minimal peridural fibrosis around the preganglionic right S1 nerve without residual or recurrent central canal stenosis, no postoperative fluid collection at the surgical site.
b. Chronic unilateral right L5 pars fracture and pseudoarthrosis without significant spondylolisthesis; posterior annular tears and disc herniations at L4-L5 and L5-S1 with degenerative central canal stenosis at L4-L5 and neural foraminal narrowing at both levels as described.
2. Central canal stenosis: Mild to moderate degenerative central canal stenosis at L4-L5 with subarticular recess narrowing and mild impingement of the preganglionic L5 nerves. No evidence of significant central canal stenosis at any other level.
3. Neural foraminal narrowing: Moderate neural foraminal narrowing at L4-L5 and L5-S1 due to disc herniation and facet joint arthrosis without ganglionic impingement.
4. Facet joint arthrosis: Moderate to severe chronic hypertrophic facet joint arthrosis bilaterally at L4-L5 and L5-S1, right worse than left contributing to right-sided neural foraminal narrowing at these levels.
5. Conus and vertebral bodies: Distal thoracic cord and conus are normal. No acute/subacute vertebral compression fracture deformity. No arachnoid adhesions or arachnoiditis.



  • I don't have any advice really. Just to get more than one opinion before you get a fusion. Fusion isn't always the only option. I tried PT and steroid injections first, but it was a losing battle because of my L4/L5 instability. Does your doctor know you are in this much pain? Even if he does know make sure you make him understand how it effects your life. Fusion also isn't the end of physical fitness. You just have to change how you work out. You also may want to try heat, ice, and nsaids for the pain. They work for some of the pain. Different things work for different people, for me the heat always helped the immediate.
  • Please try not to worry, although I know that is easy to say and very difficult to carry out. You have a complicated MRI and we on the board are not supposed to try to play doctor by giving our version of what we think a MRI says....That being said, there are a number of things mentioned in your report that are fairly standard causes of nerve compression. Annular tears are mentioned, some narrowing (stenosis), some degeneration and the L5 and S1 nerves are being compressed.

    Did you have the pars defect before the accident? It states that the spondylolisthesis is not significant, but if the pars fractured in the accident, it could cause some instability. When you say it really hurts to lean forward or backward, that is often the case with a fractured pars which results in a spondylolisthesis. In fact, people with spondy are advised to avoid any position where the back is arched backward...and most back patients need to avoid bending forward at the waist.

    In addition to problems at L4-5 and L5-S1, which are causing nerve compression, the pars defect could be the additional source of pain. Many of the things mentioned are degenerative-type problems that would be happening gradually, not the result of an accident. It may be that the impact of the accident, caused enough shock to the spine that it increased herniations or something that was already there, but prior to the accident, not a source of pain.

    Good luck tomorrow and please come back and let us know what the doctor has to say regarding a diagnosis and plan of treatment.

    Take a moment to look around the website. In addition to the forum, there are many useful articles written by spinal specialists that explain all the issues mentioned in your MRI and there is also a glossary where you can look up medical words you do not know.


    Don't be fearful of a fusion. You should not have to make a decision immediately one way or the other.

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