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Need for repeat MRI pre-op?

FarmgrrlFFarmgrrl Posts: 146
edited 06/11/2012 - 8:40 AM in Back Surgery and Neck Surgery
Hi all,

I have a question about the need for another MRI pre-op?

I had my last MRI in Oct '09 and I re-herniated L4-L5 but also have old central protrusions at L3-L4 & L5-S1 (L5-S1 was actually my first herniation ever...also do have some bilateral foraminal stenosis at L5). While the constant muscle pain in my left calf is no longer there I do still have my numbness & it can easily go into spasm if I'm not careful...this is all related to L4-L5.

However, my problem is that I'm having a very consistent lower back ache which is now more apparent that I've stopped taking NSAIDs in preparation for surgery as well as a crampy/achy feeling in both of my thighs. I've had the occasional shock in my right leg (only to the knee) but last night at work I had a shock in my right leg all the way to my foot.

I am on "light duty" at work as a nurse but last night I had no choice but to help transfer a patient quite a distance (from the hospital next door). I didn't actually push the strecher...I just steered it from the front as necessary to help my co-worker. I also had to carry a 20 lb infant and hold him for 20 mins in an akward position for a spinal tap. It was a very busy and stressful night (12 hours!)...but I had no choice but to push the limits. The right leg sciatic pain as well as the left leg spasm I had at work happened after all of this chaotic activity.

I am scheduled for an L4-L5 repeat discectomy on Jan 26th after refusing a 3-level fusion. My pre-op appointment is on Tuesday the 19th.

Should I talk to my surgeon about a repeat MRI to make sure everything is still the same? I'm hesitant for the fear that L4-L5 won't look as "bad" and that he'd cancel my surgery. On the other hand, I'm afraid maybe something is going on particularly with L5-S1...I think I'm just being a bit paranoid but I wanted to hear everyone's thoughts.

*Just a note that this surgeon is not the one that offered me the fusion, he doesn't think I'm ready for that yet...*



  • I think you should explain to your Dr what has happened as of late. Let him know how you feel compared to when you had mri. Then he should know if you need another or not.
    I would leave that judgement to him. Just my opinion, but he should know if needed or not. Good Luck, Love, Robin
  • I agree with Robin. You need to tell the surgeon exactly what is going on.

    You don't really want to go through any surgery if what you really need is a fusion. Every time you are operated on, the risk of infection goes up and the formation of additional scar tissue has the potential to develop into a problem. So you don't want to put yourself through a procedure that is not going to be more than a temporary bandaid. For this reason I would level with the doctor and tell him your concerns.

    Just as an aside -- I selected my surgeon on the basis of the recommendation for a one level fusion. There were two neurosurgeons who each, independent of one another, said they would perform a three level and maybe up to five levels depending on what they found once they got in there...This sounded so extreme to me, that I didn't even consider it...but, in hindsight, if I had gone with the 3 level fusion two years ago, I probably could have saved myself two years of frustration, tests, injections, nerve blocks, etc. In my defense, there were 6 ortho spinal specialists who all said they'd do a one level...so it is hard to know what is the right procedure!!

    Your "light duty" nursing sounds pretty intense to me...and what you describe sounds painful. I'd be surprised if you haven't aggravated something.

    Please let us know how things turn out!!

  • I'm finding my self doubting my choice lately to only have the micro-d...I guess I need to have a good honest discussion with him on Tuesday. I forgot to mention that I took a tumble in the grass on New Year's as well...I was walking in the dark and it was uneven ground and my left leg went out from under me.

    I suppose the least of my concerns is that I would look 'stupid' for changing my mind. I will see what he has to say Tuesday!

  • you wouldn't be the first person to change their mind about what type of surgery to have, or even whether to have it or not.

    You have to do what you believe to be the best thing for you, never mind what other people think. Take his advice and then decide what you think is best for you and for your future.

    I know, it is very difficult to be sure what the best thing is. I am also in that position.

    I wish you well. Let us know what you decide, we'll be here supporting you, whatever it is.
  • Hi there,

    I think others have good advice. I switched doctors and he wanted to monitor me through the holidays and I developed pain in my other leg (right leg). He is still planningon the revision on L5-S1 but because of new symptoms he's sending me for another MRI (Tuesday). He is scheduling everything as though the revision is still the right plan but he wants to be sure things are generally the same.

    I have 3 (well 4) apptointments:
    - MRI last one was 2 months ago
    - MRI results consult & Pre-Op appt (trying to do both same day)
    - Revision surgery date*

    * this will only change if he sees a need for fusion due to further hernation.

    So it's important you tell the doctor what you are feeling. I also spoke to my new surgeon about my concerns about heading into surgery and him needing to do more than planned. If you have another meeting with him, let him know your concers.

    Also, ask him what HIS success rate is with revision Microdiscectomies.
  • Christine,I just want to tell you how much I admire you in continuing in your nursing----you are helping people at the risk of your own health-----I wish you the best,and please keep us posted Jeannie
  • What is your doctor's definition of light duty? What is your employer's definition of light duty?

    Gwennie put it so well...you may think you are lifting a certain amount of weight..such as a 20 lb child, but what if the child tried to leap out of your arms, or the person pushing the bed ran into the wall and you had to do something unexpected, or fell. These are the things that you have to think about, and protect yourself from as a nurse.

  • Hi Lisa,

    My light duty restrictions are "no bending or twisting; no lifting greater than 10 pounds. No prolonged sitting."

    This is pretty much verbatim what my doctor's note said and my employer agreed that they could comply with these restrictions. I basically explained to my pain management doc what seemed to irritate me the most at work. I have had a very hard time leaning over my patients cribs & beds due to the angle...I also had a hard time sitting down to chart on my patients. My employer always has me in the charge nurse position so I rarely perform direct patient care (I do help pass meds and feed the little babies...the "light stuff"). This last shift I worked was bascially a night from h*ll. The 20 pound patient was very sick (he wasn't fighting me)...I had to make judgement call and just hold him myself because of the situation. Really I guess the overall experience just reinforced that I do need surgery. I only have 3 more shifts to work until my surgery date.

    I try to protect myself but in an emergency situation (i.e. if a patient required CPR) I would do whatever it took to help the patient and deal with the consequences later. It was very interesting when I came back to work after my Micro-D two years ago...I had to renew my CPR certification my first month back. I wasn't comfortable bending over the tables to perform chest compressions & rescue breaths on the different dolls so we put them on top of the garbage can!

    sleeprgirl said:
    What is your doctor's definition of light duty? What is your employer's definition of light duty?

    Gwennie put it so well...you may think you are lifting a certain amount of weight..such as a 20 lb child, but what if the child tried to leap out of your arms, or the person pushing the bed ran into the wall and you had to do something unexpected, or fell. These are the things that you have to think about, and protect yourself from as a nurse.

  • I appreciate your comment so much! :)

    For now, my fingers are crossed not to catch a bug from the kiddos at work before my surgery date!
  • Do you have your revision surgery date yet? You and I have been on pretty much the same track this past month or so...

    I didn't ask him about his success rates with revision micro-d's...he DID tell me my chance for reherniation is ~17%. He explained its not higher because there will be less disc material in the space to cause another reherniation after surgery.

    My mom is pushing me to request that if he has any doubts while he's "in there" (LOL) to go ahead and fuse me! She got that idea because a friend of mine's husband went in for a micro-d and came out with a fusion as they had to obtain emergency consent while he was under anesthesia from his wife because things were way worse than previously thought. My pre-op appt with him is on Tuesday then surgery planned next Tuesday.
  • (didn't realize that was your name)

    I don't have my revision date yet. My surgeon operates on Mondays and he's booked. So they are trying to get me and another 'urgent' case in on another day. They are hoping to call me on Tuesday with the date.

    I'm not urgent but asked to be treated as such b/c I'm very nervous about losing feeling down my other leg. Yes, we are on the same track.

    I think it is worth asking your doctor about the 'doubts'. I had this very discussion with my surgeon. I said "what are the odds you go in, and realize the revision won't work?" He said that has never happened to him. He did remind me my odds of rehernation are 17-20% (which I know). He said he's doing the new MRI b/c I have new symptoms but I was told in December that since my MRI was already a month old, he would probably want a new one just as a final check to be sure I didn't get worse.

    I think you should ask him. I talked to my surgeon for quite some time about this surgery, about how long he think it will last, if he thinks I will get feeling back in my left leg, etc. I also talked to him on what to expect if/when this fails. We talked about his approach to fusions again. On this point I also asked him "What if you go in for 1-level and realize you need to fuse 2?" He said that the ONLY reason he wouldn't know that going in is if he put the screw in and had doubts about how strong the vertabrae was. He did tell me that there might be a chance he'd do MI TLIF and have to cut over to regular TLIF (bigger incision) but he explained why that might happen and gave me the % of time he's had to do that.

    I am still unsure of my decision. I am sure in the sense that if it fails, I will be at peace with fusion. If this MRI shows another herniation, I think I have a new decision on my hands too.

    It's not easy. You have to feel comfortable with what you are doing. So if you are having new symptoms ask him if he thinks it's worth an updated MRI? If he says no, ask him why not? Push for it. Tell him it would give you peace of mind on your final decision and my guess is he will send you for one more MRI>

    I wish you the best. I will let you know how my MRI goes and when I have surgery date. If revision, they are trying to get me scheduled in next 2 weeks.
  • SpineAZSpineAZ WiscPosts: 1,084
    Not sure if this helps or not....but I will tell you that while MRI are great - they don't show all that is going on. After my neck fusion (ACDF) I had some new symptoms. The doctor did an MRI and CT myelogram. He thought I may have a bit of stenosis and a few bone spurs. When I woke up, he told me that the stenosis was way worse than it showed on any of the tests and that there were far more bone spurs than he saw on the tests as well.

    For this same reason I am telling my doctor, before my upcoming fusion surgery "do whatever you need to once you get in there". Now that's easy for me to say since he's booked me for nearly a whole day for surgery so he can work on stuff that doesn't show up in tests.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Well, I saw my surgeon last week. It sounds like he is planning a subtotal discectomy which is more extensive than a limited discectomy. From my research it seems the subtotal discectomys are associated with lower recurrence rates but longer recovery times and less relief of back pain. He told me to expect to be in the hospital for 4-5 days. He said I'd be up that night and start working with PT the next day. This is quite a bit different from my last surgery but I guess its really his preference. (He seems to be a bit more "old school" as the kids say LOL)

    I talked to him about the need for fusion and he again assured me that fusion would not be ideal or necessary right now. He also broke the news to me that he's relocating out of state at the end of March! He has a partner who will assume my care when he leaves. I discovered that my NS is not spine-specialty trained but his partner is. This is reassuring that if I do need a fusion in the future I have some one to see at least!

    Now I'm just getting everything ready for Tuesday. I worked my last shift on Friday night! The pain has really kicked in after working those two nights in a row then I had to start my laundry marathon so I don't leave my boyfriend with even more stuff to do post-op! (He's been a saint helping with most of the cleaning, especially taking care of the kitty box).

    Thanks guys!

  • We'll be thinking of you Christine. Hope it all goes well and that you will soon be on the way to a stronger back.

    We'll look out for you when you post after the surgery, telling us that it has all gone well and you are coping well. :)
  • Just finishing up the last load of laundry. I only have 1 hour left to drink and hopefully I'll get in a nice nap. My sleep schedule is all out of whack (love working those night shifts!) so I'm going to try to sleep while I can't drink anything! Getting my goodies together. We stopped at Wal-Mart for puzzle books for my boyfriend and mom to work on while I'm in the OR and I got a Chelsea Handler book to keep me amused post-op (not that I'll be able to read anything for a few days! LOL). :)

  • Hope all is going well for you and that you will have a smooth road to recovery.

    Let us know, when you are able to, how you are getting on.

    Take care
  • I'm sorry I didn't see this to wish you well.
    Thanks for posting...I've been keeping an eye out for you.

    I'm glad you got clarity.
    I'm going to talk to my doctor tomorrow for final details of my surgery.

    I'm thinking of you and hoping all went well. I'll keep checking back to see how you are.

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