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Ct scan results -comments?

thenadetthenade Posts: 137
edited 06/11/2012 - 7:40 AM in Back Surgery and Neck Surgery
I know we are not medical professionals but just wondering if anyone can make some general comments on my ct scan and what it means. When I see the neurosurgeon I want to be armed with intelligent questions. Questions that will help provide some answers for my pain.

Indication- Post op L4/5 fusion,worsening radical symptoms.

L2/3 is normal
At L3/4 no discogenic abnormalities seen. There is mild bilateral facet OA.

An instrumented fusion posteriorly has been carried out between L4 and L5 with a right hemi laminectomy at L4 and prosthetic disc material at the L4/L5 space.

A left posterolateral disc protrusion at L4/5 is present slightly deformed in the thecal sac but does not impinge the
L4 root and I doubt there is any impingement of the L5 root. The laminectomy decompression is adequate and note is made of a small residual facet osteophyte abutting the L5 nerve root sleeve and again I doubt this is significant but some correlation would be helpful.

At L5/S1 there is diffuse disc bulge without significant mass effect. Mild bilateral facet OA is present.

Impression: No residual central stenosis. A large dominant new disc protrusion is not seen with only a small protrusion on the left at L4/L5. Some clinical correlation would be helpful in this case.


  • What type of pain are you experiencing? Is it the same as before surgery? How soon did it start post-surgery?
  • This is what's happening. Week 1 and 2 and maybe part of three I had surgical pain. Not too bad. Was walking everyday. Sometimes up to 1 and 1/2 hours. Observed no blt rule. Did take trips in car(not driving) max 20 min each way to go to mall. Very rainy here at times and not able to walk outside so walked indoors. About week 3 I noticed some of previous nerve pain in right leg returning. Also when I walked my left leg seemed to get a pulled muscle feeling in calf.(Main problem pre surgery was right leg) Finally figured out not pulled muscle cause also had tingling and pins and needles. Later strange sensations like both feet start burning, different burning areas in legs e.i. front,side and back of thighs, same with calfs. The sensations are ever changing and do not always follow a particular nerve route pattern. All positions produce some type of pain. Seems to be very little muscular pain, always the burning, stinging nerve pain.
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  • Do you know if the surgeon tried to realign your spine at the area where you had the anterolisthesis? Do you notice any change to the surface of your skin in the areas where there is burning pain?

    I know exactly what type of pain you are talking about...and it is very frustrating to go through all this, and then to come out with different pain than what you had pre-surgery.

    The usual line is that it will probably resolve in time. Nerves have been handled and/or stretched...they are angry...they will take a long time to settle down, and if there was any damage, it will take a very long time to regenerate.

    Things to ask your surgeon: whether it could be scar tissue or "epidural fibrosis" that is attaching to a nerve, or otherwise? Sometimes when the pain lessens and then three to six weeks out, there is new pain it can be the result of scar tissue formation.

    Let's see...my amateur understanding of your scan is that there are mild degenerative changes that are a result of spinal arthritis. This is noted on the facets at L3-4 and L5-S1. These can be little nodules or bone spurs and he indicates he does not think they are causing any impingement. (noticed but likely not a source of pain generation)

    There is a slight disc bulge at L4-5 on the left side -- the opposite side from where the laminectomy was performed. It appears not to be compressing the L4 nerve root, and probably not compressing or abutting the L5 nerve root...but he wants other "correlation" (like, more testing) to be sure. Then the radiologist indicates that at L5 there is a small bit of osteophyte (bone spur) on the facet abutting the L5 nerve root sleeve. Again he indicates it is probably insignificant, but worth checking out further.

    In conclusion he states that the central stenosis was cleared out during surgery and there is no new disc protrusion. There is only the small protrusion on the left at L4-5 that he suggests the doctor might want to get more detail about. ("clinical correlation")

    Does that help any?
  • You are always so ready to help and answer questions.
    I believe he realigned and stabilized my spine. I don't notice any changes to the surface of the skin in the burning areas. When my feet burn they throb. Yes I have already heard at my previous appt with the neuro that nerves can take up to 12 months to regenerate, sometimes they only come back 60% and also they sometimes get a memory of the pain and it stays. I asked him if he had removed all of my disc at L4 and L5 and he said as much as he could from that approach. Looks like there is some left. Don't understand the"slightly deformed in the thecal sac." Sounds scary. Also looks like there is a small bone spur left. Anyways prior to surgery I asked him about scar tissue. He said "Don't worry about it" Seems like surgeons don't like to talk about it. Was it too early for it to show up in the CT or does it even show up? Did any show up on your post surgery imaging? How have you been doing lately? Any plans for more surgery or are you still researching your options?
  • From my experience and from others with whom I have talked, it seems like most of our surgeons do not talk about scar tissue. I had an experience with the surgeon who did my fusion that was amusing. I was very concerned with scar tissue. Nine months after surgery I was still having nerve pain. He ordered a MRI and when I went in to review it, we stood shoulder to shoulder looking at it. He went over a variety of things, never mentioning "epidural fibrosis" or scar tissue. I even specifically asked about it and he waved me off.

    Later that night I looked online at my electronic medical chart from that clinic and saw that my MRI report was posted. Imagine my utter shock when the most significant item mentioned was "extensive epidural fibrosis...". We were going on vacation in a day or two, so I sat down and wrote a letter to him expressing my shock at this finding...why hadn't he told me...what did it mean...here I had trusted him and now I see this, etc. I suppose I sounded fairly dramatic. @) Then I mailed it and kind of forgot about it. A couple days later my husband and I were in the middle of nowhere in the middle of a forest when my cell phone rang. It was my surgeon calling to talk about my letter. We talked for about a half hour and it was very weird. He was very different on the phone than in person -- very business-like, like he was talking with another doctor, using all kinds of medical language....it was strange. He had really taken offense by my implying that I could no longer trust him.

    Anyway, eventually I calmed down and eventually I started to believe that it was not as big a deal as I had thought...that it wasn't causing my problems, etc. This was sixteen months ago.

    A week ago I went to a neurosurgeon at a well-known neuroresearch center for a consultation. Things were going along pretty much as anticipated when, totally in passing, he mentioned something about arachnoiditis...and again, I really flipped out. It is the same as what the radiologist labeled "epidural fibrosis," except that a diagnosis of arachnoiditis is much worse. I see my other surgeon (surgeon # 2) Monday and I can't wait to ask him about it. The only thing is I will have to tell him I had an appointment with this neurosurgeon and I'm not sure how he'll react to that....anyway, I completely digress. Sorry.

    Back to you: one problem with minimally invasive surgery is that sometimes it is impossible to "get everything." In an open surgery he might have noticed that there was some tissue on the opposite side (if it was even there at the time of your surgery, which is not a given).

    You wrote: " Don't understand the"slightly deformed in the thecal sac." Sounds scary. Also looks like there is a small bone spur left. "The thecal sac is just an extension of the spinal cord...but below about L1-2, the spinal nerves are contained within a softer membrane which is the thecal sac. (The actual spinal cord stops at about L1-2 and the continuation is called the thecal sac.) When a disc below L2 bulges, it can press into the side of the thecal sac...which in turn gives way and presses on the nerve that is contained within the thecal sac. It isn't scary. It is a common occurance and can be resolved by the bulge healing on its own or by having a discectomy or possibly another procedure.

    Scar tissue shows up clearly on MRI....if you had the CT scan with contrast, it should also show up. Without contrast, it is hard to differentiate between scar tissue and herniated disc material.

    I'm done with my research. I will go back to Surgeon # 2 for a 3 level open fusion (PLIF). He'll go in over the same incision, will remove rods from my L4-5 fusion, will check to see screws are tight, will put in screws at L5, S1, L3, L4 and then will run rods from L3 to S1. He is not removing the discs at L3-4 and L5-S1 (this is the part I need to ask him about).

    When he gave me the recovery times, I told him his times were shorter than what I did with a one level fusion...so I am skeptical. Oh, and I'll have a brace this time. Surgeon # 1 does not believe in using braces. I will be going to a third hospital...so all in all, some things will be new and different. I wouldn't want to be bored by the whole experience. ;) I just haven't decided on a date.

    I had my other two surgeries in January. Since I live in the frozen northland, it is not a great time for trying to recover with all the ice and snow on the roads...and it has been running around zero! Yippee!! I think I will wait a bit longer this time, but I haven't decided how much longer I can wait!!

    Sorry this is so long...I don't usually write about my issues.

    Oh, one more thing...if he did realign, I think you are more sore and possibly have more nerve pain than people who were stable to begin with. The soft tissue has more adjustment to go through...and everything has to learn a new placement. Some ligaments have to stretch and lengthen; some will shorten. Same goes for muscles, etc. Alignment will be different. You will most likely carry yourself differently. If you were compensating for pain, it has changed your posture and you will need to make adjustments to get realigned properly to protect the integrity of the rest of your spine.

    OK, enough!!
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  • Thanks again, especially sharing your personal experiences. This is how we can learn on this forum.
    I was advised by the tech at the time of my CT that they would have to use dye as I had surgery and that's the only way to tell if it's disc or scar tissue problems. Nothing was mentioned on the report about scar tissue but maybe it was not visible at 10 weeks. I think surgeons may not like to talk about scar tissue because #1 it may somehow reflect on their surgical skills or #2 they know that not too much can be done about it. How did your last surgeon even come up with the word arachnoiditis? That's scary stuff. Are you having your fusion for an instability problem?

    Yes recovery when the weather is bad can be difficult. Hard to walk outside with ice and snow. I live just outside Vancouver. The Olympics will be starting here in about a month. We have had tons of rain, no snow on the ground. But there is alot in the mountains and they have those snow making machines going 24/7.
  • I think they don't want to talk about it because nothing can really be done about it -- at least not at this point.

    I was thinking of having my surgery so I would be home in time to watch the Olympics...Then I would have non-stop entertainment for two solid weeks while recovering. I enjoy the Winter Olympics a lot!

    My surgery is really pretty experimental. More than normal, the doctor really has no idea if it will help with my nerve pain, or not. My problem just may be that the nerve itself is scarred and cannot make a proper connection, and as a result it just fires all the time, the way a faulty electrical line can spark when not properly connected.

    I bet your scar tissue was visible at 10 weeks. It almost always has formed by then. It may not be significant, or an issue. We all have scar tissue...it's just whether it attaches to a nerve, or attaches an organ to somewhere it should not be, etc.

    Will you be attending any of the Olympic events??
  • Is your leg pain in both legs? It is driving me batty not knowing why I have this pain again and I'm only 3 months into the process. It doesn't help that the surgeon's office won't get back to me or my doctor. Although I don't know what he can do for me at this point. I'm wondering if a course of anti-inflammatories would help? I know they aren't good for the fusion process. Please keep us posted as to what you find out at your next appt. I'll be enjoying the Olympics in front of the TV. Tickets were hard to come buy. It was a very confusing process one had to go through just to be eligible to try and buy tickets. But the shape I am in I'd never make it to the event. Well at least the broadcasts will be live. No delay due to time zones.
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