1. L2/3 Shallow right paracentral disc protrusion – no stenosis
2. L3/4 Shallow diffuse disc bulge – this disc bulge is asymmetric towards the left. There is mild left neuroforaminal stenosis on today’s exam
3. L4/5 disc space narrowing. Stable disc bulge asymmetric towards right laterally. There is stable bilateral facet anthropathy, slightly more pronounced than right. Right ligamentous hypertrophy is again noted. There is mild central canal stenosis, mild right lateral recess stenosis, moderate right neuroforaminal stenosis and mild left neuroforaminal stenosis
4. L5/S1 – Status post left hemilaminotomy with resection ligamentum flavum. It appears as though there has been interval partial medial left medial facetectomy. Significant disc space narrowing. Recurrent disc bulge asymmetric toward the left. There is moderate left neuroforaminal stenosis. Soft tissue intensity material within left lateral recess which may represent epidural fibrosis.
Do I need a spinal fusion?
To determine if you need surgery, you'll need appointments with surgical specialists.
Find a couple of good surgeons who operate on maybe only 10% of the people who see them -- you want a doc who is conservative about surgery. You have to ask around in the medical community for this info -- from your pain doc, your PCP, your pain psychologist, PTs -- ask.
Also, you need at least one second opinion, and I'd seek 2 or more until I had a thorough understanding of the condition of my back, the risks and benefits of surgery. I'd want to know the risk of increased pain from surgery. I'd want to know the odds for decreased pain.
From what I read, all of your stenosis is in the mild range (lowest), which means that you can try many other treatments first.
For instance, find an interventional pain and spine doctor and see what kind of treatment they can offer.
Surgery should always be reserved as a last resort when more conservative treatments have failed.
Thank you so much for your response - I have two Surgeon consults in the next two weeks.
One more question please, you mentioned that the stenosis is at a minimum, but what does both the L4/5 moderate right neuroforaminal stenosis and L5/S1 Significant disc space narrowing, and moderate left neuroforaminal stenosis mean? Is this a different kind of stenosis?
Also my pain doctor has put me on a new medicine Gabapentin which has helped me to get some rest finally.
I still experience sciatica I think its from the tissue intensity material that remains from the original accident
That impression was: Interval development of a focal left subarticular zone disc extrusion and/or sequestration at L5-S1 producing left S1 nerve root compression and medial displacement of the traversing left S2 nerve root. The surgeon unfortunately was not able to remove the disc material as it had adhered to the nerve roots - so it seems to stay inflamed. My prayer is that they can remove it or remove most of the mass so that its not so compressed :( Any words of wisdom please?
Nerve roots exit on both sides of the spine then branch multiple times to innervate the body -- this called the peripheral nervous system. The nerve roots exit between the vertebrae in a space called the neural foramen.
Foraminal stenosis is a narrowing of that space, and placing pressure on the nerve root. This can cause radiating pain -- radiculopathy -- to the areas innervated by that particular nerve root. We call this neuorpathic pain, and gabapentin is effective against this kind of pain.
Depending on the extent and source of the stenosis, a good physical therapist can often help this condition. Interventional treatments, like steroid injections may be usefull, and as a last resort, surgery may help.
It is important to treat to prevent damage to the nerve root -- especially its myelin sheath.
The S1 issue is problematic. Extruded disc material is a common cause of foraminal stenosis. If surgery hasn't worked, (and I don't blame the surgeon for staying away from the nerve root), have you tried steroid injections to reduce inflammation?
You'll find more information on foraminal stenosis on two sites I like from qualified spine surgeons -- www.drdillin.com and the website of Dr. Donald Corenman (at the Steadman Clinic in Vail Colorado) -- I don't have his website, so you'll have to look it up.
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