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Post-Laminectomy/Discectomy Pain
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Post-Laminectomy/Discectomy Pain

Hello. I am a 34 year old male. I was in a head-on collision in October 2004 while I was stopped at a traffic light. Originally I had cervical and lumbar pain. Then I started to get a lot of numbness and pain in me left leg and foot. For the first year I saw an orthopedic surgeon who tried conservative treatments including physical therapy, acupuncture, trigger point injections and use of a tens unit and other orthopedic devices. My pain and numbness continued to get worse and I was given a referral to a pain management doctor who treated me with epidural injections and S/I injections. These helped with the pain, but after approximately 10 of them, I was no longer getting relief. That doctor sent me to a neurosurgeon and I had spine surgery in October 2006. I developed an infection post-surgery.  In November 2006 I had a spine debridement surgery to get rid of the infection. Since then I have had horrible pain. I am still on disability from work and I have difficulty sitting or doing almost anything without an increase in pain. The pain and my frustration with not being back to normal have left me depressed, so I have started to see a psychologist. The psychologist and pain management doctor decided that my depression was largely due to being under-medicated and they adjusted my medications. I am also back to having epidurals and S/I injections. Thank you in advance for your suggestions and I
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MRI LUIVIBAR SPINE WITH AND WITHOUT CONTRAST MATERIAL
HISTORY: Patient is status post lumbar spine surgery for disc herniation. The patient reportedly developed a postoperative infection and is status post debridement of infection on 11/7/06. The surgery was performed in 10/06. The Patient complained of foot numbness.

TECHNIQUE: MRI examination of the lumbar spine was performed both without and following intravenous administration of gadolinium. Comparison is made with a preoperative study performed 5/31/06.

FINDINGS: The patient had a left-sided laminectomy at the L5-S1 level. On T1 weighted images, there is intermediate signal intensity material seen in the posterior paraspinal tissues on the left side at the L5-S1 level with intermediate signal
intensity material seen within the left side of the spinal canal. This is consistent with scar tissue which demonstrate enhancement following gadolinium administration. Of note, however, there is a fluid signal intensity lesion seen in the region of the left lateral recess at the L5-S1 level which is high signal intensity on T2 weighted images and does not demonstrate enhancement following gadolinium administration . This is contiguous with the disc and is suspected to represent herniated disc material. Differential diagnosis for this finding may reflect a small postoperative arachnoid cyst. Alternatively, given the history of postoperative infection, small epidural abscess would also be in the differential diagnosis. There is no significant mass effect or compression of the thecal sac at the L5-S1 level. The nerve roots are not clumped. There is still posterior disc protrusion seen at L5-S1 and there is at least at mild-to-moderate degree of bilateral neural foraminal stenosis . No discrete abscess collection is appreciated within the posterior paraspinal musculature at the L5-S1 level. No evidence of increased signal intensity or enhancement within the disc spaces to suggest the presence of discitis. Similarly, no evidence of vertebral body edema to suggest osteomyelitis. There is again a small posterocentral and right paracentral disc herniation seen at the L4-5 level. No significant posterior disc abnormality is seen at the T12-L1, L1-2, L2-3, or L3-4 levels. Conus medullaris is seen at the L2 level and is unremarkable. No abnormal enhancement to the conus medullaris is demonstrated . Similarly, no evidence of abnormal enhancement within the thecal sac.

IMPRESSION: Postoperative changes at the L5-S1 level. There is enhancing scar tissue seen in the left side of the spinal canal no acute distress posterior to the left side of the spine. There is a small fluid signal abnormality seen in the left lateral recess on the current examination . This is suspected to possibly represent herniated disc material which does not demonstrate internal contrast enhancement. Alternatively, given the history of postoperative infection, a small epidural abscess would be difficult to completely exclude. This finding could also represent postoperative change or a postoperative cyst. Clinical correlation and followup examination is suggested.
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