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Neurosurgery (Expert Forum)
Previous fusion,broken screw,sudden pain.narrowing
Answered by
Nassim Abi Chahine, MD - General Neurosurgery
Beirut - Lebanon
Welcome to the International Neurosurgery forum. This forum is moderated by Dr. Abi Chahine who is affiliated with St. George Hospital in Beirut, Lebanon
Previous fusion,broken screw,sudden pain.narrowing
by maharaniie, Sep 21, 2009 01:20PM
Hi Dr,
I had a fusion in 2000 on L5/S1 which was successful but suddenly..
My MRI stated' Previous surgery noted at L5/S1 with intrapedicular screws at L5/S1 levels. Fixed anterolisthesis measuring 4mm of L5 over S1 noted.Narrowing of disc space with vertebral changes which are predominantly fatty are also seen.
"L4/5 There is a small disc protrusion seen measuring 3mm in the anterior posterior plane and 7mm in the transverse plane causing minimal central anterior impression on the thecal sac. There is no attenuation of the nerve roots within the recesses noted."
"L5/S1 There is right sided intervertebral foraminal narrowing seen. This is due to a combination of facet joint hypertrophy and a minimal eccentric disc bulge at this level. This is abutting and causing narrowing of the exiting L5 nerve root, however cut off of the nerve root is not moted. The S1 intrapedicular screws are also going just superior to the S1 nerve roots and are probably abutting medially and superiorly.Cutoff of these nerve roots is not seen (this may be exxagerated due to blooming artifact noted from the intrapedicular scews). The nerve roots within the recesses appear normal. Previous surgery at this level is seen."
"Post gadolinium there is some enhancement noted in the posterior soft tissues at the level of the surgery and the posterior laminectomy.There is no enhancement seen within the spinal canal."
"Complications of surgery were not seen"
Could some one please,please help me to understand these results and potentialities of treatment... I would be so grateful and it would help immensely to ease my panic. I have been in tremendous pain for 8 days now especially in buttocks and right leg.I really just want to know how what the possibilities, if any are. I would happily have surgery if it would relieve the pain and I could stop taking these awfully strong medications.
Many Thanks,
Lise
I had a fusion in 2000 on L5/S1 which was successful but suddenly..
My MRI stated' Previous surgery noted at L5/S1 with intrapedicular screws at L5/S1 levels. Fixed anterolisthesis measuring 4mm of L5 over S1 noted.Narrowing of disc space with vertebral changes which are predominantly fatty are also seen.
"L4/5 There is a small disc protrusion seen measuring 3mm in the anterior posterior plane and 7mm in the transverse plane causing minimal central anterior impression on the thecal sac. There is no attenuation of the nerve roots within the recesses noted."
"L5/S1 There is right sided intervertebral foraminal narrowing seen. This is due to a combination of facet joint hypertrophy and a minimal eccentric disc bulge at this level. This is abutting and causing narrowing of the exiting L5 nerve root, however cut off of the nerve root is not moted. The S1 intrapedicular screws are also going just superior to the S1 nerve roots and are probably abutting medially and superiorly.Cutoff of these nerve roots is not seen (this may be exxagerated due to blooming artifact noted from the intrapedicular scews). The nerve roots within the recesses appear normal. Previous surgery at this level is seen."
"Post gadolinium there is some enhancement noted in the posterior soft tissues at the level of the surgery and the posterior laminectomy.There is no enhancement seen within the spinal canal."
"Complications of surgery were not seen"
Could some one please,please help me to understand these results and potentialities of treatment... I would be so grateful and it would help immensely to ease my panic. I have been in tremendous pain for 8 days now especially in buttocks and right leg.I really just want to know how what the possibilities, if any are. I would happily have surgery if it would relieve the pain and I could stop taking these awfully strong medications.
Many Thanks,
Lise
Doctor's Answer
by Nassim Abi Chahine, MD, Sep 23, 2009 02:52AM
, Sep 23, 2009 02:52AM
You 've contacted me, Dr Nassim, the only neurosurgeon on Medhelp. So I am obliged to do my best to explain for you what you experience; as i understood from you, you had a spine surgery 9 years ago and since that time everything was ok! yes?
So now lastly you experience pain and that what is probably ADJACENT SYNDROME.
this is a nerve or nerves compression at 1 level higher, that level which was not vixed or fused but submitted a higher dose of stress or work ! because it took the role of the immobile level beneath it plus it old role: so it is a big work for such a single joint (lets say 6 degrees of movements plus 5 degrees of movements coming from the fused beneath L5_S1, which the L4_L5 is obliged to take on his own responsability) hope now you understood what is the adjacent syndrome and from where your pain comes. Please contact your local neurosurgeon, for further studies and accurate treatment
Dr Nassim
So now lastly you experience pain and that what is probably ADJACENT SYNDROME.
this is a nerve or nerves compression at 1 level higher, that level which was not vixed or fused but submitted a higher dose of stress or work ! because it took the role of the immobile level beneath it plus it old role: so it is a big work for such a single joint (lets say 6 degrees of movements plus 5 degrees of movements coming from the fused beneath L5_S1, which the L4_L5 is obliged to take on his own responsability) hope now you understood what is the adjacent syndrome and from where your pain comes. Please contact your local neurosurgeon, for further studies and accurate treatment
Dr Nassim
Member Comments (2)
by maharaniie, Sep 21, 2009 01:21PM
P.S. I am 38 years old.
