Mri results please help me

[gm74sm]

Me to understand this.
Lumbar vertebrae are normal in height and alignment. Marrow signal is unremarkable except for degenerative end plate changes at L5-s1. The conus is normal in position and appearance.

The L1-2 level shows mild diffuse disc bulging without disc protrusion.
L2-3 shows mild diffuse disc bulging without disc protrusion.
L3-4 is unremarkable except for mild facet arthropathy.
L4-5 shows mild diffuse disc bulging without disc protrusion.\
At L5-s1, the patient is postop left hemilaminectomy. There is an anterior extradural defect centrally consistent with a broad based disc protrusion. This is considerably amaller than the large disc protrusion/extrusion seen on the 12/2003 scan. This does not show post gadolonium enhancement, and is not felt to represent epidural scarring: some epidural scarring is evident laterally. There is slight lateralization to the left of the midline.

Impression:
Degenerative disc disease and associated changes, L4-s1, with post left hemilaminectomy changes.
Broad based central disc protrusion at L5-s1:this is considerably smaller than the large disc protrusion seen on prior mri od 12/03. but does not efface the ventral aspect of the dural sac somewhat. Clinical correlation will be necessary. A post myelogram CT might also be helpful. There is slight lateralization to the left of the midline. There is mild epidural scarring along the lateral aspect of the dural sac on the left.
So what does this mean? Any info is appreciated..I have been having muscle spasms lately and couldnt straighten up to stand. Some better now. My GP is little or no help and isnt saying anything about anything further even after this MRI so what should I do now if anything? Thanks Stephanie

[Wise Young]

stephanie,

From the MRI description, you had a large L5/S1 disc herniation that compressed your spinal cord on 12/03. Your postop MRI shows that you had a left hemi-laminectomy (exposure of the left half of the spinal cord at L5/S1) and the disc is mostly gone and is no longer indenting the spinal cord. There may be some scarring of the dura on the left side.

The questions that a clinician would be asking is whether or not you still have compression of the spinal cord and whether there is any surgical that could be done. The answer to both question, based on the MRI description, is no. The muscle spasms that you are feeling and inability to straighten up is probably a residue of the surgery and not due to something happening in the spinal cord.

What is your neurological function? Do you have any sensory loss, weakness, and how has that changed since your surgery. Are you getting physical therapy and are you able to get up?

Wise.

[gm74sm]

Thank you for explaining this. I have posted here a few times before this injury left me with Cauda Equina Syndrome bowel, bladder affected. I am numb in saddle area back of left leg all the way to bottom and outter side of foot. I have regained bladder function but not bowel function. I have been going to PT once a week for the last year to strengthen back and legs because legs are weak but have improved greatly. I think mostly due to my losing 60 pounds though. So with the minor disk bulges is there anything that I can do other than to be careful.

[metronycguy]

you probably need a physiatrist that specializes in this to follow your care and follow up treatments

[gm74sm]

Thank you for the response. However I have one other question regarding the mri report. Everything is the same in the report except for one part that I mistyped. The sentence was suppose to read. "Broad based central disn protrusion at L5 s1; this is considerably smaller than the large disc protrusion seen on the prior mri of 12/03, BUT DOES EFFACE THE VENTRAL ASPECT OF THE DURAL SAC SOMEWHAT" and I typed does not but it says "does". Would that make any difference? I am scheduled to see my NS tomorrow. In the past few weeks its sort of come and go with extreme back pain. However now I am having some more leg weakness in the left leg and my toes on the right foot are going to sleep when I walk. Would I be at risk at further damage to the Cauda Equina nerves with what is described in the mri. I am super scared of further damage to the cauda equina and wanted to see if that would make any difference. Thank You

[metronycguy]

your ns should explain this too you tomorrow if you ask him at the appointment, i always bring a list of questions written down to ask the doc when i see them, so easy to lose the train of thought in there,
i have found that neurosurgeons concentrate on surgery , they usually hand you off to pain management and physitrist for your future care

[gm74sm]

Thanks for replying. I saw my NS. He is sending me to the pain clinic for a Epidural steroid shot I think thats what it is. And he wants to see me in 3 weeks to see my results but he is telling me that he thinks I need a fusion at L5 s1 and to prepare for that. So Im off to research this. Im scared needless to say.

[metronycguy]

did you keep up with the pt core exercises and and all the pt stuff? i find that is very important for my lumbar injuries. i slacked off for a bit, i was still exercising bicycle riding and swimming, but i returned to pt and they said i really need do my hamstring stretches daily, and core exercise on the Styrofoam log and big ball almost daily ,
i wish i could be fused and have my back stabilsed , but i saw my ns in September and he said its not worth the risk at this point. he would have to go back into the areas that were already traumatized and i woulkd come out with less function, nothing gained