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Thread: Seroma..help understanding MRI

  1. #1

    Unhappy Seroma..help understanding MRI

    Okay. I had a Lumbar fusion at L5-S1 on June 1st, 2009. I have been having alot of problems since the surgery and Im not getting very far at all. I have no bladder sensation, I have right leg numbness and tingling and leg giving out if Im standing up for extended amount of time. After alot of complaining, my orthosurgeon sent me for an MRI and nerve test. Well when I called for the results the only thing he would tell me is that I had some swelling and to continue therapy and see him back in 5 wks. Well I went and got the report myself cause I wanted to know for myself what it said. Well there is more on it the the doctor ever brought up and I just dont understand it. I did see a neurologist and he wasnt awhole lot of help as he said neurologist usually only work on the head up. But he did mention this seroma that I have and that it was of concern and that I needed to get to a neurosurgeon as soon as possible, and he was really upset that my surgeon hadnt brought it to my attention. Anyways, this is what my MRI says if anybody could help me to understand what it means and how serious I may be looking at things. The neurologist seems to think that if this seroma continues to get bigger it will cause more nerve damage and that where it is located at that the only way to drain it is to go back in and remove the hardware. Anyways heres what the report says.

    FINDINGS At L5-S1, there is a wide laminectomy defect. I believe thee has also been prior anterior interbody fusion. There are posterolateral fusion rods which are transfixed with bilateral pedicle screws at the L5 and S1 levels. There is enhancing granulation/scar tissue surrounding the thecal sac. There is some enhancement of the posterior aspect of the L5-S1 disc space. I do not see destruction of the adjacent vertebral end plates and there is no appreciable marrow edema. There is some end plate spurring at the L5-S1 level. However, I do not see evidence of canal stenosis or nerve root impingement. At the laminectomy site there is a well defined oval shaped fluid collection along the posterior aspect of the thecal sac. This abuts the posterior surface of the thecal sac and measures up to 2.8 cm in diameter. Given the patient's clinical history this may represent a post surgical seroma. However, it should be noted that infection with abscess formation could give an identical appearance and this finding should be correlated clinically.

    Elsewhere, there is minimal end plate spurring at L1-2 and L2-3

    At L4-5, there is desiccation and bulging of the intervertebral disc. This indents the thecal sac anteriorly. There is mild bilateral facet oseoarthritis. This combination is causing mild circumferential narrowing of the spinal canal.

    IMPRESSION At L5-S1, there are post operative and degenerative changes. I do not see evidence of canal stenosis or nerve root impingement. However, there is some enhancement of the posterior portion of the L5-S1 disc space. There is also a well defined oval shaped fluid collection along the posterior aspect of the thecal sac. This measures up to 2.8 cm in diameter. This may represent a post surgical seroma. Maybe helpful in further evaluating.

    Degenerative spondylosis with bulging discs L4-5. This combination is causing mild circumferential narrowing of the spinal canal.


    Sorry I know so long im just wondering whats going on. I was hoping to get better not get worse. Any help would be appreciated. Thanks

    Tanja

  2. #2
    Get a second opinion quickly and respond before it becomes critical.

    When you find a doc for the second opinion tell them it is an emergency or have the neurologist call.

    did an orthopaedic surgeon do all the work or was it a neurosurgeon/ortho team, if a team call the neurosurgeon.

    i wouldn't wait after enough time the nerve roots become permanently damaged (speaking from personal experience).

    good luck

    Bill

    all that I am is all gone

  3. #3
    I have asked Dr Young to respond.
    AAD

  4. #4
    Quote Originally Posted by tanja37766 View Post
    Okay. I had a Lumbar fusion at L5-S1 on June 1st, 2009. I have been having alot of problems since the surgery and Im not getting very far at all. I have no bladder sensation, I have right leg numbness and tingling and leg giving out if Im standing up for extended amount of time. After alot of complaining, my orthosurgeon sent me for an MRI and nerve test. Well when I called for the results the only thing he would tell me is that I had some swelling and to continue therapy and see him back in 5 wks. Well I went and got the report myself cause I wanted to know for myself what it said. Well there is more on it the the doctor ever brought up and I just dont understand it. I did see a neurologist and he wasnt awhole lot of help as he said neurologist usually only work on the head up. But he did mention this seroma that I have and that it was of concern and that I needed to get to a neurosurgeon as soon as possible, and he was really upset that my surgeon hadnt brought it to my attention. Anyways, this is what my MRI says if anybody could help me to understand what it means and how serious I may be looking at things. The neurologist seems to think that if this seroma continues to get bigger it will cause more nerve damage and that where it is located at that the only way to drain it is to go back in and remove the hardware. Anyways heres what the report says.

    FINDINGS At L5-S1, there is a wide laminectomy defect. I believe thee has also been prior anterior interbody fusion. There are posterolateral fusion rods which are transfixed with bilateral pedicle screws at the L5 and S1 levels. There is enhancing granulation/scar tissue surrounding the thecal sac. There is some enhancement of the posterior aspect of the L5-S1 disc space. I do not see destruction of the adjacent vertebral end plates and there is no appreciable marrow edema. There is some end plate spurring at the L5-S1 level. However, I do not see evidence of canal stenosis or nerve root impingement. At the laminectomy site there is a well defined oval shaped fluid collection along the posterior aspect of the thecal sac. This abuts the posterior surface of the thecal sac and measures up to 2.8 cm in diameter. Given the patient's clinical history this may represent a post surgical seroma. However, it should be noted that infection with abscess formation could give an identical appearance and this finding should be correlated clinically.

    Elsewhere, there is minimal end plate spurring at L1-2 and L2-3

    At L4-5, there is desiccation and bulging of the intervertebral disc. This indents the thecal sac anteriorly. There is mild bilateral facet oseoarthritis. This combination is causing mild circumferential narrowing of the spinal canal.

    IMPRESSION At L5-S1, there are post operative and degenerative changes. I do not see evidence of canal stenosis or nerve root impingement. However, there is some enhancement of the posterior portion of the L5-S1 disc space. There is also a well defined oval shaped fluid collection along the posterior aspect of the thecal sac. This measures up to 2.8 cm in diameter. This may represent a post surgical seroma. Maybe helpful in further evaluating.

    Degenerative spondylosis with bulging discs L4-5. This combination is causing mild circumferential narrowing of the spinal canal.


    Sorry I know so long im just wondering whats going on. I was hoping to get better not get worse. Any help would be appreciated. Thanks

    Tanja
    Tanja,

    There is no emergency. While some of the rambling report may seem to be alarming, most of it is routine post-operative changes, pre-operative, and do not suggest the need for emergency or other surgical intervention. So, let me try to interpret it as best as I can.

    1. "At L5-S1, there is a wide laminectomy defect." This indicates that you have had a laminectomy operation, where the lamina (the posterior bone covering the spinal cord) had been removed.

    2. "There are posterolateral fusion rods which are transfixed with bilateral pedicle screws at the L5 and S1 levels." These are rods that were placed by the surgeon. This is standard.

    3. "There is enhancing granulation/scar tissue surrounding the thecal sac."
    I question this interpretation. What the radiologist might be seeing is fat tissue. Granulation or scar tissue do not typically enhance and it is too early for such tissues to have developed. This statement suggests that the radiologist is not very experienced with reading postoperative MRI scans.

    4. "There is some enhancement of the posterior aspect of the L5-S1 disc space. I do not see destruction of the adjacent vertebral end plates and there is no appreciable marrow edema. There is some end plate spurring at the L5-S1 level. However, I do not see evidence of canal stenosis or nerve root impingement."
    • All these words basically say is that the radiologist does not see a significant problem with the L5-S1 disc.

    5. "At the laminectomy site there is a well defined oval shaped fluid collection along the posterior aspect of the thecal sac. This abuts the posterior surface of the thecal sac and measures up to 2.8 cm in diameter. Given the patient's clinical history this may represent a post surgical seroma. However, it should be noted that infection with abscess formation could give an identical appearance and this finding should be correlated clinically."
    • Other that describing an area of fluid collection, this is a verbose description and overly alarming description of a common situation after surgery. After surgery, there is often fluid collection around a laminectomy site. This is sometimes called a seroma and it usually disappears after several weeks. If there is no evidence of pain and fever, this should not be interpreted as an abscess. If there is no evidence of any pain, fever, or neurological loss, nothing should be done about this. If you are worried about this, it might be worthwhile to get another MRI in several months but that would only be to reassure you and, in my opinion, is not necessary.

    6. "Elsewhere, there is minimal end plate spurring at L1-2 and L2-3. At L4-5, there is desiccation and bulging of the intervertebral disc. This indents the thecal sac anteriorly. There is mild bilateral facet oseoarthritis. This combination is causing mild circumferential narrowing of the spinal canal."
    • I don't know why this radiologist wants to even mention "minimal end plate spurring". Dessication is a word that radiologists use for reduction in MRI signal (since increased water has greater signal, dessication suggests less water and less signal) to suggest some degeneration of the disc. I also don't know what he means by "mild circumferential narrowing of the spinal canal". I wouldn't worry about this. Many people have these mild and minor changes and they don't represent a problem.

    The above MRI report provide little or no explanation for your symptoms. For example, it is not at all clear to me why you have "no bladder sensation" or why you have "right leg numbness and tingling and leg giving out if Im standing up for extended amount of time." None of the findings on the MRI suggest that there is current compression of your spinal cord. What were your symptoms when you went for the surgery? Was there compression of your spinal cord?

    Wise.

  5. #5
    The only symptom I had before surgery was constant lower back pain. When MRI was done it was found that I had a fracture at L5-S1 and spondylolisthesis.

    Heres my question then I had this MRI almost 3mths post op so how come I have the seroma still? Also I did see a neurologist who said the seroma was pushing on the nerves that goto my bladder which is why he believed I was having the trouble. However, he said it wasnt his speciality for me to see a neurosurgeon.

    An orthosurgeon is the one who did my surgery.

    Thanks for the replies.

    Tanja

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