Please review my MRI reports, as my radiologist suspects foraminal stenosis.

Hi,

Welcome to icliniq.com.

I understand your concern.

I am sorry to hear about your ordeal, particularly when problems worsened following surgery. From the MRI (magnetic resonance imaging) images (attachments removed to protect the patient's identity) stenosis can be seen.

Nerve inflammation will always present for a few days or weeks after spinal surgery. Perhaps the surgeon plans to wait for the surgical inflammation to be resolved so that the residual effect of the compression can be evaluated as tolerable, acceptable, or unacceptable. Also, I would like to assure you that there is nerve compression and inflammation, which we can give some time to heal and observe. On the contrary, there is no sign of infection, so we would have to call it a "failed back surgery" straight away.

Otherwise, I think there is no discrepancy between the radiology report and the surgeon's comments once you can perceive the context of it, as I described above.

Hello,

Welcome back to icliniq.com.

My replies below are numbered according to your follow-up questions.

1. The operative area and relevant changes (foraminotomy, facetectomy, laminotomy) are clearly identified from the images (attachmements removed to protect the patient's identity). However, the nerve exit areas are still compressed on both sides, and that is by disc herniation. Now, you did not make any mention of discectomy. Does that mean that the surgeon did not remove the disc portions? Perhaps the disc herniation was not evident in the pre-operative MRI (magnetic resonance imaging). I cannot make that comment since I did not see the pre-operative images.
2. The bright round area in the soft tissue planes may be a cyst or a blister and is not significantly related to your present matters.
3. Spine surgery is a place of very low vascularity, so whatever medicines you take, very little arrives at the affected area. So, you can check with your treating doctor and follow their advice regarding NSAIDs (non-steroidal anti-inflammatory drugs), steroids, etc.

Hello,

Welcome back to icliniq.com.

After reviewing the preoperative MRI (magnetic resonance imaging) images (attachments removed to protect the patient's identity), and comparing it with the present, I infer the following:

1. Condition of the disc is the same as before, which is, compressing upon the nerve roots at present, just similar to earlier.
2. The surgical steps that were done (foraminotomy, hemi-laminotomy, and partial facetectomy) have made little or no relief to the compressed nerve roots.
3. The possible cyst or blister is near the skin, far away from the nerve roots.

So, now, after looking at all the images and considering the overall scenario (4.5 weeks post-surgery, the pain still persists), I just feel that the herniated portions of the disc are the actual culprit. Therefore, if the respective surgeons consider it, there may be a need for repeat surgery for the discs. Obviously, mine is only an opinion, but the proper decision for this will be made by an expert neurosurgeon or a spine surgeon.

Hello,

Welcome back to icliniq.com.

1. If you have been having redness, swelling, pain, etc. involving the overlying skin or muscles, it indicates that the cyst or blister has become infected, i.e., formed an abscess. And that may mean the incision line is also prone to or already infected. In consequence, the infection may then extend to the operative site, which is, foramen and nerves. That may be the reason for the edema or cystic appearance around the nerve roots.

In that context, I suggest you visit a hospital and get MRI (magnetic resonance imaging) with contrast if doctors find it appropriate.

2. You may be aware that each disc comes in proximity with two pairs of nerve roots that it can compress; one pair that exits through the foramen at this level, and another pair that "traverses" past the disc and exits through the foramina one level below. On an MRI, which set of nerve roots is compressed by the disc is evaluated on the sagittal images, usually T2, and T1 and STIR also help.

So, if I would describe your nerve root compressions in a report, I would write like the following:

Pre-operative : Curvilinear T2-hyperintensity along posterior disc margin at disc level, involving central and left subarticular zones; annular tear. Circumferential disc bulge at the disc and suprapedicle levels, involving central as well as bilateral subarticular and foraminal zones, producing flattening of posterior disc margin and indentation upon thecal sac (no spinal canal stenosis) with narrowing of lateral recesses and neural foramina on both sides compressing corresponding traversing nerve roots on both sides as well as exiting nerve root on the left side.

Post-operative: Compressing corresponding traversing and exiting nerve roots on both sides. You may recollect that your post-operative MRI (magnetic resonance imaging) report indicated that the foraminal stenosis was worse. I hope these explanations be of benefit to you and would be glad to explain further as necessary.