Is nerve compression seen on my MRI or was it assumed because of pain?

Question

Hello doctor,

Ten months after hemilaminectomy at the L4-5 level, I suffered from severe pain in the lower back, which started radiating to the left leg. I have a diagnosis of arachnoiditis, arthritis, and low lying conus with fattening of filum terminale. Due to increasing pain and neuropsychologist recommendation, I was sent to do a new brain and L spine MRI, and I would like to hear your opinion on it.

Answer 1

Hello,

Welcome to icliniq.com.

I observed your scan (attachments removed to protect patient identity), and I agree that the conus is low lying at L2-L3 level (normally, it should end at L1 level). Facetal joint arthropathy is seen at multiple levels in the lumbar spine. Post-contrast images show abnormal enhancement of the anterior subarachnoid space consistent with arachnoiditis. However, the cause of your left side radiating pain is due to the left para-central disc bulge at L5-S1 level narrowing the neural foramina and compressing the L5 left exiting nerve roots. These changes are probably due to adjacent segment degeneration.

In my opinion, the MRI (magnetic resonance imaging) scan needs to be repeated post-therapy to see interval resolution of arachnoiditis. And also, if you can follow up with the clinical notes of the consulting physician, the imaging can be correlated to clinical exam findings. This professional advice I provided stands subject to the examination of the report or image and is based entirely on my inputs. It should be correlated with clinical findings.

Answer 2

Hello,

Welcome back to icliniq.com.

The compression of the left exiting L5 nerve is significant. However, was the L4 nerve compression given in your pre-operative scans or postoperative as you underwent surgery at that level? Can you please follow up with your pre and postoperative scans for comparison?