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Hello Dr Taka, I Am Back. I Had A MRI
Question: Hello Dr Taka,
I am back. I had a MRI on Augut 1, 2019 at Hospital for special surgery in New York.The main problem is at L4 L5as follows:
""Severe central stenosis with pinpoint narrowing the thecal sac and obliteration of CSF signal around the cauda equina. Series 6 image 16. This due to protrusion as well as severe facet arthrosis and ligamentum flavum hypertrophy. There is severe narrowing the L5 axillar sleeve in the lateral recess as well as severe bilateral L4 foraminal stenosis and nerve root impingement. Cystic changes extend along the posterior margin of the severely degenerated left facet joint".
1) Please advise your thoughts on the above.
2) The doctor proposed Laminoforaminotomy right L4 L5 done under microscope.Incision size 15 to 20 mm, lamina removal 3 to 5 mm, face joint removal of 4 mm. Surgery mainly on right side but some on left also. Please advise your thoughts especially the risks involved and is there any way to reduce the risk.
Thanks.
I am back. I had a MRI on Augut 1, 2019 at Hospital for special surgery in New York.The main problem is at L4 L5as follows:
""Severe central stenosis with pinpoint narrowing the thecal sac and obliteration of CSF signal around the cauda equina. Series 6 image 16. This due to protrusion as well as severe facet arthrosis and ligamentum flavum hypertrophy. There is severe narrowing the L5 axillar sleeve in the lateral recess as well as severe bilateral L4 foraminal stenosis and nerve root impingement. Cystic changes extend along the posterior margin of the severely degenerated left facet joint".
1) Please advise your thoughts on the above.
2) The doctor proposed Laminoforaminotomy right L4 L5 done under microscope.Incision size 15 to 20 mm, lamina removal 3 to 5 mm, face joint removal of 4 mm. Surgery mainly on right side but some on left also. Please advise your thoughts especially the risks involved and is there any way to reduce the risk.
Thanks.
Brief Answer:
It seems a sensible approach.
Detailed Answer:
I am sorry for my late response! I am away from home and in particular this couple of days (today and tomorrow) I might find it difficult to provide timely reponses.
I read that MRI report carefully as well as the proposed procedure. Of course, it is hard to judge your surgeon. Choice of procedures may vary among different surgeons and centers, may change in time also due to new technologies and equipment being introduced all the time these days and may also depend on the surgeon's personal experience with one technique or the other, how comfortable and experienced they are with it.
So, I wouldn’t take the responsibility to express a judgment on his choices, especially as technical details such as the millimeters are perhaps beyond my expertise as a neurologist, it is the spine surgeons expertise.
That being said, my opinion would be that his approach seems a sensible one. In particular, regarding the risks involved, I would say that he seems to be trying to be as little invasive as possible, so while the usual risks (nerve damage, bleeding, infection) are still there the risk is low. The extent of facet joint modeling described shouldn’t affect stability either and given the MRI description is indicated.
So I can’t recommend anything more to reduce the risks, as I said it is a minimally invasive procedure as it is.
Regards
It seems a sensible approach.
Detailed Answer:
I am sorry for my late response! I am away from home and in particular this couple of days (today and tomorrow) I might find it difficult to provide timely reponses.
I read that MRI report carefully as well as the proposed procedure. Of course, it is hard to judge your surgeon. Choice of procedures may vary among different surgeons and centers, may change in time also due to new technologies and equipment being introduced all the time these days and may also depend on the surgeon's personal experience with one technique or the other, how comfortable and experienced they are with it.
So, I wouldn’t take the responsibility to express a judgment on his choices, especially as technical details such as the millimeters are perhaps beyond my expertise as a neurologist, it is the spine surgeons expertise.
That being said, my opinion would be that his approach seems a sensible one. In particular, regarding the risks involved, I would say that he seems to be trying to be as little invasive as possible, so while the usual risks (nerve damage, bleeding, infection) are still there the risk is low. The extent of facet joint modeling described shouldn’t affect stability either and given the MRI description is indicated.
So I can’t recommend anything more to reduce the risks, as I said it is a minimally invasive procedure as it is.
Regards
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Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
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