Question: I have spinal stenosis, spondylolisthesis L4 L5. I've had hemilaminectomy's at level L4-L5 2 years ago. It has been recommended that fusion be preformed at L4 L5 my question is after the hemi laminectomy's I still had a difficult time walking due to cramping of the hip muscles around the coccyx I could only walk 1 block. Do you think the fusion would help with muscle cramping in the buttocks ? Are there any tests that can pinpoint what level is causing the cramping?

I have report of MRI read by another radiologist.I stated before,proposed fusion L4-L5 by present provider.He has done laminectomies 2013. Mayo clinic suggested fusion L3-4-5. Seems overly aggressive. I think I do have some movement from spondolythesis> There are periods that I can hardly walk,get direct nerve pain my leg gives out.That will go away.this sounds crazy but I see a Chinese women that was an MD in China. she does several hours of intense accupressure and can relieve muscle spasms and intense sciatica symptoms.She seems to think it is SI joints.

So based upon the limited information does a fusion and laminectomies seem reasonable. Again my main concern is being able to walk. The walking is stopped involuntarily, the muscle will not respond until rested.Then walking is quite painful. I am not clear on which nerve roots innervate the hip area around sacrum.

thank you, XXXXXXX Bunce,DDS
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Center For Diagnostic Imaging

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Referring MRN:

EXAM: MRI OF THE LUMBAR SPINE WITHOUT CONTRAST: REVIEW OF

OUTSIDE IMAGING STUDY

CLINICAL INFORMATION: No clinical information provided. No prior imaging studies for comparison.

TECHNICAL INFORMATION: Examination performed on a 1.5 Tesla magnet with Mayo Clinic. T1-weighted intermediate, proton density T2-weighted sagittal fast spin echo and intermediate, and T1 and T2-weighted fast spin echo axial images plus STIR sequence were obtained of the lumbar spine.

INTERPRETATION: Images reveal multiple level disc degeneration in the lower thoracic and lumbar region, with evidence of prior L4 and L5 laminectomies on the right side.

At L5-S1, there is a posterior and left-sided annular tear and 2-3 mm disc herniation, displacing the S1 nerve root. Facets exhibit mild asymmetry. There is mild narrowing of the left L5-S1 neural foramen.

At L4-5, there is grade I degenerative spondylolisthesis, estimated at approximately 8-10%. Advanced degeneration of the disc is evident. There is anterior disc herniation, dissecting downward over the anterior aspect of L5. Posteriorly, there is a broadly based annular tear and herniation of the disc centrally and to the right. Some cephalic dissection of disc material is noted centrally and on the right. Type I marrow edema is noted in the L4 and L5 vertebral bodies centrally and to the right of midline (series 4, images 8-12). The disc results in moderate central spinal canal stenosis, with high suspicion of segmental instability, as there is widening of the articular space within the severely degenerated right facet joint. Erosive changes are noted on the left. The disc herniation extends laterally on the right and results in severe up-down stenosis with right L4 nerve root and ganglionic compression. The left neural foramen is mildly narrowed in AP dimension only.

At L3-4, postoperative changes are noted. There is moderate central spinal canal stenosis with effacement of the thecal sac and impingement upon both L4 nerve roots centrally. There is a dorsal tear and 3-4 mm central herniation of the L3-4 disc, diffusely indenting the thecal sac and impinging upon the L4 nerve roots. There is mild to moderate AP and up-down narrowing of the right neural foramen. Moderate stenosis

Printed: 2/25/2015 10:30 am Page 1 of 2DIAGNOSTIC REPORT
XXXXXXX D Bunce MRN #: 0000DOB: 12/10/1949 Outside Film Consult MR Spine (Unpaired)

is present laterally on the left and there is far lateral disc protrusion, with left L3 ganglionic impingement. Marked facet joint degeneration is noted bilaterally, with hypertrophic changes on the left side.

At L2-3, the disc is degenerated and dehydrated. There is a lateral tear and bulging of the disc annulus on the left side. Mild AP narrowing of the left neural foramen is evident. Facets exhibit minor remodeling and asymmetry. No neural compression centrally.

The L1-2 and T12-L1 disc levels appear normal. Spinal cord terminates dorsal to the L1-2 disc. There is a posterior and right-sided disc herniation at T11-12 which contacts the spinal cord ventrally and on the right. Unfortunately, there are no axial images of this level.

CONCLUSION: Multilevel degenerative lumbar spondylosis with the following major findings:

1. Advanced disc and facet joint degeneration at L4-5 with segmental instability and central spinal canal stenosis. Lateral disc herniation present on the right with foraminal stenosis and severe right L4 nerve root and ganglionic compression. Active inflammatory facet arthropathy on the right.

2. Central canal stenosis at L3-4 with posterior disc herniation and facet joint degeneration. Both foramina are narrowed.

3. Posterior and left-sided focal tear and disc herniation, L5-S1 with left S1 neural impingement.

KPS:pmm

Interpreting Physician
XXXXXXX P. Schellhas, M.D.

Electronically Signed: 2/14/15 9:31 am

CC:

Self Referral