Brief Answer:
Changes noted following your fusion procedure are from surgery @ arthritis

Detailed Answer:
Good morning.

Thank you for the question on this network. It will be my pleasure to assist you in understanding what the scan results mean.

I'm assuming this is an MRI of the lumbar spine but it's not specified.

At the level of L4/5 there are changes noted by the radiologist that he recognizes as DUE TO THE SURGERY. Namely, what he did which was a HEMILAMINECTOMY at the L5 vertebral body level.

Following surgery there is scarring in the L4/5 disc as well as in the area called the lateral recess of the vertebral body and the area JUST BELOW where one vertebral body sits on top of another. This is the SUBARTICULAR ZONE.

As a result of this scarring (which in the case of bone and disc usually refers to a buildup of CALCIUM seen on the scan as roughened or sharply contoured edges where surgery was done) there is a NARROWING of the spinal canal (tunnel) through which the nerve fibers from the spinal cord travel. At the level of L4/5 there is no longer an actual SPINAL CORD but there are fine fibers that almost appear to be LIKE THAT OF A HORSE'S TAIL that extend downward into the canal. The spinal canal narrowing itself (i.e. STENOSIS) could be contacting or irritating one of those thin descending nerve filaments or fibers causing your sensation of pain.

In fact, the radiologist does mention that some of the scar tissue itself from the laminectomy procedure appears to be contacting and actually PUSHING ASIDE the RIGHT L5 nerve root. This can definitely cause sharp shooting or even burning pain down the back, buttock, and leg which you are feeling.

Arthropathy usually refers to a progression of an arthritic process secondary to osteoarthritis which though unusual in a young person such as yourself nonetheless can happen depending upon how much exertion and stress your spinal column has been under over the years. Neural formaminal narrowing ON BOTH SIDES (bilaterally) is a form of STENOSIS as well which compromises the actual opening in the vertebral body through which the L5 nerve root passes from the spinal cord itself into the buttock and eventually the leg.

Neural foraminal stenosis is often times the result of arthritic changes. In this case surgery may have been accelerated the arthritic process a bit by the subsequent inflammatory changes and calcifications which now narrow down the foraminal opening. The changes according to the radiologist are MILD.

All these findings support reasons as to why you may be feeling constant and ongoing symptoms of pain in the L5 distribution which often times is from the back and goes straight down the buttock, behind the thigh, wrapping itself to the outside of the knee then, in some cases traveling down the front area of the leg below the knee stopping either at the ankle or going right into the big toe.

Physical therapy and exercises along may over time improve the constant feelings of pain down that leg but then, again, you've got a lot of postoperative changes and regular arthritic changes mixed in so nobody will be able to say for sure if the pain will subside or continue long term. Time will tell and repeat surgery, would be something I'd be EXTREMELY HESITANT to suggest or pursue at this point. I think it's better to do things conservatively and see what happens over the long haul. More surgery in the future leads to more scarring and this will increase everything you read in the report plus add new changes at another level. It's almost like chasing a never ending sort of battle.....better to recuperate, perhaps live with a small amount of discomfort instead of trying to get back to a perfect state and risk worsening things.

Good luck.

If I've satisfactorily addressed your question then, could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback and a 5 STAR rating to our transaction if you feel the response has helped you? Again, many thanks for posing your question.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 22 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---

Brief Answer:
Thank you for your clarifications

Detailed Answer:
You have essentially described the symptoms of sciatica or L5 compression radiculopathy. I believe that there is ALWAYS a chance that regeneration and restoration of function is possible. I can tell you that in my own experience of athletic training I've suffered from traumatic sciatica when trying to do excessive leg lifts in competition results in terrible sciatic pain and discomfort which I thought would never go away. It lasted 9 months. I began subsiding after about 6 months. I was able to fully recover from that episode. I was on a physical rehabilitation program with stretching...no medications...I HATE pills! LOL!

I had another injury of a shoulder that was subluxed in a wrestling tournament when I was in college. It was daily pain and limitation of movement in that shoulder that after years I simply assumed would continue and I adjusted. Nearly 18 years later...one day....I suddenly was driving in the car when it dawned on me that my right shoulder which had been daily paining me which I had just resigned myself to have to withstand....now had ZERO pain in it....I was so shocked that I think I almost crashed into the car ahead of me when it stopped because I was so confused at not feeling the usual pain. 18 YEARS after the injury. I suspect that's a bit unusual...but it simply defines my belief in never saying never.

Having said that....I think there is a point where one simply (as I did) has to start the adaptation process, without giving up the rehab process....I never gave up the rehab process...ever....I continued to train for my sport, enter competitions, do my stretches, lifting my weights...but I had compensated for that shoulder. I don't know if that's what took my pain away or was it just TINCTURE OF TIME which can even erode mountains into piles of dirt! Seriously....right? So, I would suggest that you do what you can on a daily basis and continue to strengthen, stretch, and USE the paraspinal muscles, the buttock muscles, the thigh, calf, and foot/ankle muscles. Keep everything in shape....fight through the pain as necessary. Consider aquatherapy and other conservative measures, TENS devices, etc. I never used medication for any reason in combating the radicular pains....I relied upon concentration and undivided attention to what I had to do each day to keep that shoulder moving and the brachial plexus active....and yes, it did hurt....but after a while....that pain became part of everything else I had to withstand in a day....

I would definitely NOT consider at this time....and probably never in the future....doing any second surgeries for the purpose of "cleaning" up scar tissue....please read my first opinion. The risk of what we call an ARACHNOIDITIS when doing multiple back or spinal surgeries is extremely high...and then, patients get into a downward spiraling circle where one surgery begets another begets another and each surgeon keeps promising something they can't produce. The body is very unforgiving when it comes to manipulation of nerves, breaching the spinal cord covering and fooling around doing laminectomies, laminotomies, scrapings, and so forth.....

I would not expect success from any CLEANUP surgical procedure. If cleanup were to happen....it would be by way of the body's systems but it will take TONS OF TIME to produce the effects you're hoping for..so don't get impatient.

I believe that if you think positively, act positively, and move positively that there will come the day you will FEEL POSITIVELY BETTER and it would not XXXXXXX me in the least if you will tell a very similar story to the next person you hear ask the question of whether or not it were possible to improve even though it's been so long.

Could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback and a 5 STAR rating to our transaction if you feel my responses has helped you? Again, many thanks for posing your question.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 67 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---