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QUESTION: I had a 3 level fusion L3-S1 on July 23, 2012.  I have new increased pain now lower back left side mostly,  front of thigh/outer down through shin, again outer, and foot.  Major electrical jolts that make my leg jump right off the bed. Prior to my surgery the the results showed Left paracentral disc bulge at L2-L3 with left foraminal narrowing

Broad basded disc bulge at L3- L4 with moderate central stenosis and bilateral foraminal narrowing.  this is only the parts that I didnt have fused.  No need to post all the other damage. Went to ER...just have the actual scan, not a written report.  Broad based disc bulge at L3... also have a could this be causing all of this pain? Also, am I looking at fusing another level or is there something less invasive to do here.  Back to no quality of life.

ANSWER: Hi, Ellen.

A 3-level fusion from L3-S1 would fuse L3-L4, L4-L5 & L5-S1, so it would seem that you have already had L3-L4 fused.

The nerves at the level of L3-L4 affect the sides and front of your legs. Search for "dermatome map" images, and you will see which part of the body each spinal nerve affects.

As for further treatment, I cannot advise you. I am only the MRI radiographer and am not trained in diagnosis or treatment. I recommend you ask your physician about less invasive treatment for your pain.

I wish I could be of more help. Best of luck to you.

Sincerely,
Delia White
Santa Barbara Extremity MRI

---------- FOLLOW-UP ----------

QUESTION: Thank you for your quick response.  I just received the written report and wondered what you thought.  Does it explain my increased pain.  Im thinking I will not need further surgery.  I know you can not say anything in regards, but it has looked a lot worse for me over the years.  ;)  The steroid taper seems t be helping a bit with the pain.  My question now is do you see any findings that would explain the thigh and shin pain...it has been high, and I know pain!  FINDINGS: There is a grade-I anterior spondylolisthesis of L3 with respect to L4, and L5 with
respect to S1, which is stable in comparison to previous. The conus ends in normal position
without focal enlargement or abnormal signal. Bone marrow signal intensity is normal. T12-L1:
There is mild loss of disc signal. There is a 1 mm disc bulge without canal or foraminal stenosis.
L1-2: There is mild loss of disc signal. There is a 2 mm disc bulge without canal or foraminal
stenosis. L2-3: There is moderate loss of disc signal and signal intensity. There is a 4 mm
left central and lateral recess broad-based protrusion, which moderately flattens the anterior
thecal sac, particularly the left lateral recess, affecting the left L3 intrathecal nerve root.
This, in combination with moderate facet hypertrophy, moderately narrows the canal. The neural
foramina are patent. These findings are similar to previous exam. L3-4: There is moderately
severe loss of disc height. There has been an anterior fusion with graft. There has been a left
hemilaminectomy and partial left facetectomy. There has been a posterior fusion with pedicular
screws and rods in good position. There is no residual canal or foraminal stenosis, unchanged. L4-5
: There has been an anterior discectomy and an anterior fusion with graft, a left hemilaminectomy
and partial facetectomy and a posterolateral fusion with a left L5 pedicular screw, in good
position. There is no canal or foraminal stenosis. No right L5 pedicular screw is present. These
findings are unchanged. L5-S1: There is moderate loss of disc height and signal intensity.
There is a 3 mm anterolisthesis of L5 with respect to S1. There has been a left hemilaminectomy
and left partial facetectomy without canal or lateral recess stenosis. There has been an anterior
fusion with graft and a posterolateral fusion with pedicular screws and rods. The tips of the
pedicular screws at S1 extend slightly beyond the anterior margin of the sacral ala bilaterally
lying adjacent to, but not displacing the L5 nerve roots within the presacral space. These
findings are unchanged.
IMPRESSION:
1. L2-3: There is a 4 mm left central and lateral recess broad-based protrusion, which
moderately flattens the anterior thecal sac, particularly the left lateral recess, affecting the
left L3 intrathecal nerve root. This, in combination with moderate facet hypertrophy, moderately
narrows the canal. The neural foramina are patent. These findings are similar to previous exam.
2. L5-S1: There is a 3 mm anterolisthesis of L5 with respect to S1. There has been a left
hemilaminectomy and left partial facetectomy without canal or lateral recess stenosis. There has
been an anterior fusion with graft and a posterolateral fusion with pedicular screws and rods. The
tips of the pedicular screws at S1 extend slightly beyond the anterior margin of the sacral ala
bilaterally lying adjacent to, but not displacing the L5 nerve roots within the presacral space.
These findings are unchanged.
3. L3-4, L4-5: There has been anterior and posterolateral fusion, hemilaminectomy and
facetectomy, as described, without canal or foraminal stenosis, unchanged.

Answer
Dermatome
Dermatome  
"...increased pain now lower back left side mostly,  front of thigh/outer down through shin, again outer, and foot. Do you see any findings that would explain the thigh and shin pain?"

Yes, I do, Ellen. You said your new, increased pain is mostly on the left side. The way I understand this report, the left L3 root canal is narrowed. This could put pressure on the L3 nerve root, which would cause pain in your left lower back and down the front of your left leg.

You also had some vertebral bone removed on the left side at the L5-S1 level (hemilaminectomy & partial facetectomy). This may be causing some of the left lower back pain.

As I said before, I am not a physician, so cannot advise you on treatment. For your information, I am attaching an dermatome image to illustrate which spinal nerves affect which parts of the body.

Hope this helps,
Delia White
Santa Barbara Extremity MRI

Radiology

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Delia White

Expertise

I am not qualified to interpret diagnostic imaging or to diagnose disease. Please consult a physician for that information. I am the photographer. I can tell you what to expect during most MRI, CT and X-ray procedures.

Experience

I now have more than 30 years experience in diagnostic imaging. My specialty is MRI. I am also very familiar with CT and the way we used to take x-rays (everything's digital now)!

Education/Credentials
I received my Bachelor of Science degree in Radiologic Technology.

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