Alignment and bone marrow signal are within normal limits. Vertebral body heights broad are maintained. The conus medullaris and cauda equine are unremarkable. An accessory articulation is again seen between the right side of the L5 vertebral body and the right side of the sacrum.
L1-2 Unchanged small broad-based disc protrusion without significant narrowing of the spinal canal. AP diameter of the thecal sac is 14mm. Bilateral neural foramina are present.
L2-3 Unchanged broad-based disc protrusion without significant narrowing of the spinal canal. AP diameter of the thecal sac is 12mm. There is mild unchanged bilateral neural foraminal narrowing. There is unchanged moderate bilateral facet arthropathy
L3-4 Unchanged broad-based disc protrusion with mild narrowing of the spinal canal. AP diameter of the thecal sac is 9mm. There is unchanged moderate narrowing of the right neural foramen and mild narrowing of the left neural foramen. Protruding disc material in the right far lateral region approaches the exiting right L3 nerve root, unchanged. There is unchanged moderate bilateral facet arthropathy.
L4-5 Postoperative changes consistent with left hemilaminectomy are noted. There is a broad-based disc protrusion, but the left paracentral extrusion seen on the prior exam is no longer present. AP diameter of the thecal sac is 10mm. Enhancing granulation tissue is noted along the operative tract and involves the left lateral epidural space. No recurrent disc extrusion is seen. There is unchanged relatively severe narrowing of bilateral neural formina . Moderate bilateral facet arthropathy is again seen.
L5-S1 No significant disc herniation, spinal canal stenois, or neural foraminal narrowing. There is moderate left facet arthropathy, unchanged.
Question ? Why am I still in so much pain in the legs and buttocks. I tried physical therapy after surgery and it only sends the pain off the scale.
I am very sorry for such a delay in replying...but here it is.
Back pain is teh most complex condition there is...really. There are so many causes that may or may not visible on the MRI. Even things that we see on MRI, even severe things may not correlate with pain at all. I see patients with significant degeneration at all levels and all they have is a symptom that correlates only to one specific nerve.
There are several things that still may give you pain, and specifically radiculopathy. This needs to be correlated very carefully with your symptoms and the MRI. AT L45, you got some significant narrowing of the foramina that may correlate with L4 symptoms. Post operative scarring/granulation may also cause symptoms along L5 nerve root on the left. Degeneration of facet joints is certainly a known midline back pain. Not sure how your spinous processes look but they may also give you back pain in the mid line.
You also have what is called a transitional anatomy at the lumbosacral region as mentioned by accessory artifulation - this also is sometimes a cause of pain. You may want to consider a second opinion and try some nerve blocks and facet block and see if your pain will improve from any of these.
Sorry, no majical answer here. This is tough as back pain is complex.
Hope this helped somewhat.