I am a 52 year old male who had major back surgery June of 2007 with fusion of L4 – L5 and L5 – S1, since the surgery, I continue to have numbness in my lower left leg and four toes in my left foot, with pain shooting into my toes. The last sixteen to seventeen months, I start experiencing the same symptoms in my right leg and foot. I have an abnormal knee jerk, periodic with pain in front of both right and left leg between thigh and knee...period tingling or numbness in right and left toes and ball of my foot with stabbing or shooting pain in four out of five toes, stabbing or shooting pain in both lower legs. With lower back pain. Between June 2009 and January 2010, my back and leg problems has caused me to fall six time, twice down the steps and four times while walking on level flooring. My legs often keep me up at night traveling from bed to bed or sofa to safe trying to find a place to get conformable so I can sleep. The longer I walk the more pain I experience. The longer I stand on my feet the more pain I experience. If I set to for long periods of time pain start shooting into my toes. The pain is keeping me from working and performing normal day to day functions. Wuld surgery resolve my problems?
I attached a copy of my Myelogram CT with findings
Exam: Lumbar Myelogram:
History: Bilateral leg and foot numbness. Prior lumbar fusion in 2007
Technique: Following explanation of the procedure to the patient, and obtaining informed consent, a lumbar puncture was performed under sterile conditions at L1-L2 level. Clear spinal fluid was obtained. 10cc of Isovue-M-200 was administered intrathecally.
Findings: Posterior fusion is present from L4 through S1. Position of plates and pedicle screws appear satisfactory. Intradiscal material at L4-L5 and L5-S1 appears well positioned.
There is evidence of mild central stenotic changes at the L2-L3 and L3-L4 levels with no clear-cut root encroachment at any level which would suggest a disc herniation.
Lateral films were obtained with flexion and extension and demonstrate minimal anterolisthesis at the L3-L4 level which is slightly accentuated with flexion.
The conus and lower thoracic cord appears normal.
Impression:
1. Post fusion from L4 through S1.
2. No significant stenosis or suggestion of recurrent disc herniation at the postoperative levels.
3. Mild anterolisthesis at L3-L4 slightly accentuated with flexion.
4. Mild stenosis at L2-L3 and L3-L4
5. Postmyelogram CT will follow, and be reported separately.
EXAM: Post Myelogram CT of Lumbar Spine:
Technique: High-resolution CT performed with multichannel helical acquisition and multiplanar reformats, following lumbar myelogram.
Findings: A posterior fusion is present from L4 through S1. Position of plates and pedicle screws is good. Osseous fusion appears solid bilaterally.
There are no abnormalities seen at T12-L1 or L1-L2
At L2-L3 and L3-L4, there is moderate central and biforaminal stenosis from short pedicles and hypertrophy of facet. No acute appearing disk herniation seen.
At L3-L4, there is also air within both facet joints consistent with degenerative facet changes.
At L4-L5, there is a small right paracentral disc bulge slightly distorting the thecal sac but not extending into the foramen or causing definite root compression.
At L5-S1 there is a small broad-base central disc protrusion without significant compression of the thecal sac or the nerve roots.
Interdiscal space material at the L4-L5 and L5-S1 level appears well-positioned
Impression:
1. Posterior fusion from L4 through S1 with good position of hardware and solid-appearing osseous fusion.
2. Moderate central and biforaminal stenosis at the L2-L3 and L3-L4 levels primarily due to hypertrophied facet and short pedicles.
3. Small right paracentral disc protrusion at L4-L5 not causing definite root compression.
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