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Superimposed Disc Herniation MRI result ?

Please help me decode this result. I am seeing the neurosurgeon in a week and want to understand so that I can discuss intelligently with him.

Background: I have had two previous surgeries at L4-L5 and one at L3-L4. The last was two years ago last month. Previously at L4-L5 have had a laminectomy and diskectomy for a previous herniation. Pain was better but never completely resolved.

A few months back it suddenly got much worse and pain medicine no longer touches it most days. Had an MRI that shows the following and need help understanding what it means:

There is mild disc bulging at L4-L5. In addition, there is a superimposed left posterolateral disk herniation as seen on parasagittal images 6 and 7. There is adnormal signal and enhancement involving the herniated portion of the disk compatible with a radial tear. The patient has undergone previous surgery at this level. There is enhancing granulation tissue within the left lateral recess. There is extruded disk material present within the left lateral recess. There is bilateral facet hypertrophy at this level. There is severe impingement upon the bilateral lateral recesses, left greater than right. There is no significant spinal stenosis at this level.

Neural encroachment as detailed above.

I am having significant back, leg and foot pain.

I would appreciate any views. Particularly the definition of a "superimposed disk herniation". What does superimposed mean in this context???

Thanks all!
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replied November 25th, 2009
Extremely eHealthy
hi...i too was baffled by the term ''superimposed''. i googled it and found it used in conjunction with many back problems. the word doesnt seem to change the meaning of those conditions. i dont understand how it changes the condition of disk herniation so we can just call it a disk herniation as far as i can see.
there are other problems also...
...granulation is scar tissue from previous surgery
...excruded disk material is a piece of disk that broke off and is floating around
...facet hypertrophy is an arthritic condition of the facet joints that relate to your back flexibility.
...severe impingement to the lateral recess areas.[i myself dont quite understand whether this severe impingement is causing pain because mri report goes on to say there is no stenosis at that level...i do believe nerve roots are found there]...i would ask if this severe impingement might be causing sounds like it is...
the biggest question is CAN I BE HELPED?...there are lots of issues.
I sure hope surgeon can come up with a solution....Please keep us posted...

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