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Having intense leg pain after hemilaminectomy. Had MRI of spine. Findings?

Nov 2013
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Practicing since : 1994
Answered : 5289 Questions
I have been having intense leg pain after a hemilaminectomy at L4-L5, so just had an MRI, w/ and w/o contrast. Can you explain what the following means and if there is anything they do about this. I am a 38 year old female who is so exhausted by 2 years of back pain:
"Evidence of postoperative changes are present secondary to a left-sided hemilaminectomy at L4-L5. Abnormal T2 prolongation is identified within the parasagittal posterior soft tissue regions consistent with postoperative inflammatory changes. In addition, smoothly marginated, slightly lobulated fluid collection is identified within the posterior central soft tissue region just behind the posterior spinous processes of L2 and L3 vertebral bodies. Inferiorly, this collection appears to extend to the level of the L4-5 disk space. This collection measures approximately 3.5 x 4.6 x 2.3 cm in AP, height, and transverse diameters respectively. After administration of contrast media, mild enhancement of this soft tissue from post operative changes is seen surrounding the fluid collection. The fluid collection may or may not be infected. There is no direct communication between the fluid collection and the spinal canal".

Thanks so much for your help!
Posted Mon, 23 Sep 2013 in Brain and Spine
Answered by Dr. Sudhir Kumar 3 hours later
Brief Answer:
Most likely an abscess

Detailed Answer:

Thank you for posting your query.

I have gone through the detailed history and MRI report sent by you.

The description most likely looks like an abscess (infected collection), which has probably formed after the surgery.

In view of pain, it is better to drain this collection. The fluid (pus) may be sent for culture and sensitivity, and antibiotics given as per the report.

I hope this helps. Please get back if you have any more queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by
Follow-up: Having intense leg pain after hemilaminectomy. Had MRI of spine. Findings? 11 hours later
Do they typically drain with a needle percutaneously, or do they have to go in to drain it due to the location? Is it likely to refill after being drained, or is that not typical because that healing stage of the surgery is over?

Thanks again!

Answered by Dr. Sudhir Kumar 27 minutes later
Brief Answer:
Usually percutaneous drainage is done

Detailed Answer:
Thank you for getting back.

The usual method is to drain it percutaneously, may be under the guidance of a CT scan. If it is completely drained and a full course of antibiotics are taken, then, re-collection is uncommon.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
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