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Spinal problems, post harrington rod surgery, idiopathic scolisosi, numb left foot

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Orthopaedic Surgeon
Practicing since : 1996
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44 yold female 136 pounds 5ft 4 in, post harrington rod surgery in 81 at 13 for idiopathic scolisosi to the left hardware maintianed resulting severe flatback , taken out of work on ltdisability for intractacble pain after 20 facet blocks epidurals and Radio freq, nerve abaltions w/out relief. Been seeing PM for 2 yrs have been tol by 3 surgeons i need a PSO for revision but symtpom are changing had new ct scan last wk and my previous mzzri only showed severe facet arthrosis, radiculopathy, DDD and chronic mench, lbp and neurslgia in hands toes.

zlast month i haave left leg go 100% dead and cant feel entire leg if i sit on a toilet and urine retention no uti, numb groin area and all in left leg and foot.

CT scan shows sever flatback PLUS
Lumbar FINDINGS"

Lumbar spine demostrates a levoscoliosisis centeres at approx tge L 1-2, L2 level.
There is about a 3mm of retrothlisthesis as well as mild left lateral sublaxation of L4 upon L5.
This is asccosiated with modertae to severe disc height loss and vacume disc phenomena.
Discogenic sclerossis endplate spurring are also appreciated. There is moderate to severe sisc height loss at L5-S1 also with discgenic sclerosis and endplate spurring.


there is modertate degree of bilateral foraminal stenosis at L4-L5, greater on right than left.
Moderate left L5-S1 neural foraminal stenosis is also appreciated. Moderate facet degenerative changes are present at L4-L5 and L5-S1.


A posterior fusion mass os identified extending from teh visulaized lower thoracic spine to teh L3-L4 level. Two posterior fusion rods are identified. the fisuion rod on the right extends from the thoracic spine to L4 and is transifxed by a single laminar hook at this level. No evidnence of a fracture or hardware complciation

Conlcusion

Levoscolisosis centered at approx L1-L2
3mm of retrolisthesis of L4 upon L5 with accompnying findiings of degenerative disc diseasre and facet arthrosis. Moderate bilateral fora XXXXXXX stenosis is present at this level greater on right than left.


Moderate to severe disc height loss at L5-S1 w/ discogenic sclerosis and moderate left sided foraminal stenosis.


Posterior fusion mass extending from the visualized lower thoracic spine to L3-L4 level with posterior rods as deescribed above.


Thoracic Findings are ( i never had anything noted in this area other than rods in MRI)


S shaped scoliosis of thoracic spine


posterior bony fusion nass extending from T5 to the visulaized thoracolumbar junction with placement of psoteriror fusion rods fixed by laminar and tansverse process hooks. No evidence of a fracture or hardware complication
no stenosis or neural sclerosis was ever seen ON MRI of 08 and i walk pitched forward all the time from flatback and my PM dr told me if i do show stenosis i could lose use of left leg
Posted Fri, 27 Apr 2012 in Brain and Spine
 
 
Answered by Dr. S S Soni 8 hours later
Hi XXXXXXX

Thanks for the query.

Here is my opinion:

In 1981, correction of scoliosis was generally done by Harington's Rod, which has its own disadvantages, like you had ,flat back, & also the spine segment above & below the corrected segment also used to have adverse effect in terms of reverse scoliosis, disc degeneration, Listhesis etc.
With time the correction of scoliosis has been changed to Latest i.e. Pedical Screw Fixation
Now what you need is revision surgery, in which decompression of spinal canal & correction of retrolithiasis also will be done along with maintaining the right spinal curvatures with the help of Pedical screws.

You can discuss these options with your orthopedics specialist

Hope I have answered your questions, I'll be available for your follow up questions
Above answer was peer-reviewed by
 
Follow-up: Spinal problems, post harrington rod surgery, idiopathic scolisosi, numb left foot 5 hours later
I stated already that i knew i needed a PSO revision surgery , 3 surgeons told me that but the new CT i got last week, shows these new changes that I want to understand what they mean...

what is " modertate degree of bilateral foraminal stenosis at L4-L5, greater on right than left. "

"Moderate left L5-S1 neural foraminal stenosis is also appreciated. Moderate facet degenerative changes are present at L4-L5 and L5-S1."

Lumbar spine demostrates a levoscoliosisis centeres at approx the L 1-2, L2 level.

"There is about a 3mm of retrothlisthesis as well as mild left lateral sublaxation of L4 upon L5. "

This is asccosiated with modertae to severe disc height loss and vacume disc phenomena.

"Discogenic sclerossis endplate spurring are also appreciated."

" There is moderate to severe sisc height loss at L5-S1 also with discgenic sclerosis and endplate spurring. "

There is modertate degree of bilateral foraminal stenosis at L4-L5, greater on right than left. "

"Moderate left L5-S1 neural foraminal stenosis is also appreciated. Moderate facet degenerative changes are present at L4-L5 and L5-S1."


A posterior fusion mass os identified extending from teh visulaized lower thoracic spine to the L3-L4 level.

Conlcusion

Levoscolisosis centered at approx L1-L2
3mm of retrolisthesis of L4 upon L5 with accompnying findiings of degenerative disc diseasre and facet arthrosis.

Moderate bilateral foraminal stenosis is present at this level greater on right than left.

Moderate to severe disc height loss at L5-S1 w/ discogenic sclerosis and moderate left sided foraminal stenosis.

Posterior fusion mass extending from the visualized lower thoracic spine to L3-L4 level with posterior rods as deescribed above.


Thoracic Findings are ( i never had anything noted in this area other than rods in MRI)


S shaped scoliosis of thoracic spine


posterior bony fusion nass extending from T5 to the visulaized thoracolumbar junction with placement of psoteriror fusion rods fixed by laminar and tansverse process hooks.

I want to know , what these new findings mean in layman terms , and could it be responsible for urinary retentiion , I dont have any urine infections but my whole left lef up to groin are goes dead when Im seated in certain lower seat like a toilet.

thank you


Asked by Me , 13 hours ago Doctor's reply to your above
 
 
Answered by Dr. S S Soni 19 hours later
Hi XXXXXXX

Thanks for your questions.

Before answering your questions, let me first explain you the anatomy of the spine.

A human spine is made of bone piled one upon another (vertebrae) along with soft tissues (discs) in every alternate vertebra to cushion it. They act as a shock absorbing structure. It is divided into three parts : Cervical spine (neck), thoracic spine (upper back),lumbar spine (lower back) and sa. The spine contains spinal cord which passes through small openings (foramina) present in every vertebra and supplies nerves to different levels.

Vertebrae are arranged in such a way that when viewed from behind, it falls in a straight line. However in some individual, this straight line is lost. This lateral curvature of the spine of the normally straight vertebrae is described as 'scoliosis'
The most common type of scoliosis is Idiopathic - it can present from birth and can also be inherited.
The other types of scoliosis are: Neuromuscular scoliosis and Degenerative scoliosis.
Treatment for scoliosis includes Back braces or in severe cases Surgery.

Now to answer your questions:

1) Levoscoliosis centered at L1-L2: You have a left curvature of the spine with the point of maximum curvature (center) at L1-L2.

2) 3mm of retrolisthesis of L4 upon L5: Retrolisthesis is a posterior(backward) displacement of one vertebral body over another. In your case there is 3mm of posterior displacement of L4 over L5 along with degeneration of the vertebra.
Facet joint is a joint between the two individual vertebra and arthrosis is arthritis of the joint making it painful and reducing its mobility.

3) Bilateral foraminal stenosis: As I explained to you before foramen are the small openings in the vertebra in which spinal cord or nerves pass through. Stenosis is reduction in the size of foramen. It can be due to degeneration of the vertebral body or accumulation of connective tissue on a normal organ specific tissue. In your case, at the level L4-L5 it is more on the right than the left. While at the level of L5-S1 there is moderate left side stenosis due to sclerosis.

4) Posterior bony fusion mass from L3-L4: It is fusion of the two vertebrae L3-L4 done surgically in treatment of scoliosis along with Harrington rod.

5) S shaped scoliosis: It is a type of scoliosis in which the shape of the vertebral line which is normally a straight line is in 'S' shaped.

6) Micturition (urination) is influenced by nerves arising from lumbar as well as sacral spines. In this context, lumbar scoliosis could be causing urinary retention. In such instance review of the surgery with nerve decompression (if any) is essential.

Position of the back can add to or relieve symptoms of nerve compression. The numbness of left leg are probably due to reported neural foramina stenosis.

Surgical decompression of the affected nerves may be needed to treat the symptoms.

It is best advised to follow your orthopedicians advise.

Pleasure to answer your query.

Wish you a quick recovery.

Regards.
Above answer was peer-reviewed by
 
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