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What causes pain radiating between back, buttocks and leg after a beltectomy?

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Posted on Tue, 2 Dec 2014
Question: Background: Aug. 29th I underwent a lower body lift (beltectomy) Surgery went smoothly and healing was a breeze.Approx. 6 weeks out of surgery I started developing mild back pain that eventually migrated into my left back-buttocks, then my left hip, moved down my left leg etc. After it became increasingly worse I sought medical attention where they started treating me for sciatic nerve. After two weeks of medicine and my condition worsening, I scheduled my MRI. I am now to the point that on a good day with the ketoprofen and tramadol i can walk with minimal pain and slight limp, a bad day I can only walk with assistance of a cane or crutch for stability, and I now have progressed to a few horrible days where I seem to lose all function in my left leg all together.

My MRI results are as followed, and am currently being referred to a back surgeon.

MRI of the lumbar spine without contrast
Location L. 11
History: Lumbargo and left lower extremity radculitis

Multiplanar, multislice MRI of the lumbar spine is performed without contrast on a 1.5 Telsa magnet

Comparison: None

Lumbar lordosis is adequate. Signal within the marrow of the regional osseous structures is normal. Mild loss of disc height is present at L4-5 and L3-4. The conus terminates approximately at the T12-L1 level. A 2.2 cm left adnexal cyst is probably functional. There is an oval fluid signal intensity in the subcutaneous soft tissue along the posterior margin of the right ilium, incompletely assessed on this exam, but measuring at least 2 cm, of unclear etiology. Please correlate clinically.

At L5-S1, a minimal dorsal annular bulge is suspected, without nerve impingement.

At L4-5, there is a 2 or 3 mm concentric disc bulge or protrusion lateralizing to the foraminal regions. There are mild foraminal stenosis without impingement upon the existing L5 roots. Minimal posterior annular fissuring is seen.

At L3-4, there is minimal dorsal bulge with right paracentral/foraminal annular fissuring, but no nerve impingement.

the L2-3 through T12-L1 disc levels are unremarkable.

Impression:

At L4-5, a 2 or 3 mm concentric disc bulge or protrusion is present with posterior annular fissuring. THere are mild foraminal stenoses, without nerve root impingement.

Minimal dorsal annular bulging is present at L3-4 and L5-S1, without nerve root impingement. At L3-4, there is right paracentral disc foraminal annular fissuring.



My question is without nerve impingement why am I losing function in my leg? also the adnexal cyst from what i search refers to reproductive organs? However Ive had a hysterectomy since 2002 with my only ovary being removed in 2010 due to a tumor. Can you help decipher this into understandable english for me?
doctor
Answered by Dr. Erion Spaho (1 hour later)
Brief Answer:
Probably lymphatic cyst or sacral lesion.

Detailed Answer:
Hi, I had gone through your question and understand your concerns. From your lumbar MRI report, seems you suffer from mild degenative disc and column disease. I don't see a clear correlation between your symptoms and MRI findings and don't see anything to be solved surgically. About the cystic lesion ( probably lymphatic cyst post surgery) found by MRI, it needs further imaging evaluation to determine its nature. Maybe it is responsible for your symptoms, needs to see if cyst has contact with your lumbosacral nerves. I think you need an CT scan of sacral and pelvic region to determine cyst extension and any sacral lesion, because of your past tumoral history. You need an EMG study of left leg nerves to determine where's the nerve lesion. Hope this answers your question. If you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions.
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Erion Spaho (1 hour later)
Should I go to be evaluated for possible MS? I know there is no markers to determine heredity but I do have an Aunt that is diagnosed for a while now. I have many of the issues and symptoms that correspond but wasnt sure if thats an avenue I should pursue.
doctor
Answered by Dr. Erion Spaho (23 minutes later)
Brief Answer:
MS is less probable.

Detailed Answer:
Hi and thanks for asking again. In my opinion MS is less likely to be in this case. I think most probable cause of your symptoms is a mechanical nerve damage ( compression) and this could be from exiting of nerve from spine, down its road to the leg. This may be confirmed or ruled out by EMG and CT scan of your pelvis and sacral bone. If these tests result negative, then other conditions should be checked for. ( neuritis, MS, metabolic/ toxic nerve damage etc.) Hope this helps.If you have further questions, feel free to ask.
Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 4272 Questions

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What causes pain radiating between back, buttocks and leg after a beltectomy?

Brief Answer: Probably lymphatic cyst or sacral lesion. Detailed Answer: Hi, I had gone through your question and understand your concerns. From your lumbar MRI report, seems you suffer from mild degenative disc and column disease. I don't see a clear correlation between your symptoms and MRI findings and don't see anything to be solved surgically. About the cystic lesion ( probably lymphatic cyst post surgery) found by MRI, it needs further imaging evaluation to determine its nature. Maybe it is responsible for your symptoms, needs to see if cyst has contact with your lumbosacral nerves. I think you need an CT scan of sacral and pelvic region to determine cyst extension and any sacral lesion, because of your past tumoral history. You need an EMG study of left leg nerves to determine where's the nerve lesion. Hope this answers your question. If you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions.