Hello doctor,Ten months after hemilaminectomy at L4-5 level, I suffer from severe pain in the lower back which lately started radiating to the left leg. I have a diagnosis of arachnoiditis, arthritis and low lying conus with fattening of filum terminale. Due to increasing pain and neuropsychologist recommendation, I was sent to do a new Brain and L spine MRI and I would like to hear your opinion on it.
Hello. I observed your scan (attachment removed to protect patient identity) and I agree that the conus is low lying at L2-L3 level (normally it should end at L1 level). Facetal joint arthropathy is seen at multiple levels in the lumbar spine. Post-contrast images show abnormal enhancement of the anterior subarachnoid space consistent with arachnoiditis. However, the cause of your left side radiating pain is due to left para-central disc bulge at L5-S1 level narrowing the neural foramina and compressing the L5 left exiting nerve roots. These changes are probably due to adjacent segment degeneration. In my opinion, the MRI scan needs to be repeated post-therapy to see interval resolution of arachnoiditis. And also, if you can follow up with the clinical notes of the consulting physician the imaging can be correlated to clinical exam findings. Regards, “This is only a second opinion platform. This professional advice provided by me stands subject to the examination of report/ image and is based entirely on inputs provided to me. It should be correlated with clinical findings.” For more information consult a radiologist online -->