From the Research
The patient's current MRI findings indicate successful post-surgical changes following an L4-5 transforaminal lumbar interbody fusion (TLIF) procedure, and no immediate intervention is needed for the mild progression of degenerative changes at the L3-4 level. The interbody spacer is slightly posterior to the disc space margin, but the spinal canal at L4-5 has been effectively decompressed with no significant stenosis remaining. There is mild progression of degenerative changes at the L3-4 level above the fusion, resulting in mild to moderate spinal canal stenosis and mild foraminal stenosis that is more pronounced on the right side. No concerning paraspinal masses or fluid collections are present. These findings are typical after spinal fusion surgery, as adjacent levels often experience increased stress and accelerated degeneration following fusion procedures 1. The L3-4 changes should be monitored during follow-up visits, as they may eventually become symptomatic and require treatment if they progress further. For now, no immediate intervention is needed based on these imaging findings alone, though clinical correlation with the patient's symptoms would be important for determining any necessary treatment. Some studies suggest that minimally invasive procedures, such as minimally invasive lumbar decompression (MILD), may be effective in treating lumbar spinal stenosis 2, 3. However, the decision to pursue further treatment should be based on the patient's symptoms and clinical presentation, rather than the imaging findings alone. Regular follow-up and monitoring of the patient's condition, as well as consideration of the potential risks and benefits of different treatment options, are essential in determining the best course of care 4. It is also important to note that epidural steroid injections (ESI) may be used to treat symptoms of lumbar spinal stenosis, but the timing of these injections in relation to surgical procedures should be carefully considered due to the potential risk of post-operative infections 5.