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Dr. Corenman,
I had my 2nd microdiscectomy on L4-L5 in December 2020. I had my initial surgery at this level in 2014. Leading up to the 2nd surgery, I began to have increasing low back pain, which made it difficult to stand very long without needing to sit. Was especially bad when standing in one spot. However, the sciatic pain wasn’t terrible, it was mostly low back pain that was the main issue. I went to my surgeon for this issue prior to the 2nd surgery. After consulting with him, he advised that I needed a TLIF to correct the problem, stating the level was very unstable and thus causing my low back pain. Between that consult, which was in October 2020 and November 2020, I began to experience severe sciatica down my right leg. I had to cancel my TLIF due to contracting the coronavirus, had it rescheduled only to have it canceled again due to the hospital being overwhelmed with COVID patients and suspending inpatient surgeries. I contacted my surgeon and asked that he perform the microdiscectomy to provide relief, to which he agreed. He did, however, tell me that I would eventually need the TLIF. Following the 2nd surgery, it took some time for the residual sciatic pain to subside, and that’s where I came to find this forum, in trying to figure out what was going on.At this time, I’m back to where I was previously, with moderate low back pain which is sometimes severe, and minimal sciatic pain. The sciatica is there, I just wouldn’t classify it as moderate or severe. The low back pain is what gets me. Any activity or standing for very long really aggravates my low back. I’m 41 but feel twice that in my low back. What advice would you give on this? I don’t want to rush back to my surgeon and seek surgery, but he did say I would eventually need the TLIF. I also don’t want to lose anymore time with my children from being down and out in my low back, I’m tired of hurting. Guess I’m just nervous about the possible outcomes, even though I know many good outcomes. I know a new MRI would be necessary, but with what I have described, would you suggest moving forward with a fusion? Thank you for your time.
Generally, lower back pain is caused by degenerative/unstable vertebral levels. Leg pain is caused by nerve compression. The decompressions sound like they did their job relieving the nerve root compression but of course did not take care of the lower back pain.
Without knowing what your X-rays and MRI demonstrated, I cannot comment on the need for a TLIF but it does sound, based upon your symptoms that you would probably need “something surgical” to help your back pain.
You can cut and paste your radiological report here (without names) if you want further help.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Thanks for the response. Below you will find the report from my MRI from September 2020. This MRI was done prior to the sciatic pain becoming severe and the 2nd microdiscectomy in December 2020. I placed an asterisk beside 2 sections in which my surgeon singled out. He told me I had a bulge at L3-4, which could cause a problem at some point if I had the fusion, but also noted it may not cause a problem at all. Thanks for taking the time to review this.
PROCEDURE NAME: MRI Lumbar W/WO-KIC 09/24/2020
REASON FOR STUDY: Low back pain, pain down the right leg. No recent injury. Previous back surgery.
MRI OF THE LUMBAR SPINE WITH AND WITHOUT CONTRAST MATERIAL:
FINDINGS: MR imaging of the lumbar spine demonstrates normal lumbar vertebral body height and alignment. There is moderate desiccation of disk material at the L3-4 and L4-5 levels.
The marrow component signal return of the vertebra appear normal in this examination.
Post contrast imaging was performed with IV administration of 15mL of ProHance.
**There is a right laminectomy defect at the L4-5 level. There is disk material extending into the right lateral recess and right neural foramen abutting the right exiting nerve root at the L4-5 level. There is no nerve root compression demonstrated in this exam.
At the L3-4 disk interspace level, there is indentation of the right dorsal lateral aspect of the thecal sac secondary to the degenerative changes of the right articulating facet and mild hypertrophy of the ligamentum flavum at this level. There is no significant compromise of the neural foramen demonstrated at the L3-4 level.
The L1-2 and L2-3 disk interspace levels are normal. There is moderate narrowing of the disk interspace at the L5-S1 level. No disk herniation is evident at this level. There is no significant compromise of the neural foramen.
IMPRESSION:
1. Postsurgical changes identified on the right at the L4-5 level.
2. There is disk protrusion into the right lateral recess and neural foramen at the L4-5 level.
**3. Moderate desiccation of disk material present at the L3-4 and L4-5 disk interspace levels.
4. Additional imaging findings as discussed above.Interesting MRI report as it did not discuss the L5-S1 level other than “moderate narrowing of the disk interspace at the L5-S1 level”.
You have degenerative changes of L3-S1. There are no comments on alignment or slippage. Maybe an X-ray of your lumbar spine (4 view motion X-rays while standing) could be helpful in indicating your problems.
This might be a case where you consider a long-distance consultation with me (see top of the web page for information).
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books. -
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