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  • jayd10033
    Participant
    Post count: 69

    Hello Doctor, one week ago I underwent MIS for a right L3-4 extraforaminal disc herniation. The MRI showed a clear herniation. I had been having sciatica and low back, buttock and searing leg pen on and off for 4 months. Activity modification and a cycle of pain management (3 epidurals, 2 weeks apart) with only moderate relief, I decided to have the aforementioned surgery given the size of the herniation. Prior to the surgery the MOST severe symptoms had subsided, but my experience is they had come and gone over 4 months. At the point of surgery I was having a little weakness in the front thigh hip (no foot drop) and some low back ache that persisted.

    I have a 4 month old daughter, and so I thought it best to nip this in the bud.

    This question is about post-op pain. I’ve read some of the other threads, but posting for peace of mind since everyone thinks their situation is unique ;)

    I’m mobile, I’m walking. I wear a lumbar belt (Aspen Horizon 637) when moving.

    Incision soreness minimal, low back discomfort as expected post surgery. I can’t say I’m not doing ANY BLT, given I do care for an infant, but I try move properly, etc.

    I’m concerned about a persistent burning feeling, or sometimes bruised feeling localized to my right buttock. It feels bruised to the touch and is sensitive to clothing over it etc. It hurts to lie down on that side. Very slight other nerves sensation on my thigh, but the “painful” feeling is localized to my right buttock. I’m having no shooting pains, no radiating pain that I can perceive. I was put on a Medrol dose-pack, but hasn’t had any effect.

    Is this burning/bruised feeling in my buttock “normal” ?

    Thank you for this wonderful forum!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    A far lateral herniation at L3-4 will compress the L3 nerve root which goes to the quadriceps muscle which explains your knee weakness (“was having a little weakness in the front thigh hip (no foot drop”). That, in my opinion would be an indication for surgery at the beginning of symptom presentation. Nonetheless, you chose to try conservative treatment for 4 months before surgery which is acceptable, especially since you were about to deliver your child.

    You are only 1-2 weeks out from surgery which requires root retraction for clear the herniation. Give it 6 weeks but if symptoms are really disagreeable, consider some oral steroids to reduce the inflammation.

    Dr. Corenman

    jayd10033
    Participant
    Post count: 69

    Thank you,Doctor. They did put me
    on a dose pak. Today was the last dose – still no change in level of pain in buttock. I guess it’s just too soon after surgery.

    jayd10033
    Participant
    Post count: 69

    Hi Doctor, I see other people have posted MRI results, which I didn’t do but will put here for posterity. Let me know your thoughts. Again, 1.75 weeks post-op. Pretty persistent right buttock pain standing, sitting or laying down. No shooting pain, no pain in back. Minor tingling that comes and goes on lower back/thigh. Course of oral steroids is over with no change in buttock pain.

    PS – I find your site fascinating, I’ve read a ton of posts, which are really helpful, even if from just a therapeutic point of view as I recover (hopefully!)

    Below is pre-op findings.

    EXAM: MRI LUMBAR SPINE WITHOUT CONTRAST
    HISTORY: Lower back pain.
    TECHNIQUE: Multiplanar, multi-sequential MRI of the lumbar spine was obtained on a 1.5T scanner using a standard protocol.
    COMPARISON: Lumbar spine MRI 11/24/2020.
    FINDINGS:
    Bones: Five lumbar bodies are assumed. No evidence of acute fracture or pars defect. Vertebral body heights are preserved. No areas of bone destruction or abnormal marrow replacement.
    Alignment: Unchanged mild retrolisthesis at L2-L3.
    Disc spaces, spinal canal, and neural foramina: Disc desiccation unchanged moderate disc height loss at L2-L3. Partial disc desiccation at L1-L2 and L3-L4 with mild disc height loss at the latter. Evaluation of the individual motion segments demonstrates the following:

    — T12-L1 and L1-L2 levels: No disc herniation, canal narrowing, or foraminal narrowing.

    — L2-3 level: Mild retrolisthesis. Mild disc bulge with mild compression of the ventral thecal sac. Mild canal narrowing. Mild bilateral foraminal narrowing.

    — L3-4 level: Mild disc bulge and worsened superimposed large right foraminal/extra foraminal disc protrusion, with worsened moderate-severe right foraminal stenosis and disc contact on the exiting right L3 nerve root. Mild canal and mild left foraminal narrowing.
    Small 3 mm synovial cysts at the posterior margin of the left facet joint and the inferior margin of the right facet joint. Neither cyst indents the thecal sac.

    — L4-5 patent L5-S1 levels: No disc herniation, canal narrowing, or foraminal narrowing. Mild right facet arthropathy at L5-S1.

    Spinal cord: The spinal cord terminates at the level of T12-L1. The visualized segment of the cord is unremarkable.
    Paraspinal musculature: Unremarkable.

    Retroperitoneum: Visualized portions of the retroperitoneum are unremarkable.

    IMPRESSION: MRI of the lumbar spine demonstrates:
    1. At L3-L4: Mild disc bulge and increased large right foraminal/extraforaminal disc protrusion, with worsened moderate-severe right foraminal stenosis and disc contact on the exiting right L3 nerve root. Unchanged mild canal and left foraminal narrowing. Small 3 mm facet cysts bilaterally.

    2. At L2-L3: Unchanged mild retrolisthesis and mild disc bulge. Mild canal and bilateral foraminal narrowing.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    The radiological report notes the large L3-4 right far-lateral herniation causing compression of the L3 nerve root which fits with your preoperative symptoms.

    Dr. Corenman

    jayd10033
    Participant
    Post count: 69

    Thank you. I had my 2 week follow up. Doc said pain in buttock should subside and did not think another MRI was warranted yet. So far is is plateaued at pretty consistent discomfort. I wonder if it is nerve or piriformis- not sure how to tell.

    What is your recommendation for lumbar belt wearing duration post far lateral MIS?

    Do you suggest any type of easy range of motion I can do now?

    Current guidance I have is 4 weeks belt when moving and zero PT or ROM exercises. Just walking, upright bike.

    Lower back is getting super tweaked I think from no flexion.

    Thank you,
    Jay

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