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  • Kalona
    Post count: 1

    Good afternoon. As a way of background, I had a microdiscectomy performed on the L5-S1 disc that had bulged and impinged the nerve on 11/25/2019. I am currently 10 weeks post-op.

    Pre-surgery MRI results from 11/4/2019 were as follows:

    The vertebral bodies demonstrate expected height. Bands of degenerative marrow edema abut the anterior right aspect of the L5-S1 disc, more so at the L5. The L4-5 and L5-S1 discs as well as the T11-12 disc have degenerative desiccation.

    Conus: The lower thoracic cord appears unremarkable. The conus terminates at T12-L1.

    T11-12 – the disc bulges minimally with no significant stenosis.

    T12-L1 and L1-2: No disc protrusion or stenosis is noted.

    L2-3: The disc bulges minimally with no significant stenosis. The facet joints are mildly arthritic.

    L3-4:The disc bulges minimally with no significant stenosis. The facet joints are mildly arthritic.

    L4-5:The disc bulges minimally with no significant stenosis. Central posterior annular tear is also present. The facet joints are mildly arthritic.

    L5-S1: The disc has focal extrusion centrally and to the right with an 11mm fragment of disc extending superiorly along the right L5 lateral recess. The protrusion and fragment compress the thecal sac, compressing and distorting the right S1 nerve root sleeve and nerve as it exist the thecal sac.

    The prevertebral and posterior paraspinous soft tissues are unremarkable.

    Surgery went well with no complications. Post-op I experienced pain, which I had anticipated. Post-op X-ray taken on 12/20/2019 findings: Mild discogenic degenerative disease at all levels, greatest at L5-S1. Mild lower lumbar facet arthrosis. No fracture seen, no osseous lesion.

    Approximately 3 – 4 weeks post-op I was still in significant pain in my lower back, but the pain down my leg and into my foot was starting to lesson. 6 weeks post-op, pain in my lower back was increasing and walking became more difficult. At times the pain would be so severe, I couldn’t walk even short distances without assistance.

    Approximately 8 weeks post-op I began to experience intermittent pain down my leg and into my foot, again. The more I move, the more pain I experience. I returned to work after 4 weeks. I work from home 2 days a week, more if the pain is too much. Lying down, sitting up straight, standing, walking, adjusting my position all HURT significantly. Today, I felt a stabbing pain in my lower back when I moved my shoulders forward as a reaction to something someone said. I have no quality of life. I walk with a cane and cancel personal engagements because I’m just in too much pain.

    I’ve started acupuncture treatments and I finally have the approval of my surgeon to start PT (which is scheduled to start in 3 days). My surgeon believes I probably have a hemotoma around the internal surgical sight and once that dissipates and is absorbed by the body, the pain will subside.

    After surgery I was prescribed 3 separate rounds of steroids (no relief was felt from that). I took pain meds (narcotics) for a short time and then Torredol and eventually Ibuprofin (which I’ve stopped due to stomach issues). At this point, I’m only taking Gabapentin. I’m struggling to focus on work due to the pain. The emotion of this is weighing on me and I can feel depression starting to work its way in. I’m tempted to call my surgeon and ask him to put in orders for an MRI, but my husband thinks I should wait to see what the physical therapist sees when I’m evaluated in a few days. I’m concerned about a re-herniation, but I don’t want to be a pest by calling my surgeon about the pain, again. The slightest movement can cause me to scream out in pain (I don’t mean to…it just happens). I’m absolutely miserable and constantly in pain.

    I’m reaching out to you in hopes of getting your opinion. Do my symptoms sound ‘normal’ to you at this stage? Should I request an MRI? Should I seek a 2nd opinion?

    Thank you in advance for your thoughts and insights.

    Donald Corenman, MD, DC
    Post count: 8660

    I think you need a new MRI with gadolinium. You might have a seroma (a post-surgical fluid collection), a recurrent HNP, a missed fragment, an infection or a disorder at a different level (unlikely). Your post-op symptoms are not typical and you need further work-up> I would include labs to look for infection.

    Dr. Corenman

    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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