[Johnnyjasp]

#31150

Thank you for the forum and the opportunity to ask you questions!

I’m a 35 year old male former athlete … had an l4-l5 herniation (11mm) and was in total agony before hand … afterwards for about 2 weeks I did very little but short walks and felt generally better but still had sciatica issues.

At the end of week 3 I had a set back while doing a stationary bike and immediately felt sharp buttock/hamstring pains and numbness in my toes. I had begun with my doctors blessing to try a light elliptical but it was clearly too much.

Repeat mri showed a “small fragment protrusion” but nothing else remarkable. I am back on melaxicam and pain medicine but I am not any better.

My surgeon wants to try an epidural and therapy and if that is unsuccessful he wants to do an “exploratory surgery” … I am at a total loss. The pain is extreme. I cannot live like this much longer. I’m in week 6 of my recovery and I feel largely like I did before surgery.

[Donald Corenman, MD, DC]

#31154

I assume that you had a microdiscectomy at L4-5 which afforded you the initial relief. You did some exercises and had a recurrent disc herniation (“small fragment protrusion”) with return of symptoms. That is not uncommon occurring at a rate of 10-20%.

I would agree that an epidural injection would be the next consideration as long as you don’t have motor weakness. If you don’t improve after that injection, a repeat microdisectomy should be considered as long as the potential fragment is lodged in an area that is compressing the nerve root. The fragment does not have to be big to cause significant pain, especially after a microdiscectomy which can tether the nerve root.

If you have motor weakness, consideration should be to go to surgery sooner.

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.

[Johnnyjasp]

#31236

Thank you for your response … an update …After some more therapy there has been a progression of pain – it is now extremely sharp in my hip/buttock with calf/shin soreness … there is mild pain in my lower right back area but not severe.

I have been doing extensions and have been able to find a point with pressure which makes my leg and toes tingle.

Is it possible something went wrong during surgery? I was told that the nerve root is clear on a second opinion. The doctors know each other though and I got the feeling that he was holding back on saying he thinks something is wrong.

The mri report also stated a “residual” protrusion. Both doctors said it would be impossible to tell if that was missed from the initial surgery and they attributed it to a new herniation.

I’ve just lost faith in my doctor at this point and need a new doctor – however finding one that is not familiar with him has proven difficult.

Any time I stand or sit or “elongate” my lower right back hip buttock area there is a severe shooting pain. I can not afford to stay out of work.

[Donald Corenman, MD, DC]

#31237

This could be a missed fragment or recurrent HNP but the cause does not matter at this point. I cannot comment on the second surgeon’s opinion. Please cut and paste the radiologist’s report on the new MRI as that can be helpful.

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.

[Johnnyjasp]

#31243

Original –

l2-l3 mild disc bulge and superimposed small central disc protrusion mild canal narrowing

L3-4 mild disc bulge and superimposed small central disc protrusion

L4-5 diffuse disc bulge superimposed large right lateral recess-foraminal disc herniation impinging on right l5 nerve root nearing right l4 nerve root. Small left foraminal protrusion. Narrowing of the right lateral recess

L5-s1 tiny central disc protrusion.

Summary large right lateral recess right foraminal disc herniation l4-5 impinging on right l5 nerve root and nearing the l4 nerve root

Newest mri 5 weeks 1 day post operative

Lumbar vertebrae aligned in the Sagittal plane normal height and signal demonstrated. Straightening of normal lordosis is likely postural or muscular. No Instrinsic conus lesion and no evidence of conus compression

Evidence of recent l4-5 hemilaminotomony and microdiscectomy. There is enhancing material of soft tissue intensity in the right aspect of the spinal canal and extending posteriorly through the laminotomony defect along the right aspect of the spinous process. There is evidence of a small residual right postereolatersl disc protrusion

Mri finding is consistent with postoperative peridural and perineural fibrosis.

Intervertebral discs at remaining levels are unremarkable and appear unchanged. No other abnormalities.

[Johnnyjasp]

#31244

The operative report (the main parts)

Palpitated the pedicle and then mobilized medially and the laterally with microscope. Large herniation at the disc space level. Opened a thin layer of posterior longotudinal ligament and the herniation was extracted. This was removed in multiple fragments. There was some tracking laterally that was also freed up.

Small amount of disc and a hole in the annulus. The nerve root was completely freed.

Everything else seems to be procedural

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