[george]

#33508

Hello Dr. Corenman,

I had a microdiscectomy at L5-S1,4 weeks ago, after 8 months since everything started.
The pain I had before the surgery was the most intense in my buttock and the exterior of the hip and less intense down the left leg up to the ankle on the exterior of the calf,and it ocuured mostly when seating and when getting up ,or when bending forward.
Right after the surgery, I was feeling a little bit of pain on the exterior of the calf but not in my bottock, then in the first week post op.the pain was also present in my buttock, at a mild level, not as it was before the surgery, my surgeon told me that is normal if the pain is not very intense.
I started walking outside the house in the following days and the pain got more intense,sometimes greater than before the surgery or comparabale and sometimes it fells a little different than before and on a larger part of my leg, the difference between before and after is that the pain is not so bad when sitting or getting up, but is greater when walking or standing up or even when laying down.
Initial recommendation was to begin kinetotherapy 2 weeks after surgery, buy I informed the surgeon about the pain and he said to not do anything yet.
I took diclofenac and mydocalm for a few days,during this time I felt better, but my concern is that taking this meds I will never know my real level of pain or recovery.
Should I continue to take meds?
If the nerve is not compressed anymore, should I still feel this kind of pain, or shouldn’t that go away little by litlle every day?
Should I wait for the pain to completly go away in order to start any excercises, kinetotherapy?
Is phisiotherapy also indicated?
Is an MRI relevant on this stage of recovery? Would the images reveal the real or actual nerve situation or would that be prevented by the scar tissue?

Thank you very much.

[Donald Corenman, MD, DC]

#33509

The possible causes of increased leg pain after a period of relief after microdiscectomy surgery are inflammation of the nerve, seroma, recurrent herniation and infection with some much more rare conditions like facet fracture.

Inflammation is common after decompression of the root. A compressed structure that was injured will “swell” and become congested. Oral steroids and time are the best treatment.

Seroma is a common condition. Fluid exudes from surgical sites and can build up and congest and compresses the nerve root. Seromas typically resorb after some time but occasionally need to be aspirated by needle. This is diagnosed by MRI and treated by needle aspiration.

Recurrent herniation occurs in 15% of patients and normally increase pain significantly. Recurrent weakness and a “tighter” leg (SLR) are common. If the recurrence is not too large, sometimes an epidural injection can be helpful. A redo microdiscectomy is not uncommon in the face of a recurrent herniation.

Infection should be rare at less than 1% of all surgeries. Interestingly, many patients do not have fevers or chills but have increased back pain that translates to leg pain eventually. Lab tests are the beginning for diagnosis. Diagnosis is by lab tests and patient symptoms.

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.

[george]

#33531

Hello Dr. Corenman,

I’m coming back to you with an update of my situation.
I still have sciatic and buttock pain but not as intense as when I’ve send you the first message.
It’s been 6 weeks since I had a microdiscectomy at L5-S1, a few days ago I had a post op MRI (Lumbar spine MRI without contrast) and here is the result(I had to use a web translator, there might be mistakes ,hope you will understand):
Native MRI examination of the lumbar spine reveals:

-postop status for left paramedian disc herniation L5-S1 left bone edema at the level of adjacent vertebral plates, with a left paramedian hernia recurrence, caudally migrated with maximum dimensions of 10/14/20mm, which compresses the left S1 root.

– diffuse edematous infiltration of the lower lumbar paravertebral muscles

Could you plese tell me what are my options now?

How can you explain that the pain level is lower compared with 2 weeks ago considering that there is a reherniation? For example, 2 weeks ago when I was trying to do the SLR test I could hardly lift my leg because of the buttock pain, now I can lift if to, let’s say 60 degree angle before starting to feel that pain.

In the case of a new surgery , what is the success rate , is that efficient or the risk is even higer than the first time?

Thank you very much.

[Donald Corenman, MD, DC]

#33536

You have a recurrent disc herniation (HNP) which is somewhat large (“left paramedian hernia recurrence, caudally migrated with maximum dimensions of 10/14/20mm, which compresses the left S1 root”). Each herniation is not comparable to another as the position of the herniation in the canal really is the key factor. Some large HNPs are asymptomatic and some small HNPs are extremely painful.

Success rate for a second surgery should be almost as good as the first one. There will be some scar which makes surgery somewhat more challenging but still should have a good success rate. However, if you have yet another HNP after this surgery, you would need a fusion so you don’t develop permanent nerve injury.

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.

[george]

#33539

Is the risk of reherniation higher after the second surgery or is it the same 10-15%?
Are there any other options in my case?
Could you please shortly explain the term fusion?

[Donald Corenman, MD, DC]

#33541

Second HNP is the same risk as the first HNP. A second recurrent HNP risk (third HNP) is higher risk which is why a fusion is necessary. If you have no motor weakness and your pain is tolerable, you can try PT and injections/medications.

Fusion is a way to ablate the disc space and get the two vertebra to join so no further HNPs are possible.

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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