Buttocks pain after L5 / S1 microdiscectomy

///Buttocks pain after L5 / S1 microdiscectomy
Buttocks pain after L5 / S1 microdiscectomy
Viewing 6 posts - 13 through 18 (of 18 total)
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  • AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6759

    Increased pain 4 days after surgery is concerning. A new MRI was appropriate. Two MRIs within 6 weeks maybe means the second MRI was not of good quality. I will assume that infection was ruled out through imaging and lab tests as that is a possibility for your symptoms.

    If no infection, a steroid injection would be the next suggestion. Make sure you don’t have lateral recess stenosis which would require a redo decompression or foraminal stenosis which would require a fusion.

    See https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/ or
    https://neckandback.com/conditions/lateral-recess-stenosis/ to see if either of those fit your 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.
    Avatarnbassano82
    Participant
    Post count: 4

    Thanks for the quick reply. I don’t believe foraminal stenosis as that was never shown before or after the surgery on the MRI w contrast. My surgeon believes it’s nerve irritation. It’s been 6 weeks and I haven’t noticed any improvement. I did have the epidural steroid injection about 2 weeks ago but that didn’t help either. What is a reasonable time frame for nerve pain to last? It feels like anything more than walking causes a lot of irritation and makes it worse. I’m

    My surgeon offered do a revision and try to create a little more space off the nerve.

    Avatarnbassano82
    Participant
    Post count: 4

    Hi dr. Corenman

    Here is my follow up mri about one month post surgery. For some reason. They didn’t release it to me until I asked.

    Impression
    Similar residual/recurrent left paracentral/foraminal disc protrusion compressing and posteriorly displacing the left S1 transiting nerve root. Improving enhancement of left S1 transiting nerve root and left lateral epidural space. Decreasing postoperative fluid collection.

    Narrative
    MRI LUMBAR SPINE WITHOUT AND WITH CONTRAST

    ** HISTORY **:
    36 year old man, status post microdiscectomy L5-S1 left, which was done on 5/13/19.

    ** TECHNIQUE **:

    MR images of the lumbar spine were acquired without and with 8 mL Gadavist intravenous contrast.

    COMPARISON: Postoperative MRI 05/24/2019

    ** FINDINGS **:
    NUMBERING: Last fully formed disc space is designated L5-S1.

    SPINAL CORD: Normal conus. Conus terminates at the L1-L2 level. No abnormal intrathecal enhancement.

    DISCS: Similar disc desiccation and mild disc height loss at L5-S1. Redemonstrated is the residual/recurrent left paracentral/foraminal disc protrusion compressing and posteriorly displacing the left S1 transiting nerve root (series 6, image 14). Improving enhancement of the left S1 transiting nerve root, left lateral epidural space. There is small fluid collection following the left L5-S1 hemi-laminectomy. The fluid collection in the region of the left epidural space measures approximately 0.9 x 0.9 cm (series 9, image 15). Superficially within the subcutaneous tissues of the fluid collection measures 1.5 x 0.9 cm (series 9, image 14), which is smaller in size previously.

    BONES: Vertebral body heights and alignment are normal. Marrow signal is normal.

    SOFT TISSUES: As described above.

    T12-L1: No spinal canal or foraminal stenosis on the sagittal plane.

    L1-L2: No spinal canal or foraminal stenosis on sagittal plane.

    L2-L3: No spinal canal or foraminal stenosis.

    L3-L4: No spinal canal or foraminal stenosis.

    L4-L5: No spinal canal or foraminal stenosis.

    L5-S1: Redemonstrated is the residual/recurrent left paracentral/foraminal disc protrusion compressing and posteriorly displacing the left S1 transiting nerve root (series 6, image 14). Improving enhancement of the left S1 transiting nerve root and left lateral epidural space. There is small fluid collection following the left L5-S1 hemi-laminectomy. The fluid collection in the region of the left epidural space measures approximately 0.9 x 0.9 cm (series 9, image 15). Superficially within the subcutaneous tissues of the fluid collection measures 1.5 x 0.9 cm (series 9, image 14).

    OTHER: None

    I’m having more pain now than before my surgery. Given the results. Would it be appropriate for a revision surgery or as my surgeon suggested wait thinking it will get better on its own. What would be a reasonable time frame. I don’t feel like waiting as the pain is bad.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6759

    You have what I assume is a recurrent disc herniation at the same level (“Redemonstrated is the residual/recurrent left paracentral/foraminal disc protrusion compressing and posteriorly displacing the left S1 transiting nerve root”). The radiologist implies that this appears to cause the same amount of compression as the first disc herniation. It sounds like you might need a redo microdiscectomy. I don’t think waiting will improve the situation if your pain is worse than prior to the initial surgery.

    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.
    Avatarnbassano82
    Participant
    Post count: 4

    My Surgeon says that there is only a small residual annular bulge that is touching the nerve which he doesn’t consider compression. He indicates that a follow up surgery would be to explore the nerve root and make sure there isn’t something else that isn’t showing up on the mri.

    It’s just really disheartening how sensitive the nerve is. I had been feeling well for a few day and then one day back at work and the sitting made me feel worse than I’ve felt in a long time. Is this all part of the healing process. Do you have any experience where a patient needs an exploratory surgery? FWIW I’m now about 8 weeks post surgery. Pain level sitting is about an 8.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6759

    I am not clear if your surgeon is inaccurate in his assessment or the radiologist is exaggerating the imaging findings. By your lack of nerve root pain improvement after surgery and possible worsening pain, it could be that the radiologist is “more” correct. Whatever the surgeon wants to call it (“exploration of the nerve root”), a redo surgery and removal of that fragment seems to be the better pathway to take.

    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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