[CaroleL]

#29963

Hello, Dr.

I had a microdiscectomy in June, 2016 for a severely herniated L3/L4 disc. The surgeon told me post-op that there was significant adhesion of the disc material to the L3 nerve root, likely due to the length of time between the herniation and the surgery (nearly 2 weeks). He described the surgery as more lengthy and tricky than typical because the nerve root needed to be “scraped” to free it from the protruding nucleus fragments. I am now 2.5 years out from this surgery, and still feel constant pain, tingling, and other sensations on the inside of my right leg/knee area. A subsequent MRI in April, 2017 revealed “…mild 2 mm left and 4 mm right-sided posterolateral disc protrusion along with mild right- greater than left-sided hypertrophy resulting in moderate right L3 foramina narrowing…Associated potential exists for symptomatic impingement upon the exiting right L3 nerve root.”

I have been trying to determine whether this perpetual pain is a result of inadequate removal of the herniated fragments, or if it is more likely that my symptoms are caused by permanent damage to the nerve root itself so I can decide if it is worth seeking additional treatment options. Advice from the original surgeon was simply to seek long term pain management.

Thank you for your time.

Carole

[Donald Corenman, MD, DC]

#29964

It is hard to tell by the information supplied whether or not your nerve symptoms are caused by continued compression from the residual herniation, new compression from the foraminal stenosis or from injury to the nerve root itself from the initial herniation or even they surgery.

If you have more pain in the leg with standing and walking that is relieved with sitting or lying down, this would be a good indication of new onset foraminal stenosis which would be a surgically “fixable” condition. If you have lateral recess stenosis from residual herniation, this too is a surgical condition. If however, you have nerve root injury from the prior compression, surgery might not be helpful.

See: https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/
https://neckandback.com/conditions/lateral-recess-stenosis/
https://neckandback.com/conditions/chronic-radiculopathy/

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.

[CaroleL]

#29965

Thanks, that’s helpful information. The pain is definitely made worse with activity, but it is almost always an issue, even when inactive/lying down. Am I understanding correctly that if my pain is the result of nerve injury, then activity (or lack of) would not necessarily make a difference? Or…perhaps my problem is a little of both (nerve injury AND residual herniation).

[Donald Corenman, MD, DC]

#29966

Roots that are swollen due to continued compression will cause more continuous pain that ones that are only compressed in certain positions. However even chronic radiculopathy roots can become somewhat worse with stretch or compression. The diagnosis is related to the quality and intensity of the pain and is a matter of degree. A selective nerve root block is also not capable of differentiating if the disorder is chronic radiculopathy vs compressive radiculopathy as anesthetizing the root in either case will yield relief.

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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