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  • Jeannie
    Member
    Post count: 3

    Teally hoping for some advice. I had back surgery in march. Originally the pain Seemed so much better. However, since then I have has increasing issues. I still have pain in my right leg with weakness. I had nerve test done with showed mild adnormLty in that leg. Since my surgery I have horrible pain in my butt when I sit. I can’t sit more than an hour without wanting to crawl out of my skin. Now I M having pain in my right side. With the pain in my leg butt and side I can’t stand it. I saw a pain doc who prescribes cymbaltA And nucynta. It’s been a month with no improvement. My latest MRI reads:
    Sagittal images demonstrate slightly progressing discogenic endplate signal changes at l5 s1 now demonstrating a mild amount of increased stir signal intensity suggesting reactive edema. A mild amount of endplate enhancement is seen. There is a stable disc disk cation throughout the lumbar spine with stable mild to moderate loss of disc height at l4 s1.

    L1s1 l2 l3 stable appearance of a small filum terminale lipoma

    L3 l4 l4 l5 there is a stable mild broad base annular bulge facet and ligamentum flavum hypertrophy resulting in mild canal and minimal left neuroforaminal narrowing at L3L4

    At l5s1 there is a new right hemilaminotomy detect enhancing granulation tissue is seen within this region abutting the posterior lateral aspect of the thecal sac without evidence of deformity. Enhancing granulation tissue peridural fibrosis changes are seen extending into the disc operative defect. There is a small broad base posterior central disc protrusion indenting the ventral thecal sac. Stable superimposed mild broad based annular luging and facet hypertrophy again resulting in mild neuforaminal narrowing.

    While this finding is thought to be postoperative fibrosis and underlying mild discitis and endoplate osteomitis would be diifficult to rule out.

    L3L5 mild canal narrowing at L4

    I don’t see my surgeon until January and feel like my legs are getting worse. Any insight would be appreciated.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    You underwent a microdiscetomy on the right L5-S1 level in March for what I assume was a disc hernation. You improved initially but now the pain has returned in your right leg. You mention no lower back pain so I am unclear how much of this pain is buttocks and leg (nerve originating) and how much might be lower back pain (disc originating). Prolonged sitting causes significant right buttocks pain.

    The MRI notes reactive endplate changes at the surgical level. There are inflammatory changes that surround the nerve and extend into the disc at the level of surgery.

    The two possibilities for these changes are inflammation (healing tissue that is turning into scar tissue) or infection. Some simple laboratory tests can help to look for infection. If these tests are inconclusive, you could have an interventionist put a needle into the area and “wash and culture” the region, looking for a possible infection. One of the infecting organisms that has to be considered is P. Acnes. If infection is ruled out, an epidural steroid injection can be helpful.

    You need to approach your surgeon and ask him about the possibility of infection.

    Dr. Corenman

    Jeannie
    Member
    Post count: 3

    Thank you for the response. I’ve had blood work which came back fine. Since I started the medicine the sharp pain is reduced and now I feel the deep pain in my lower back. The pain in my butt is more the center I guess it’s called the coccyx . I’m concerned that the next step is going to be a fusion. Does anything in the report suggest this and if not why am I having so much pain

    Thank you again

    Jeannie
    Member
    Post count: 3

    Should I be concerned about an infection?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    If your lab tests were normal, it is still possible but unlikely that you have an infection. An epidural steroid injection would be the next step if you were my patient.

    Dr. Corenman

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