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  • Outdoorsy
    Participant
    Post count: 5

    Dear Dr. Corenman,

    I herniated my L5/S1 disc in February 2020. It was a 6 mm left lateral disc herniation that displaced the S1 nerve posterior laterally. Due to Covid, I didn’t start PT until early May. In June I saw a surgeon because I continued to experience buttock, back of leg and foot pain. Surgeon recommended surgery but I wanted to avoid it. I agreed to another MRI to see if there was improvement which occurred in July. The MRI results showed I still had a 6mm disc herniation but this time it was classified as an extrusion. On August, I finally had a microdiscectomy, after my pain symptoms intensified.

    Recovery went well initially. I never had to take any narcotics post surgery. I suppose I have a high tolerance for pain. By three weeks I was walking 2+ miles a day. I started PT at 6 weeks and have been diligent in doing my exercises. I’m also walking 4+ miles a day now. Around the 5th week, I started to get some radicular pain on my buttock, thigh, leg and foot. However, instead of it being in a straight line, like pre-surgery, it was more a patchwork. I also started to experience pain in parts of my leg and foot that are not associated with L5/S1.

    I got another MRI this past Monday and this is what it reads:
    L3-L4: There is a 1.7 X .4 X 3mm left foraminal and paracentral disc extrusion which displaces the left L3 nerve root within the neural foramina. The left L4 nerve root is displaced within the lateral recess.
    L4-L5: There is a 1.2 X .03 X 3.6 mm disc extrusion with spondylosis which displaces the L5 nerve roots within the lateral recesses. Central canal and neural foramina are patent.
    L5-S1: Operative changes of left laminotomy are noted. There is a recurrence/residual left foraminal 1.3 X .4 X 2 mm disc extrusion which displaces the left L5 nerve root wihtin the neural foramina. The left S1 nerve root is displaced within the lateral recess.

    My MRI from July 2020 reads:
    L3-L4: At the L3-L4 disc space, there is a 3 mm far left lateral bulging annulus with minimal distal foraminal stenosis. Disc is seen contiguous without displacing the sensory root ganglion. There is a minute Schmorl’s node of the superior endplate.
    L4-L5: At the L4-L5 disc space which is desiccated, there is a minute Schmorl’s node of the superior endplate and a 2 mm bulging annulus without central or foraminal stenosis.
    L5-S1: At the L5-S1 disc space, there is a 6 mm left lateral extruded disc herniation displacing the left S1 nerve root posterior laterally. There is no central canal stenosis. There is a quite capacious spinal canal. There is no foraminal stenosis.

    What would you recommend as a next course of action? I’m meeting with my surgeon on Friday to go over my MRI results so I’m curious as to your recommendations. I am a 44 year old female who was extremely active prior to this injury. I did sprint triathlons, ran and did boot camp style workouts 4 days a week. I can’t help but feel those days are behind me now.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Well, unfortunately, you have a genetic variation of weak annular collagen and you have discal tears at the lowest three discs in your back. You have developed a far-lateral herniation at left L3-4 that is of significant size (” 1.7 X .4 X 3mm left foraminal and paracentral disc extrusion which displaces the left L3 nerve root”).

    L4-5 is also mild-moderate HNP and is probably causing symptoms (“1.2 X .03 X 3.6 mm disc extrusion with spondylosis which displaces the L5 nerve roots within the lateral recesses”). This one is brosd based and thin (.03mm) so it might not be a significant pain generator.

    L5-S1 has a recurrent HNP compressing your S1 nerve root (“At the L5-S1 disc space, there is a 6 mm left lateral extruded disc herniation displacing the left S1 nerve root posterior laterally).

    Part of what you should consider depends upon your current symptoms and findings. Do you have weakness of your left quad muscles (squats) which is what the L3-4 HNP can do? If so, surgery is advised with a far lateral approach. If not, maybe you could try an injection (TFES!). Same for the recurrent HNP at L5-S1. Do you have calf weakness? If not, an injection can be helpful.

    You have to start considering managment of these disorders as the only other choices are microdiscectomies and if continued recurrence, fusions which are not the end of the world but better than continued leg pain.

    See;https://neckandback.com/conditions/symptoms-of-lumbar-nerve-injuries/
    https://neckandback.com/conditions/home-testing-for-leg-weakness/
    https://neckandback.com/conditions/far-lateral-disc-herniations-lumbar-spine/
    https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/

    Dr. Corenman

    Outdoorsy
    Participant
    Post count: 5

    Thank you Dr. Corenman for your time and knowledge. You stated what I feared and suspected, that this is likely a genetic disposition.

    I did make one critical typo. My L3-L4 herniation measures at 1.7 X 0.4 X 1.3.

    I did test for weakness for L4, L5 and S1 and found there are none. My pain is mostly from S1. However the reherniation is much smaller now than pre-surgery which was at 6 mm.

    I’ll keep you and the forum posted after reviewing my condition with my surgeon tomorrow. Thanks, again.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Thank you

    Dr. Corenman

    Outdoorsy
    Participant
    Post count: 5

    I spoke to my surgeon to review the MRI results. He asked what my symptoms were. He said he likes to review the images himself and not rely only on the MRI report and thought my spine looked good. The other findings were not visible without contrast and he was not concerned. He told me to keep up with PT, no physical restrictions. I will continue with walks (4+ miles a day) and PT and nothing else. I am getting a TFESI at L3/L4 and hope it does the trick.

    I need to maintain a positive outlook. I do believe there is a psychological element to feeling pain and healing and it helps to believe and work toward the best chance to a full recovery.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Make sure that you keep a pain diary after the TFESI. See https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/

    Dr. Corenman

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