[Donald Corenman, MD, DC]

#7266

In general, a second herniation at the same level requires only a repeat microdisectomy, not a fusion. If however, the level is associated with a spondylolisthesis, isthmic or degenerative, there may be an indication for fusion. Nonetheless, if your only symptom is leg pain and not back pain, the surgical plan should lean toward decompression.

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.

[malikfida]

#7269

SIR,
As I am dental surgeon not know enough but i would say that the surgical approach was
not a microdisectomy but was an open laminectomy the surgeon had cut my back more than 5 inches, that why the orthopaedic spine surgeon told me that you are suffering from post laminectomy syndrome and hence your spine is instable, could you please elaborate difference between microdisectomy and open laminectomy? If i could go for the spinal fusion what should be the possible complications?
thanks

[Donald Corenman, MD, DC]

#7270

Post laminectomy syndrome is a catch-all term for failure of surgery to relieve pain. An open laminectomy with a large incision does not necessarily mean that the surgery was done improperly but that the surgeon is probably from the “old school” where the philosophy was “incisions heal side by side” and it did not matter how long the incision was.

A full laminectomy does not generally create instability of the spine. The spinous process is removed but the facets are generally left intact which are the main stabilizing processes (other than the disc). A microdiscectomy is a much “smaller” surgery with only a very small portion of the lamina removed (laminotomy) and the approach is from only one side. The laminectomy is performed from both sides.

Your spine could be unstable but that term is used for a number of different pathologies. True instability is the inability of the spine to maintain normal anatomical relationships with forces that cause shear, torsion and flexion/extension.

Pain generation could be from instability, foraminal stenosis, lateral recess stenosis, degenerative disc disease, isolated disc resorption, or chronic radiculopathy. See the website for description of each.

Spinal fusion- if needed, might be your answer but a thorough workup needs to be performed to determine the cause of your pain. As to complications of fusion, look to the website for “complications” for a good description.

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.

[malikfida]

#7783

Hello doctor,
Sir i had travelled to thialand(bangkok) for my spinal problem,
As the surgeon was orthopaedic spine surgeon he had suggested a lumbar
Fusion but later on when he examined me and se my l/S x rays he put me
On certain medicines and exercise, Well now i had feel another problem that i
Feel difficulty in walking, standing too long on my right leg cause so much pain
And numbness that i want to take support from surrounding objects,SIR
what is ur opinion about my this recent change? Is it going to worst? Is this
Something related to muscle weakness?
THANKS.

[malikfida]

#7788

Hello Sir
I am waiting anxiously for ur reply?
Thanks in advance.

[Donald Corenman, MD, DC]

#7789

Sorry for the delay.

With a prior history of a laminectomy and now leg pain with standing, a potential pain generation condition could be foraminal or lateral recess stenosis (see website). In these conditions, the nerve passage (foramen or lateral recess) becomes narrowed. When standing, the narrowing becomes worse and leg pain occurs. With sitting or lying down, the spine flexes and gravity’s effects are eliminated which reduces the leg pain.

Typically, these dynamic compression conditions do not cause motor weakness (with some exceptions) as when the pain becomes bad enough, you can “get off the nerve” by bending forward or lying down. This decompression maneuver generally prevents significant damage.

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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