LA_FrankieParticipantAugust 29, 2020 at 11:00 amPost count: 21
You were very helpful and nice enough to reply to my messages post-op. So thank you. Here is my bleak update.
12 weeks ago I underwent a ‘successful’ (in the words of the surgeon) microdisc and decompression L5/S1. Surgeon removed a large disc that was severely compressing my S1. The compression caused significant atrophy in right leg, calf weakness and I experienced a lot of post-op nerve pain but was doing well after 8 weeks. Going to PT, exercising daily, etc.
Two weeks ago was 10 weeks post-op, in the middle of the night I rolled over in bed and re-herniated the disc! Pain was an immediate 10. Over the past 2 weeks however it has mellowed out and I am able to walk, sit without a lot of pain. I CANNOT do any exercises however without radicular pain returning down the right leg. I am in active rest mode, walking only.
Pain doctor said injections are not as successful on reherniations and he said he was less confident that I would get relief. He suggested I see the surgeon again.
Surgeon wants to take a ‘wait and see’ approach even though the reherniation is at the same location, level and same size as disc he removed. Because the symptoms are not as urgent as before surgery he wants to give it time.
Both doctors give me the feeling that there is nothing they can do for me now. Is this the right approach? I am in pain, just not bed-ridden pain as I was before surgery.
Is it time for a second opinion or is this the standard procedure for reherniation?
Lastly, and most importantly, can a reherniation HEAL on it’s own much like a virgin disc herniation? or does the compromised disc from previous surgery make this a problem forever…?
Thank you so much for your time.
FrankieDonald Corenman, MD, DCModeratorAugust 30, 2020 at 9:04 pmPost count: 8465
You note “12 weeks ago I underwent a ‘successful’… microdisc and decompression L5/S1…10 weeks post-op, in the middle of the night I rolled over in bed and re-herniated the disc…CANNOT do any exercises however without radicular pain”.
Then “Pain doctor said injections are not as successful on reherniations”.
Recurrent herniations are not common at about 15% but do occur and more commonly in the immediate (12 week) post-operative period. They should be treated like first time herniations. Epidurals and PT if there is no motor weakness and withstand-able pain. These can “heal” without further surgery. A redo microdisectomy is required if there is motor weakness or intractable pain. If non-surgical treatment fails in 6 weeks (no improvement greater than 40-50%), a redo microdisectomy is considered.LA_FrankieParticipantSeptember 1, 2020 at 8:00 pmPost count: 21
Thank you for the prompt reply as always.
My surgeon said exactly the same things you mentioned in your reply.
However, since I still have motor loss in my right calf from S1 decompression 12 weeks ago as well as significant muscle atrophy in right leg, my surgeon said he can do the revision surgery for me sooner than later as to not risk further weakness/atrophy.
He left it up to me to get another ESI. The first one I had this year in May had no effect.
Question: what are the risks involved with multiple ESI within a 6 month time period? Does it negatively effect the outcome of the healing and or structure surrounding the disc herniation?
Lastly, would you advise a patient to try and tolerate the pain for a minimum of 6 weeks after reherniating to reassess surgery as an option?
FrankieDonald Corenman, MD, DCModeratorSeptember 1, 2020 at 8:15 pmPost count: 8465
The problem with nerve root “healing” is that is is not compatible with normal tissue healing. Tissues heal with inflammation and scar tissue formation which is a big negative for nerve roots. Steroid application reduces healing by reducing inflammation and scar tissue formation. In my opinion, you can have as many as 3 injections in 6 months in your situation (normally 3-4 per year in a normal situation).
Pain is a personal experience and we try to judge how much pain can be tolerated before we pull the trigger on another surgery. It really depends upon how the patient is functioning. With “severe pain”, I’ll repeat a discectomy quickly.
Dr. CorenmanLA_FrankieParticipantSeptember 2, 2020 at 9:10 amPost count: 21
Are ESI following reherniation less effective because of the presence of scar tissue from the previous miscodisc surgery? In my case at 10-12 weeks, would there typically be enough scar tissue to affect the outcome of the ESI?
Same question regarding the revision surgery and recovery? How does the scar tissue affect risks? And will recovery from revision carry any more restrictions than a virgin microdisc?
Thank you kindly!
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