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  • MidwestW
    Participant
    Post count: 17

    I am two months post a laminectomy (no discectomy) on left L4/L5 for recess stenosis, along with revision discectomy at L5/S1 on the right (had reherniated from prior surgery).

    -My right side, with the discectomy revision, is doing great. Very little pain, no nerve pain.

    -The left side was improving but has started going backwards. My surgeon ordered an x ray to check for instability, but there is no instability. I see him in two weeks but it now feels like I never even had surgery–exact same symptoms in my back and down my buttocks/leg.

    Some background: I had both an EMG that indicated L5 radiculopathy, an MRI, and selective nerve root block all indicating that L5 was the culprit. And I did have improvement in symptoms for a while.

    My questions:
    *what could the possibilities be for this returned pain without instability? Prior to surgery, I did have some narrowing of the L5/S1 disc space with mild-mod foraminal stenosis but without any impingement. This new x ray says that is still there but it is “stable.”
    *Could the laminectomy on the left have caused that level to collapse on itself and cause re-entrapment of L5? Would that collapse not show on x ray?
    *Is there any other potential cause for this that I am not thinking of? My surgeon’s nurse told me to “baby it” for a couple more weeks til I see him, but did not give me any other insight into what could be happening since we have ruled out instability.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    You could have lateral recess stenosis, foraminal stenosis or new onset disc herniation along with chronic radiculopathy. With symptoms returning to pre-surgery intensity, a new MRI is recommended.

    Dr. Corenman

    MidwestW
    Participant
    Post count: 17

    Okay–my surgeon has ordered a new MRI which will be done right at the 2 month mark. It is ordered without contrast. Is that okay..I remember reading on here about needing contrast if post op?

    MidwestW
    Participant
    Post count: 17

    [quote quote=32512]Okay–my surgeon has ordered a new MRI which will be done right at the 2 month mark. It is ordered without contrast. Is that okay..I remember reading on here about needing contrast if post op?[/quote]
    Should have been more specific–the area where I’m having pain, I had a laminectomy done, but not a discectomy. Would the contrast be needed to show a new herniation there (when only bone/ligament work was done)?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    An MRI with gadolinium can be helpful but is not absolutely necessary. Scar tissue (which is what contrast is used to identify) can be discerned without Gad but with more difficulty.

    Dr. Corenman

    MidwestW
    Participant
    Post count: 17

    Thanks. I have my MRI results. Again, this is 8 weeks post left L4/L5 laminectomy for lateral recess stenosis and right L5/S1 revision discectomy. I had a return of symptoms at 7 weeks, hence the MRI.

    FINDINGS: There is straightening of the lumbar lordosis. There is no
    evidence of acute fracture or subluxation. Lumbar alignment is
    satisfactory. There is disc space narrowing and disc dehydration
    particularly at the lower lumbar levels with slight spurring at the
    endplate margins. The vertebral body heights are maintained. A small
    fluid collection in the deep subcutaneous tissues in the midline at
    the L4-L5 levels likely represents a postoperative seroma. There is
    residual edema in the paraspinal musculature on the left side as
    well. The conus medullaris terminates normally at the L1 level.

    L4-L5: There are postsurgical changes posteriorly on the left where
    there has been partial hemilaminotomy. There is mild diffuse
    posterior bulging of the disc with mild facet and ligamentum flavum
    hypertrophy. There may be a small focus of granulation tissue or
    inflammation in the left lateral recess. Absence of intravenous
    contrast makes this distinction difficult. There is moderate left
    lateral recess stenosis contacting and possibly slightly impinging on
    the left L5 nerve root.

    L5-S1: Disc space narrowing contributes to moderate bilateral
    foraminal stenosis. There has been partial hemilaminotomy on the
    right. There is mild diffuse posterior bulging of the disc and there
    is a new herniated disc fragment in the right lateral recess. The
    extruded fragment measures approximately 1.4 cm sagittal by 1.1 cm AP
    by 1.5 cm transverse. It displaces and likely compresses the right S1
    nerve root. The right L5 nerve root is contacted but not displaced or
    compressed.

    IMPRESSION
    L4-L5: Small postoperative seroma in the posterior soft tissues and
    edema in the left paraspinal musculature. Slight disc bulge with
    facet arthropathy causing left lateral recess stenosis where there
    may be residual or recurrent impingement on the left L5 nerve root.

    L5-S1: Postsurgical changes on the right. There is a new 1.5 cm x 1.1
    cm right lateral recess disc herniation. The right L5 nerve root is
    contacted but not displaced or compressed. The right S1 nerve root
    appears displaced and compressed.

    Questions:
    -Is this seroma causing nerve compression? Or is it just “there”?
    -It appears the lateral recess decompression I had on the left has now been re-compressed, and the right side has reherniated for the second time. Is a fusion my best bet at this point? Or do I try another left laminectomy and right discectomy?

    Thank you!

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