[Donald Corenman, MD, DC]

#32523

Your symptoms are on the opposite side (left) of what I would expect. You have a new somewhat larger disc herniation on the right side (1.5 cm x 1.1 cm) but your symptoms are on the left side. You have continued left lateral recess stenosis (“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”). This is probably causing your symptoms.

The first thing to consider is a diagnostic/therapeutic small volume transforaminal epidural injection (TFESI) at left L4-5. If you gain great temporary relief (3 hours), the diagnosis has been made. The steroid which is injected at the same time will hopefully give you some long-term relief. If you gain only short-term relief (diagnostic only), then you can have a redo decompression. You don’t need a fusion at this time with only one prior decompression and no instability. At the same time. I would consider having the new disc herniation at L5-S1 removed too.

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.

[MidwestW]

#32527

Thanks. To clarify–I have numbness, spasming, and a bit of weakness on the right side (going up on my toe is hard). They told me the numbness would be the last thing to go, so I was less concerned about that side, especially since the left hurt so much. But now the MRI makes all on the right make sense.

Also–my last discectomy at L5/S1 on the right, which has now reherniated, was the second time I had it fixed. So repairing again would be the third time, and I’m starting to feel like I don’t know how many more times I can do this. That’s what I asked about a fusion, if it’s typically done at the three strikes you’re out phase.

[Donald Corenman, MD, DC]

#32528

OK. Your right-sided symptoms are a result of your new herniation. Your left-sided symptoms are more likely from the continued lateral recess stenosis. Since you have had two prior decompressions on the right at L5-S1, you do now need a fusion of that level.

However, since you need a surgery of the level above (L4-5) on the left with a prior decompression already under your belt, this level should be considered to have a fusion (TLIF) also. You could choose to have an L5-S1 fusion and a redo 4-5 decompression only but with prior failed surgery at L4-5, a fusion would be a good choice or this level could break down again leading to a future fusion. I still think the TFESI mentioned earlier should be considered to connect the MRI findings with the symptoms.

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.

[MidwestW]

#32551

To follow up: I saw my surgeon today. Despite the MRI, he thinks my symptoms are from radiculitis on the left. And said the disc fragment on the right is “very, very small.”
He ordered ESI and SNRBs on both sides.

He said the MRI shows a little bit of the fever joint touching the L5 on the left, but not much at all. He said if he went in to address it would require a fusion, and also on the right. He basically told me I should do anything possible to avoid a fusion. I think I will do the injections but get a second opinion on the MRI, as the report doesn’t match what he’s saying.

[Donald Corenman, MD, DC]

#32552

The new herniation fragment is not small (1.5 cm x 1.1 cm) but depending upon the location in the canal, may not be causing severe compression. Nonetheless, you do have new symptoms on the right which correlates with the new herniation. I think that if the injection can give you long term relief, then you can avoid a fusion (as long as there is no associated motor weakness) but if only short term relief is noted, you might need at least a one-level fusion.

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.

[MidwestW]

#32577

Thanks. A couple things:

-I do have weakness on the right. It is not extreme, but I cannot hold myself up on my toe very long. My surgeon has still indicated he thinks that I should try injections first.

-On the left side, the MRI report notes some mild compression of the L5 nerve root, which corresponds to my symptoms on the left. But my surgeon says he doesn’t see that and thinks it is inflammation. Even if something is “mildly” compressing a nerve, can it cause pain? I definitely have pain there (no motor weakness, that is just on the right).

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