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  • Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    If you can’t hold yourself upright on your right side with a heel raise (up on your “tippy toe”), then you do have some motor weakness and that L5-S1 right sided HNP is causing motor dysfunction. It is my opinion that with motor weakness, surgery is indicated to decompress the root sooner than later. You can wait if you so choose but I find that decompression of the root performed sooner has a better outcome.

    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
    Participant
    Post count: 17

    Thanks. I decided to send you my MRI and records to review. I talked with Sara and you should be getting them soon…so I will talk to you in the near future!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Look forward to talking with you in person.

    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
    Participant
    Post count: 17

    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

    Dr. Corenman,
    You and I spoke last week (I’m Wendy M.), and I’m scheduled with you later this month for a TLIF on L5/S1 due to the third-time reherniation there (copied our prior conversation above since it’s been a while). What we did not discuss on the phone is the left side.

    The same time I had my last discectomy at L5/S1, I had a laminectomy at L4/L5 for lat. recess stenosis. While the right got better (until it reherniated), the left only got a little bit better, and I continue to have L5 radicular symptoms on that side. The new MRI, which you have, shows “residual compression of the L5 nerve due to facet hypertrophy,” and I even paid to have the MRI read by a board certified neuroradiologist, who found the same thing (I am copying his report below). Three weeks ago, I had a TFESI at left L5 and had immediate relief that then lasted two weeks. The anesthesiologist told me this confirmed that the compression at L5 in the lateral recess was to blame for the pain.

    I actually have an appt to talk with you on Thursday, but thought this might be faster–I’m really concerned that the L5/S1 fusion will help with the right-sided pain, but that I, like you suggested earlier in the forum, also need a TLIF fusion on L4/L5 since I have remaining stenosis that requires a facectomy. I really want to fix all the nerve pain once and for all, and definitely want you to be the one to do it, so wanted to ask you about a TLIF at the L4/L5 level ASAP in case that changes scheduling. Here is the MRI report I got from the neuroradiologist out of New York (I sent the original report with my CD). I’m sorry if this is burdensome to you since we are already talking this week, but as I am in trip-planning mode I want to make sure that if this level is added on the schedule stays the same. Sara has all my info and I’ll talk to you on Thursday but wanted you to have the benefit of this info first. Thank you!

    NEURORADIOLOGIST READING:
    Narrative to patient: The left lateral recess is stenotic with compression of the nerve roots. There is an annular tear of the L4-5 disc; however, I suspect the root compression from left facet hypertrophy should explain the pain rather than chemical radiculitis. Facet hypertrophy contributes to foraminal effacement at L4-5 and L5-S1. The loss of disc height at L5-S1 may contribute to the development of the hypertrophy. There is stenosis of the left L4-5 lateral recess and direct left forminal effacement at L5-S1. Both of these may contribute to left L5 dermatome radiculopathy.

    Report:
    L4-5: There is loss of disc height and T2 weighted signal. Mild disc bulge with an annular tear is
    noted. Facet hypertrophy contributes to left foraminal effacement and stenosis of the left lateral
    recess. The left L5 root is compressed.
    L5-S1: There is loss of disc height and T2 weighted signal. There is disc bulge with an annular
    tear and a large right paramedian disc herniation with obliteration of the right lateral recess. Facet
    hypertrophy yields left foraminal effacement.
    Paraspinous structures are within normal limits.
    IMPRESSION:
    Post-operative changes with disc disease at the L3-4, L4-5, and L5-S1 levels.
    Significant right l5-S1 disc herniation yields obliteration of the right L5-S1 lateral recess.
    Facet disease contibutes to left L4-5 lateral recess stenosis and L5-S1 foraminal effacement.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    I am a little unclear regarding your history. I thought you had only one left L4-5 decompression. Did you have one or two decompressions at L4-5? Did you also have a surgery at L3-4 (“Post-operative changes with disc disease at the L3-4, L4-5, and L5-S1 levels”).

    Was the nerve block you had recently at the L4-5 level or the L5-S1 level? (“Three weeks ago, I had a TFESI at left L5 and had immediate relief that then lasted two weeks. The anesthesiologist told me this confirmed that the compression at L5 in the lateral recess was to blame for the pain”).

    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
    Participant
    Post count: 17

    Hi. I had only one decompression at L4/L5, which did not relieve the pain.

    My TFESI was done at L4/L5

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