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  • AvatarWKBW
    Participant
    Post count: 6

    Dr. Corenman,
    I met with my neurosurgeon to review my new MRI results of a symptomatic large recurrent disc protrusion at L5-S1, exactly where my first one was. Per your suggestion this included a discussion regarding my previous lumbar CT scan report from Feb. which stated I had a “Left L5-S1 spondylolysis” along with a SBO defect at S1, which you referred to as a “floating facet”. (See previous posts for exact details). He explained that it was, in actuality, an intact (non-fracture) elongated pars that likely developed along with my SBO.

    He then said that due to his previous pre-op concerns regarding these two findings, he checked the stability of my spine during surgery and made note of it being “quite sturdy”. In regards to the thinner bone area, he further explained that he will enter through the same incision and only remove a little more bone to give him a slightly bigger window. Consequently, he and I feel confident that a revision microdiscectomy is the most appropriate choice for me at this time.

    We briefly discussed the possibility of other pain generators, but the fact that my symptoms are so similar to before and were completely resolved following the first surgery, he feels sure this revision will have the same affect with a more long-lasting result. There’s never a full guarantee or a crystal ball, but do you agree with his thinking?

    Also, I know that each surgeon has their own post-op instructions/guidelines, but do you offer your patients (going through revision microdiscectomy) any additional instructions that you feel would help prevent another reherniation? If so, I would appreciate any suggestions.

    Finally, thank you so much for helping me with my recent situation. Your willingness to take the time to read my story and give quick responses to my questions, has been remarkable! I’m lucky to have found your forum, been educated by the vast “free” information you have available on your website, and most of all, to have had the benefit of your knowledge and experience. Thank you for selflessly giving back to all of us here.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7523

    He was obviously there and inspected the pars. He apparently found the pars to be intact (but dysplastic). If that is the case, then it is appropriate that another microdiscectomy could be attempted. I do worry that a “stretched pars” (what a dysplastic pars really is) puts you at a higher risk of a repeat herniation but still the risk is reasonable if the pars is intact.

    The instructions for a revision discectomy would be the same for a first time discectomy. Avoid BLT (bend load twist). Let the back get “somewhat stiff” in the first six weeks but do cardiovascular exercise and gently stretch (floss) the nerve root.

    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.
    AvatarWKBW
    Participant
    Post count: 6

    Once again, thank you vey much Dr. Corenman for your time. You’ve been extremely helpful!

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