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  • renee_indy
    Participant
    Post count: 3

    Hi. I had a laminectomy done about 3 months ago for recess stenosis at L4/L5. I had some improvement post op, but after about a week a major flare up in symptoms which got a little better with prednisone. Since then, I’ve had constant radiculopathy just like before surgery–worse with walking and extension.

    I got a new MRI, which shows “contact with possible slight compression” of the L5 nerve root and “granulation tissue or inflammation in the lateral recess.” I assumed L5 contact/compression was the cause of my continued symptoms, but doctor says that when he looks at the MRI he sees no compression. I had another neurosurgeon look at it and he also said he didn’t see any significant compression of L5.

    I had a nerve block done at left L5 which gave me total relief, then a steroid that helped a lot for about ten days. My surgeon says that this will calm down eventually, but should other tests be done? Could this be from the disc itself there, which is bulging and has a tear in it (I read about leaking onto the nerve root even if not herniated)? I’m very confused the radiologist saw compression but two neurosurgeons do not.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    It seems like your symptoms are the same intensity and distribution as before surgery, correct?

    There are other things that can cause nerve compression other than lateral recess stenosis. Instability and foraminal stenosis come to mind. Do you have standing X-rays with flexion-extension laterals? These X-rays can help determine if either of these two conditions exist which might be missed on an MRI.

    Since you did have a nerve block of the L5 nerve which gave you excellent relief, the focus obviously should be on that nerve root. It can get caught at the L4-5 level posterolaterally or at the L5-S1 level in the foramen. Finally, unlikely as it is , this could be a chronic nerve injury

    See:
    https://neckandback.com/conditions/foraminal-collapse-lumbar-spine/
    https://neckandback.com/conditions/lumbar-spine-instability/
    https://neckandback.com/conditions/chronic-radiculopathy/

    Dr. Corenman

    renee_indy
    Participant
    Post count: 3

    Thanks. Yes it feels a lot like pre op. I did have the flexion/extension x rays done and they told me no instability. My MRI also says I have “moderate foraminal stenosis at L5/S1” but it doesn’t say if anything is compressed.

    My surgeon has basically told me it will go away on its own, but sounds like I need to get him to go over the MRI with me and explain why I got relief with the block and steroid but it didn’t last long.

    Thanks for the help.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Is your pain worse with standing or sitting?

    Dr. Corenman

    renee_indy
    Participant
    Post count: 3

    It is worse standing and walking, and also worse with vibration like in a car on a rough road. I have deep back pain that then goes down into butt/outer leg/shin.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    This pattern is not typical for nerve compression from a mass like a herniated disc which typically causes pain with sitting/better with standing. Foraminal stenosis (as well as lateral recess stenosis-which should have been cleared by surgery) causes more pain with standing than sitting. Ask to see if that could be a cause.

    Dr. Corenman

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