bill335MemberJuly 27, 2012 at 1:42 pmPost count: 10
I had a micro-d operation on the l5-s1 fours months ago for a very large right herniation that was pitching the S1 nerve. Before surgery, the pain had gotten to the point where I had to pretty much lay on bed all day as it was pinching the S1 nerve causing me to limp when walking on top of pain for two months.
Post surgery I felt great, usual flare up the first couple of days but felt great for the first 6 or 7 weeks. Walked and stand almost pain free, just a small amount of pain here and there. Followed Dr’s instruction to the T regarding lifting and twisting. Started PT the 8th week or so and every since it has been down hill. I started noticing bad right calf pain to the point where I had to take two Advil or Aleeve to get through the day.
The doctor prescribed a week course of Prednisone which helped a lot. Calf pain mostly gone but now have back pain and pain around the right paraformis and thigh. Cannot stand for longer than a hour without pain. Laying down for 15 minutes and pain will be gone but standing up it will come back after say 30 or so minutes. The pain is a lot better than before surgery but it’s enough to effect me from doing much.
Dr. then put me on Neurotin (Gabapentin) 300mg x 3 a day. I have been taking it for a month and haven’t notice anything besides giving me blur vision and being drowsy.
So my question is, does this sound like a reherniation or the nerve “waking up big time” at the 7th week post surgery mark?? Everything I read online seems to indicate people being in lots of pain and nerves waking up earlier, like the first couple of weeks of surgery, and not vice versa like mines. It is now four months and has been very depressing seeing progress go backwards from the first 2 months. Is it time to ask for a second MRI?Donald Corenman, MD, DCModeratorJuly 28, 2012 at 10:30 pmPost count: 8465
If you had good results for eight weeks after a microdiscectomy and then started with recurrent leg pain that has crescendoed, I would put a recurrent hernation near the top of the list for diagnosis.
Chronic radiculopathy (see website) is a possibility but this is a diagnosis of exclusion. This means all other possibilities have to be ruled out before this diagnosis can be entertained.
A new MRI of your lower back with gadolinium would be the next step if you were my patient.
Dr. Corenmanbill335MemberJuly 31, 2012 at 8:21 amPost count: 10
Thank you for the reply Dr. Corenman. I’ve ask the Dr’s office for a 2nd MRI, hopefully they can get in approve soon and let me know what is going on back there.bill335MemberAugust 6, 2012 at 7:28 amPost count: 10
Hello Dr. Corenman,
I did the 2nd MRI last week, can you please help with interpreting the results. Thank You.
General description: Patient is status post right L5 laminotomy and microdiscectomy. Vertebral bodies are normally aligned. No signal is homogeneous. No evidence of compression deformity. Conus medullaris terminates at T12 and is normal in caliber, contour and signal.
Level by Level description:
L1 – L2: Normal
L2 – L3: Normal
L3 – L4: Normal
L4 – L5: Normal
L5 – S1 There is moderate loss of disc height and disc dessiccation. There is a broad base disc protrusion present measuring 4mm in AP dimension resulting in very mild effacemenet of the anterior thecal sac without substantial central canal stenosis. There is is mild caudal neural foraminal stenosis bilaterally. Patient is status post right-sided microdiscectomy. No evidence of exiting L5 nerve root compression. There is enhancing granulation tissue at the right lateral epidural space encasing the right S1 nerve root at the lateral recess.
Impression: Status post right L5 – S1 laminotomy and microdiscectomy. No evidence of exiting L5 nerve root compression.
Enhancing granulation tissue encases the right S1 nerve root as it traverses the lateral recess.
It appears there is a disc buldge (or reherniation) of 4mm at the L5-S1? Will this self absorb with rest and time?
Is granulation tissue the same as SCAR TISSUE? I presume the granulation tissue is touching, pushing, trapping, poking, the right S1 nerve causing my right leg pain? Is there anything I can do to clear up the S1 nerve? More surgery? Injection? Shots? Just wait and rest? Or am I looking at being passed to a Pain Management doctor ……
I’ve stop doing PT stretches or much walking the past few months out of fear of making any problems in the back worst. Should I restart them?
My current symptoms are still the same as above. A assistant from the Dr’s office called and said everything looked ok and gave a new prescription for a single pain med until I see the Dr in a few weeks.Donald Corenman, MD, DCModeratorAugust 6, 2012 at 9:23 pmPost count: 8465
The MRI indicates that you have inflammatory tissue surrounding the nerve root now about two months after the surgery. There is some mild effacement of the root but according to the radiologist, there is no significant compression remaining.
Radiologists can misread the scans but assuming that he or she is correct, the root is now inflamed but not compressed. In my practice, the next step would be an epidural injection of steroid to reduce the inflammatory tissue.
PT is important but has to be performed with great care. Too much aggressive treatment, the root will become more inflamed and your leg pain will worsen. Too little therapy and you will not make progress. This is where the “art” of medicine comes in and a good therapist is worth their weight in gold.
There is always the possibility of foraminal stenosis at the level of surgery that has occurred after the herniation that has not been diagnosed but this would be unusual (see section on lumbar foraminal stenosis).
Dr. Corenmanbill335MemberNovember 3, 2012 at 7:01 amPost count: 10
Hi Dr. Corenman,
I’m back and needing your expert advice. So I’m a little over 6 months out of the Micro-D. Unfortunately, I still have leg pain, not as bad as before surgery but still enough to bother me daily.
I saw my Dr. who did the procedure shortly after my last post here with you two months ago. The only thing he said was that the nerves takes a long time to heal since my herniation was very large and nothing else. When I asked if Granulation tissue was scar tissue his answer was it was “healing tissue”. Well, it didn’t leave me with much to say considering the radiologist noted it under his impression which really worrys me. I asked for a epidural but he said no. Got a Rx for Ibuprofen 600mg and Lyrica.
My question is, will inflammation of the nerve/nerve root still exist 6 months after surgery? Unfortunately, I’m not sure if I really irritated the nerve since last week because I noticed a little extra increased in leg pain since last week. Time for a steroid pack?
I need to take one 600mg Ibuprofen at lunch to get through the day since returning to work 2 months ago. Is scar tissue really starting to form around the nerve root since I notice a bit of increase in extra pain in the leg since last week?
I am 6 months post microdiscectomy, so what are the options now really?
Have a great weekend Dr. Corenman!
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