woodlawn1ParticipantApril 2, 2021 at 9:00 amPost count: 6
Approx 2012 on and off leg pain down to the foot. Did the PT, injections, etc routine. MRI showed small L5/S1 herniation, but apparently perfectly situated. Left sided
August 2014: L5/S1 hemilaminotomy, medial facetectomy, decompression. They removed a disc fragment, but did not remove any other disc material. There was a facet cyst compressing the S1 nerve root. The cyst was removed, but so adhered to the dura that when done the dura tore. This was repaired. Notwithstanding the spinal headache, 100% pain free for about a month. Pain returns, MRI shows a large pocket of spinal fluid displacing the S1 nerve root.
December 2014: Redo all of the above plus add a lumbar drain. Co-surgeon says the spinal fluid was a ball valve effect.
Relatively fine until 6 months ago, apart from periodic flare ups that would subside on their own. For about six months, the pain is constant and worse with walking. MRI showed modest progression of the prior disc protrusion, but height looks pretty good, mild facet arthropathy, and moderate lateral recess stenosis. There is also quite a bit of scar tissue where the CSF leak was. Presently going through the usual PT, injection, rinse repeat.
Orthospine recommends L5-S1 fusion, either ALIF or MIS TLIF. 2nd opinion with neurospine (at a renowned institution) has the same recommendations, noting that they can’t decompress the nerve without risking serious injury. Neuro also said that area will keep flaring up unless they completely restore the disc height and remove the disc entirely. He also said something about micro-instability, but admittedly I didn’t catch it. I know x-rays show very modest movement, but not gross instability.
I guess the question is this- is there any other way to deal with the scar tissue that doesn’t involve a fusion?Donald Corenman, MD, DCModeratorApril 2, 2021 at 10:26 amPost count: 8459
Do you have lower back pain or is it only buttocks and leg pain?
If you only have leg pain, your path will not be easy. With the initial tear, the pseudomeningocele (“MRI shows a large pocket of spinal fluid displacing the S1 nerve root”) and the post 2 surgeries scaring, the root will be difficult to decompress effectively. If the root can be decompressed, a TLIF surgery would give you the best chance of successfully decompressing the root.
If you don’t have significant lower back pain and the root is significantly fibrosed without compression, you might be better leaving it alone.
Dr. Corenmanwoodlawn1ParticipantApril 2, 2021 at 12:22 pmPost count: 6
Predominantly leg pain, probably 85/15 leg to back. I reread the MRI report and there is apparently still some displacement of the nerve root. Not sure if that makes a difference?Donald Corenman, MD, DCModeratorApril 2, 2021 at 1:34 pmPost count: 8459
If the displacement is due to herniation (use gadolinium scans to determine that), then a redo surgery could have benefit. If displacement is due to scar only, decompression will be less helpful.
You mainly have leg pain, so a fusion to help back pain would not be recommended. However, if there is presence of disc herniation, a TLIF would be helpful to access the nerve root safely.
Dr. Corenmanwoodlawn1ParticipantJune 14, 2021 at 12:40 pmPost count: 6
So, bit of an update. Had modest relief after an epidural, but it was only for about a week.
I just had an EMG/NCS and have an active, acute on chronic L5-S1 radiculopathy on the left and active, mild L5-S1 radiculopathy on the right. I am mostly asymptomatic on the right apart from very occassionally feeling a pinching sensation.
Would that alter your prior opinion one way or another?
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