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  • zman
    Participant
    Post count: 12

    Dr.Corenman- I had Micro Discectomy l4/l5 surgery on April 11th, 2016 due to left leg pain and lower back pain on the left side. PT, Injection , Opioid didn’t work to reduce the pain. After the surgery , I was feeling good and my surgeon didn’t recommend any Physical therapy. About 6 weeks ago I started feeling the pain again. Mostly back pain on left side. Some leg pain but not as severe as before surgery. Pain is severe when walking or standing up , just like before the surgery. Went to see my Neuro surgeon , he ordered an MRI. Result is below:

    “Examination of the sagittal imaging demonstrates normal alignment and a degenerative
    appearance of the vertebral bodies. In addition, there is an overall decrease in AP
    diameter of the spinal canal consistent with congenital stenosis. The conus medullaris is
    seen to be normal.

    The intervertebral disks demonstrate decreased T2 signal.

    At L4-5 there is evidence of left hemilaminotomy with postoperative change. Soft tissue is
    seen within the left lateral recess is unclear as to whether this represents postoperative
    change or disc material. There is apparent mass effect upon the left L5 nerve root.

    At L3-4 there is a diffuse degenerative bulging disc with stable mild central stenosis.

    Review of the remaining levels does not demonstrate evidence of focal abnormality, disc
    herniation or stenosis.

    Impression:

    L4-5 postoperative change with question disc herniation versus granulation tissue.”

    My doctor told me that the pain is due to some scar tissue and it is not a re herniation and he asked me start Physical therapy which should reduce the pain and eventually I will feel better. I did some research on Google and i am scared the I might have epidural fibrosis. I would like to hear your opinion. Thanks.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    The MRI report does not differentiate between a recurrent disc herniation and granulation tissue. Hopefully, you had an Mri with Gadolinium which can light up scar or cast a shadow if this is recurrent disc hernation (which happens in 10% of patients). It is possible that this is granulation tissue but without gadolinium, this would be conjecture and not science.

    If it is a recurrent herniation, a repeat microdiscectomy might be in order. If it is granulation only, time might be more helpful. In either case, an epidural steroid injection can reduce the inflammation and give you a better chance of reduction of pain.

    What concerns me is that your pain pattern fits more with a foraminal stenosis or a lateral recess stenosis picture. This could be from collapse of the disc height (common after a hernation) and a mechanical bony compression. A recurrent hernation with lateral recess stenosis is also a common scenario. Look up these conditions on this website and also let me know if you did have gadolinium with your MRI.

    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.
    zman
    Participant
    Post count: 12

    Thanks Dr.Corenman for a fast response! Really appreciate what you do. MRI was a non contrast so i guess it wasn’t done with Gadolinium . Should I ask the Doc for another MRI with Gadolinium or wait till my next visit in 6 weeks after Physical therapy ? How can i get a confirmation whether pain is caused by foraminal stenosis or a lateral recess stenosis?
    Thanks again.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    An MRI with gadolinium would be the next step. This can be done without repeating the entire MRI by just doing the T1 sequence with gad.

    The X-rays can yield clues to the presence of foraminal stenosis (angular collapse on the side of leg pain) and careful perusal of the images can also give a clue.

    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.
    zman
    Participant
    Post count: 12

    Thanks Dr.Corenman. Been on PT for 4 weeks now and pain has gone back to pre surgery level.It certainly feels like i was misdiagnosed.Have an appointment with NS next week. I’ll bring up what you suggested.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Please keep us informed.

    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.
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