[Donald Corenman, MD, DC]

#32894

Probably not if first one gave you no relief.

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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#32903

Hi Dr.,

Report is below:

L4-L5: There is right microlaminectomy. There is a fluid collection within the right paraspinal soft tissues and subcutaneous tissues measuring 21 x 37 x 52 mm (anteroposterior X transverse X craniocaudal) with surrounding postcontrast enhancement. There is a 3 mm focal central disc protrusion with posterior annular fissuring. There is mild to moderate central canal stenosis.
There is enhancement of the posterior epidural space at this level, with a 5 mm region of focal fluid posterior to the right of midline opposite L4. Image 33, series 12. Image 8, series 11.

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#32904

Hi Dr.,

Report is below with impression:

L4-L5: There is right microlaminectomy. There is a fluid collection within the right paraspinal soft tissues and subcutaneous tissues measuring 21 x 37 x 52 mm (anteroposterior X transverse X craniocaudal) with surrounding postcontrast enhancement. There is a 3 mm focal central disc protrusion with posterior annular fissuring. There is mild to moderate central canal stenosis.
There is enhancement of the posterior epidural space at this level, with a 5 mm region of focal fluid posterior to the right of midline opposite L4. Image 33, series 12. Image 8, series 11.

IMPRESSION
1. Intrathecal right L5 nerve: Mild diffuse enhancement along the intrathecal course of the right L5 nerve. This can be a postoperative finding that can be associated with neuritis and may be related to standard postoperative inflammation.
2. L4-L5: Status post right microlaminectomy. 3 mm central disc protrusion with posterior annular fissuring. Mild to moderate central canal stenosis. There is a 52 mm focal fluid collection in the right paraspinal soft tissues and subcutaneous tissues, and a 5 mm fluid collection within the posterior epidural space opposite L4. This can represent a standard postoperative appearance, though recommend correlation with any potential infectious symptoms.
3. Mild congenital central canal stenosis.

[Donald Corenman, MD, DC]

#32907

It appears that you have inflammation of the root within the dural sac (radiculitis-“Mild diffuse enhancement along the intrathecal course of the right L5 nerve”) as well as a large seroma (a post-operative fluid collection-“5 mm fluid collection within the posterior epidural space opposite L4”).

I know you are having some significant symptoms currently. You could choose to wait as these findings will most likely resolve over the next three months. A faster way to gain symptom relief is to have an aspiration of the seroma and injection of steroid (a TFESI-transforaminal epidural steroid injection).

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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#32908

Dr. Coreman, thank you very much for the update! It is very helpful that you offer your services for this board.

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#33260

Dr. Coreman,

To update, the seroma resolved on its own and all the associated centralized back pain has gone away. Now I am almost 4 months post op and all the symptoms I had pre-op are exactly the same if not worse- including the symptoms that led me to surgery which was server pain in my right buttocks when sitting (same still if not worse), and pain in my right foot (walking). The foot pain is now server just standing for a bit and will make it intolerable to walk more than 5 minutes. I now have pain lying on my right side which was not there before as well as lying on my back on the couch. Being that it is 4 months out, is this within an acceptable range of post op inflammation or at what point do I consider it as FBSS? I’ve contacted my Dr. numerous times ands was only told “the nerve was fully decompressed and healing can take 1 year”. What are your profession thoughts from experience?

Thank you!

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