[Dhviola]

#9009

Hello Dr. Corenman,
I am a professional violist with the New York Philharmonic. In February 2012 I had a microdiscectomy on L4-L5. In August it reherniated, and I had another microdiscectomy in October. Now I have a third herniation, same disc, same side. it is classified as moderate.
My surgeon doesn’t think a fusion will help, since the surrounding discs are also somewhat degenerated and unstable. My symptoms this time are mild, though significant enough that I knew something had happened. I have been going to PT regularly since October, and doing 30-45 minutes of exercises and stretching every morning.
I am obviously reluctant to go through another surgery unless it is necessary. What would you recommend?
Thank you!

[Donald Corenman, MD, DC]

#9010

The first question to ask is whether or not you have enough pain or impairment to need another surgery? Even recurrent herniations can be treated conservatively with physical therapy, epidural injections and medication.

If the pain or symptoms are such that you require surgery, the third disc herniation at the same level generally requires a fusion. Not for back pain but for prevention of a fourth recurrent disc herniation.

The reason for the fusion is to try and prevent the “battered root syndrome” or chronic radiculopathy (see website for description). There have been no studies to my knowledge as to the percentage chances of a fourth herniation. In my experience (I see many patients who have had three prior microdiscectomy surgeries elsewhere for re-herniation and come in to see me with a fourth HNP), the chances of another disc herniation are high. I believe this is due to the disc becoming incompetent after so many prior herniations.

Some of these patients who have had four herniations and surgical decompression do not obtain enough relief after the fusion even when the root is fully decompressed. Hence, the “battered root syndrome”.

This is why the general recommendations are to fuse this level to prevent a fourth herniation.

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.

[Dhviola]

#9011

Thanks, I will read more. My symptoms are not that bad this time. I may try to come and see you when we are playing in Vail over the next weeks.

[Donald Corenman, MD, DC]

#9012

If you want an appointment, please call the office now and let them know we have made contact. If we need to get you in while you are here, advanced planning is helpful. The new patient wait time can be somewhat long occasionally.

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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