- LA_FrankieParticipantJune 28, 2020 at 9:59 amPost count: 7
I had microdiscectomy and decompression of L5/S1 4 weeks ago. The plan was to fix both L4/L5 and L5/S1 during the procedure but the surgeon felt there were not significant symptoms coming from the L4/L5. I was told that I presented with mostly S1 symptoms — back of leg, back of calf pain with accompanying weakness.
However, when I re-read MRI reports (there were two) the L4/L5 sound more significant to me. The use of the word, ‘severe’ is most alarming.
1. The L4-L5 disc level demonstrates a shallow right posterior and proximal foraminal disc herniation is present causing focally severe right subarticular recess encroachment (sequence 5001, image 37), with presumed impingement upon the traversing right
L5 nerve root. Evaluate for possible right L5 radiculopathy.
At L4-L5, there is mild disc degeneration and disc height loss and associated annular fissure. There is disc bulge with prominent right subarticular component. There is resultant at least moderate narrowing of right subarticular zone and crowding of the
descending nerve roots. There are moderate bilateral facet hypertrophic changes. There is no central canal stenosis. Neural foramina are adequately patent bilaterally. These are unchanged since prior exam.
Impression from 2nd exam:
At L4-L5 there is at least moderate narrowing of right subarticular zone with crowding of the descending nerve roots, stable since prior exam.
As a surgeon, what would make you deviate from the original plan? I asked if the L4/L5 looked as if it were healing and was told, “We didn’t get a look at that level because we would have had to make a larger incision and cut more bone.”
I was also told the MRI is only a static picture and what is goings on at the L4/L5 might not be causing any symptoms, and may heal on its own. Sounds like a lot of maybes and ifs.
Do you think my situation warrants a second opinion?
Thank you.Donald Corenman, MD, DCModeratorJune 28, 2020 at 12:13 pmPost count: 7523
I would hope that the first surgical plan did not include also operating on L4-5 only because it would be highly unusual to plan to operate at that level and cancel the plan intraoperatively.
Some of the questions I have would be what was done with the diagnostics? Did your exam note only the S1 nerve involved with your symptoms and not the L5 nerve (sometimes hard to differentiate without motor weakness). Did you undergo any diagnostic selective nerve root blocks to “root out” the nerve or nerves involved?
Your MRI reading notes L4-5 nerve compression according to the radiologist; “The L4-L5 disc level demonstrates a shallow right posterior and proximal foraminal disc herniation is present causing focally severe right subarticular recess encroachment … with presumed impingement upon the traversing right L5 nerve root”. I am unclear why the L4-5 level would not also be addressed surgically unless there was clear evidence that the L5 nerve root was not involved.
Sometimes, “the proof is in the pudding”. How much better do you feel after only having the L5-S1 level addressed surgically?
Dr. CorenmanPLEASE 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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