L5S1 Revision Discectomy

///L5S1 Revision Discectomy
L5S1 Revision Discectomy
Viewing 5 posts - 13 through 17 (of 17 total)
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  • AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6840

    I would assume that when you “moved something” when the pain started, this action involved “BLT” (bend twist and lift) at the same time. This is the active position that more times than not, causes recurrent herniations.

    Scar formation occurs on occasion after a microdiscectomy. Post operative physical therapy (nerve flossing) is designed to move the nerve root to prevent adhesions from adhering the root to any structure. Even with this therapy, adhesions can still form.

    Herniations that occur after a prior herniation surgery can be much smaller and cause similar pain. Small extrusions can tent the tethered nerve root and cause this pain. The radiologist has to be very precise to recognize this small fragment.

    A foraminal approach will not decompress the nerve root. This approach is designed to decompress nerve outside the canal (far lateral disc herniation- see website).

    Adhesion removal or neurolysis by itself (no compression of the nerve root found on MRI) can be effective but the success rate is about 50%-a far cry from the greater than 90% rate for a microdiscectomy.

    There are other mechanical causes for nerve root compression. Foraminal stenosis and lateral recess stenosis are two additional causes. See website for further explanation.

    Fusion for nerve root pain is only undertaken for compression from alignment causes; spondylolisthesis and foraminal collapse.

    There is always some risk that scar will adhere to the root but this is not common.

    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.
    AvatarHoosemec
    Member
    Post count: 8

    Hi Doctor

    I have sent you an MRI, and ask that this please be reviewed at your convenience. I believe its a recurrent herniation. It feels like one. The reading last March after my second discectomy surgery stated recurrent herniation moderately sized. This report does not state that, which contradicts the last report. This latest MRI was performed at one of the top hospitals in Boston, but I agree with you assessment that a precise reading is required. Considering my lack of back pain compared to the leg problems, and apparent spinal stability, i would agree a fusion doesn’t make sense. It’s been about 5 weeks of symptoms now with minimal improvement so far. If it’s herniated, and doesn’t improve significantly, would a third discectomy be out of the question? Again, this seems it stems from back to the second surgery (residual herniation or early re-hernitation). I can’t find much at all anywhere on all that I have have researched on anyone having had 3 discectomies. But It must be indicated and have a chance for success in some circumstances depending on the specific case.

    Thank you.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6840

    In general, three discectomies should be discouraged. If the disc has failed three times, the chance of a fourth discectomy being successful is less than 50%. In addition, nerve roots cannot tolerate four separate compressions without significant damage to the root. Four surgeries also leads to greater scar tissue which is also detrimental to the root.

    All in all, if there has been two prior separate microdiscectomies, the third surgery should be a decompression and a fusion to prevent further damage to the root.

    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.
    Avatarmc6613
    Participant
    Post count: 1

    Hello Doctor,

    Following up on this string, It’s been a while. As I have stated in the past I have 2 prior discectomies for L5S1, 1 in 2001 and a repeat in 2013. I have been able to be very active (playing ice hockey and coaching ice hockey over the past 5 years as well as coaching little league. However, I’ve been experiencing intense low back pain and mild sciatic pain in my left leg since June 2019 after a plane ride to Florida. Feels like there is a knife in my back at times. I have had this knife like pain flare up a few other times over the last 5 years. I have a long commute and sit most of the day at work. I have a recent MRI that shows a small L5 S1 Left Lateral Herniation (left over from the second discectomy, but the para central L5 S1 excised herniation did not re-occur. The MRI states this protusion is more or less the same size as past imaging studies from 2013 and 2015. I am going to attempt PT starting tomorrow and pain management (injection). My spine is stable, however, I am concerned that at this point, should I consider surgery? Or just continue to ride it out. If no surgery, where am I going to be in 5, 10, 15 years… Is TLIF the best approach for to decompress the disc/scar tissue from the 2 previous discectomies? What is activity level like after TLIF of L5S1? Also, what about spinal cord stimulator implantation, any thoughts on this? I can send you my MRI. I believe I requested a package last week to send an MRI, would that package be coming in the mail? Thank you for you time.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 6840

    “I’ve been experiencing intense low back pain and mild sciatic pain in my left leg since June 2019 after a plane ride to Florida…2 prior discectomies for L5S1, 1 in 2001 and a repeat in 2013”.

    Symptomatic degeneration of the disc after two microdiscectomies occurs in at least 10% of the population. This sounds like your problem. I would assume you have symptoms somewhat similar to IDR. See https://neckandback.com/conditions/isolated-disc-resorption-lumbar-spine-idr/.

    This condition is not dangerous but can be quite disabling. Read this https://neckandback.com/treatments/conservative-treatment-mechanical-lower-back-disorders/ but you might eventually be a candidate for a fusion of this level.

    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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