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  • Donald Corenman, MD, DC
    Moderator
    Post count: 8652

    Your comment “I did get some relief with the L5-S1” along with your symptoms “where initially pain was felt in the gluteal region and R hip. I had difficulty with sit to stand. This gradually went away. Now, my foot issues appear to be amplified with prolong sitting” does fit with a radiculopathy. Added to the symptoms, relief with an L5-S1 block points to the HNP right L5-S1 as your pain generator.

    I’m not clear what surgeon B thinks but surgeon A’s advice; “do a laminectomy to see if we can unroof this and give him as nerves more space with a foraminotomy and medial facetectomy on the right side” sounds like a good idea. No fusion should be contemplated especially below a pars defect.

    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.
    leroydog
    Participant
    Post count: 9

    Surgeon B only recommended a microdisectomy at L5-S1 Level vs laminectomy. Are there certain scenarios with a herniated disk where a laminectomy is preferable than removal of disk? Or am I just getting lost in the nomenclature as there will be a laminotomy with a microdisectomy?

    To be clear surgeon B did not think I was a fusion candidate at L5/s1 level.

    Best,

    Luke

    Donald Corenman, MD, DC
    Moderator
    Post count: 8652

    I would agree more with Surgeon B that a microdiscectomy is all that is needed, While he is there, he could probe the foramen and if tight (unlikely), he could additionally perform a foraminotomy.

    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.
    leroydog
    Participant
    Post count: 9

    Hi Dr. Corenman,
    I just wanted to provide an update. I ended up having the microdisectomy done in August. I ended up doing the original MD surgery with surgeon B. (I think it is a natural human tendency to go with the surgeon who gives you the “best” news (least invasive)). Unfortunately, I didn’t really get any relief and feel like I am back to square on. Lots of right leg tingling, and sometimes pain in foot and calf. Lots of R gluteal pain and pain on the R SI joint. Surgeon B seems somewhat flumoxed on my symptoms now and I’ve lost confidence in him. Thus I returned to surgeon A, who was initially concerned about the pars defect. He reviewed my f/u MRI- thinks I reherniated and/or adequately was not decompressed on L5/S1.

    I am also learning that different surgeons seem to be interpret imaging very differently and also have a different read on the radiologists reports. Is this normal?

    This was the CT (April 2023):
    1. Bilateral L4 complete spondylolysis with no osseous bridging and no evidence of L4
    anterolisthesis. Mild diffuse disc bulge L4-L5 disc space with no significant central canal
    narrowing or neuroforaminal stenosis.
    2. Redemonstration of previous L5-S1 right hemilaminectomy and medial facetectomy and
    redemonstration of what was proven to be prominent enhancing epidural fibrosis obscuring the
    axillary portion of the right S1 nerve root. There is minimal/mild increase in mild to moderate
    central canal narrowing at this L5-S1 level specifically in the region of the right anterior
    lateral epidural recess.

    Per Surgeon B; I have 5mm of spondlyolisthesis at L4-L5 as well as significant dis height loss at L5-S1. He is recommending L4-S1 ALIF with posterior instrumentation to repoair the pars fracture and address central and forminal stenosis. Obviously this is a big surgery and I am hesitant to get another surgery. I also want to be back to some activities I miss and be without nagging discomfort and pain. Are there any other approaches you would recommend? It sounds like trying another decompression at L5-S1 is off the table and for a “permanent” fix he is recommending a fusion secondary to spinal instability. My understanding is that both levels need to be fused secondary to the state of L5/S1.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8652

    Part of the diagnosis is what is the prevailing symptom? Do you have predominant right buttocks and leg pain or more lower back pain?

    To determine what the compressive mass consists of at L5-S1 (herniation vs scar), an MRI with gadolinium would be necessary.

    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.
    leroydog
    Participant
    Post count: 9

    Predominately R butt/leg. I did do a MRI w/contract in December 2022. Neither surgeon has mentioned scar tissue being a factor.

    Would it be helpful for me to do a formal imaging review?

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