[Donald Corenman, MD, DC]

#27886

You had a far lateral disc herniation if you had an L4 radiculopathy at the L4-5 level as the exiting nerve (the one that goes through the foramen called the exiting nerve, not the one that travels across the disc space called the traversing nerve root which would be L5). If you also had a herniated disc fragment in the canal, this fragment could not be reached from the far lateral surgical approach. You would have to have a posterolateral approach to remove that fragment.

See https://neckandback.com/conditions/far-lateral-disc-herniations-lumbar-spine/ and
https://neckandback.com/conditions/herniated-disc-lumbar-spine/

Your physical examination should identify the L5 nerve as involved in your pain and the new MRI should identify the fragment in the canal at that 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.

[Qhorsegal2]

#27911

Thank you Dr. Corenman. The articles you linked to were very helpful!

We have an appointment to see the surgeon on Monday morning. I am praying we have a good plan in place after that visit.

Q

[Donald Corenman, MD, DC]

#27921

Ask him or her questions and ask him/her to go over the new MRI images with you.

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.

[Qhorsegal2]

#28196

I have been meaning to give an update for a couple weeks. I guess now is as good a time as any!

We were able to go back in on April 4th for another surgery with his original surgeon. She went in approximately an inch to the left of his original incision. This time into the intracanal space between L4/L5. She said she found a very small sequestered fragment, and some stenosis which she removed. She also had to remove a piece of the lamina on the right side. She said that she followed the nerve through the entire space and made sure she had it completely free. She did not do a fusion, but said we would need to be aware of any severe back pain later on which may indicate instability in the area. If that occurs we will have to revisit the idea of a fusion.

He had immediate relief from nerve pain upon waking from surgery, but much more surgical pain than the prior operation. It was wonderful to know that the surgery seemed to work this time! He continued to improve daily, so much that 2 weeks post-op he was walking a mile and a half every morning with no nerve pain. We had a glowing report from the surgeon that week, and she said he could likely return to work by the end of May if he kept improving at this rate.

The next week he started Physical Therapy, and began to have some nerve pain recurring. The second week of therapy brought more nerve pain, but not continuous. The last two days have been worse though. I am at a loss. I am praying this is normal healing, and possibly swelling causing more nerve irritation because of increased physical activity.

I have not witnessed him doing anything which would cause re-injury…but I know it doesn’t necessarily have to be a bending, twisting, lifting over-use to create a new fragment.

Any thoughts on this Dr. Corenman? Could this be a normal part of healing, or would you be concerned with the change in pain levels if it was your patient?

[Author]

Posts