[anadine]

#27435

Had surgery in 03 and 05 on my lower back (L4/L5 disc herniation) been managing the remaining chronic pain with medication, PT, yoga, and massage.
Had a baby in August 2017, in October 2017 pain came back intense, but I could not take the medication because I was breast feeding. I ignored it thinking I would adjust after surgery and when I could take medication again.
December lost control of my bladder. Had an MRI done first week of Jan 2018.
Just got results back, doctor said there is a slight bulge at L5 (I’m guessing its L5/S1 not L4/L5 because I was under the impression my disc was empty and only a shell remained). There is also what they’re causing scar tissue distortion.
The Dr who reviewed said that the bulge was not near my bladder or any nerves.
I’m wondering if the pain and Right leg weakness could be a completely different issue or if its more likely that something was missed and I should get a 2nd opinion on my MRI.
The pain and weakness in leg and bladder mirror my surgery in 2003 exactly.

[Donald Corenman, MD, DC]

#27441

I assume you had 2 microdiscectomies at L4-5 due to herniation and recurrent herniation. You then delivered your child and had recurrent pain that duplicated your previous nerve pain.

Your loss of control of your bladder probably is not related to cauda equina syndrome (CES) if it only occurred once and you don’t have the other significant signs of CES (leg weakness, saddle anesthesia, severe bilateral leg pain, etc…). Cauda equina syndrome occurs after a massive disc herniation that compresses the entire canal. Most commonly, bladder loss, especially temporary, can be caused by the stretch of your pelvic floor muscles (which commonly occurs with pregnancy). That’s what Kegel exercise are designed to help.

The disc at L4-5 is not empty, even after two prior microdiscectomies. There probably still is some nucleus left and certainly cartilage endplate which can shear off and become another recurrent disc fragment.It is possible that there is a new herniation at L5-S1, but my money would be on another recurrent disc fragment at L4-5 if your pain mirrors your first two episodes.

Fragments can “hide” in scar at the L4-5 level and I have also seen missed far-lateral herniations. I assume you had gadolinium injected with this last MRI which would be helpful to look for a fragment. You can have these images reread by another radiologist as there are times that “misses” will occur.

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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