bbaker1ParticipantMarch 8, 2017 at 10:52 amPost count: 2
Good Morning Dr. Corenman,
I am 3.5 months post surgery and I am still experiencing ongoing hip and inner leg pain. The pain in my hip is almost a pulling/pinching pain and the pain in my inner calf is a burning/tingling pain. I had a hemilaminectomoy and discectomy on 11/21/16. I was good up until about Christmas and then similar symptoms to pre op started to come along. I had a post surgery MRI on 1/24/17, which showed now recurrent herniation. Below is a breakdown of what the MRI found:
L3-L4: There has been interval right partial hemilaminectomy and partial discectomy at this level with resolution of previously seen right lateral recess stenosis. There is mild right neural foraminal stenosis without nerve root encroachment. Edema is seen in the soft tissues posteriorly as well as within the disc. There is postoperative fluid and enhancing soft tissue seen along the surgical tract extending into the laminectomy defect with mild associated epidural enhancement.
I had an ESI 2 weeks ago that helped some, but nothing substantial. My pain management dr wants to do another and see if it will help some more. I was told that it is potentially scar tissue causing this problem, but from what I read off the MRI, scar tissue is not impending the nerve root.
What do you think is the next step and what could be causing this issue?Dr. CorenmanModeratorMarch 8, 2017 at 7:25 pmPost count: 4956
You note a recurrent herniation but your radiological report does not read for a recurrent herniation. The report notes “There is postoperative fluid and enhancing soft tissue seen along the surgical tract extending into the laminectomy defect with mild associated epidural enhancement”. There is no mention of recurrent disc herniation.
Your symptoms could be from nerve inflammation but infection could also be a part of the differential diagnosis. Make sure there is not a recurrent herniation and if not, an aspiration of the fluid by a meticulous injectionist with cultures could be a next step. I would assume if there is an infection, it would be with a low virulence organism (an organism that can’t cause much damage like P. Acnes).
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.If this forum has helped you, please let Dr. Corenman know!bbaker1ParticipantMarch 9, 2017 at 10:06 amPost count: 2
Hey Dr. Corenman,
I apologize for the confusion. I meant to say no recurrent herniation.
Infection? interesting, i have yet to have that brought up by a physician. Would there be other symptoms involved with an infection?
I went and saw my spine surgeon today, and he stated he believes scar tissue is irritating the nerve and advised to get another shot. He stated the irritation/inflammation from the scar tissue would go away with time, but it could be a few months for it to do so.
He did say he did not think the pain would get any worse, which is a good sign.
What has been your experience with scar tissue? Does my case sound like that could be the problem?
Thanks!Dr. CorenmanModeratorMarch 9, 2017 at 6:21 pmPost count: 4956
Scar tissue can affect the nerve root but the chance of that is not high. Inflammation of the root (more common) can “take forever” to subside and is helped along by steroid injections. If you are scheduled for an injection, have the interventionist aspirate and send the fluid for culture. Some of the more common organisms might take as long as 11 days to grow.
Sometimes, it just takes time for the root to calm down. Patience is important.
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.If this forum has helped you, please let Dr. Corenman know!
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