Ongoing leg and hip pain 3.5 months post hemilaminectomy and partial discectomy

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  • bbaker1
    Participant
    Post count: 3
    #24466 |

    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. Corenman
    Moderator
    Post count: 5602

    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. 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.
    If this forum has helped you, please let Dr. Corenman know!

    bbaker1
    Participant
    Post count: 3

    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. Corenman
    Moderator
    Post count: 5602

    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. 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.
    If this forum has helped you, please let Dr. Corenman know!

    bbaker1
    Participant
    Post count: 3

    Hello Dr. Corenman,
    Hope all is well.
    I am continuing to have pain down my right leg, following the l3-l4 nerve path. I had another MRI this past week and the results are below:

    Central disc protrusion at L3-L4 indents the ventral thecal sac with mild canal stenosis. Mild bilateral Neural foraminal narrowing is noted at this level. STIR images reveal mild Modic Type I changes along the adjacent endplates at this level.

    What does this Modic type I mean and how can it be treated?

    My pain is at its worst while sitting and/or standing still.

    Thanks in advance.

    -Brett Baker

    Dr. Corenman
    Moderator
    Post count: 5602

    This disc level is going down the cascading degenerative pathway. Modic changes generally mean that the disc no longer acts like a cushion (shock absorber) and the endplates are “getting beaten up”. With greater forces to the spine (falling, jumping, impact), the disc cannot absorb all the shock forces and greater forces are transmitted to the bone endplate. This endplate suffers micro-fractures and “Modic” changes are the result. This generally causes lower back pain and not leg pain unless the nerves are affected by foraminal stenosis (narrowing of the nerve exit holes). Your MRI notes “mild” canal and foraminal stenosis. Of course, beauty and moderator terms (mile, moderate and severe) are in the eye of the beholder.

    Your nerve pain (buttocks and leg pain) could be from the prior nerve injury due to the herniation not having healed, possibly from the surgery itself or from your current “mild” foraminal stenosis. If your pain is more constant, it may be from the chronic nerve injury. If the pain occurs more with standing, walking and impact, the foraminal stenosis could be to blame (which is fixable surgically).

    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.
    If this forum has helped you, please let Dr. Corenman know!

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