[CliffRoss]

#34943

Hello Dr,

I had a MD 3 months ago on my L5-S1 for an 8mm herniated disc. Since then, I have had ongoing pain without any real relief. Mainly burning pain in my lower back, upper glute, my hip and my foot (all left side). Which feels consistent with what I was experiencing before, and to be honest, a little worse.

I had an MRI with contrast last week and the results were the following:

FINDINGS:

The vertebral bodies are normal in height. There is no evidence of acute fracture. The bone marrow signal is unremarkable.

There is straightening of the lumbar lordosis without significant subluxation.

There is disc desiccation at L4-5 end L5-S1 with mild loss of disc height at L5-S1.

The conus terminates at the L1 level and demonstrates normal signal characteristics and size.

There are postsurgical changes at the level of L5-S1.

L4-L5: There is a 2 mm broad-based disc protrusion. There is no significant central canal or neural foraminal stenosis.

L5-S1: There has been prior left hemilaminectomy and microdiscectomy. There is a 4 x 16 mm protrusion off the left paracentral aspect of the disc with diffuse enhancement most consistent with granulation tissue rather than recurrent/residual disc which causes left lateral recess stenosis and may displace the central left S1 nerve root.

According to this report granulation tissue is hitting my nerve I guess?

What can I do, if anything to get some relief?

[Donald Corenman, MD, DC]

#34944

Did this MRI have gadolinium (a “dye” injected into your vein) right before imaging? Gadolinium would have been necessary to differentiate scar from recurrent (or residual) disc HNP. If no gadolinium, you need to go back to the imaging center and demand a gadolinium series so this can be ferreted out. If there was gadolinium, you need an “over-read” where another neuroradiologist reads the film and gives his or her opinion.

With no relief after surgery, my bet is that the root was not fully decompressed. If it really was, it would be quite unusual to have such a large mass of scar tissue present. I would suspect there is a mix of herniated disc and scar as I’ve seen many times before but that would require gadolinium imaging. Even if it was only scar, the nerve can be re-decompressed but with less success rate.

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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