[pec5002]

#30616

Hi Dr,

I am 33, had my first mico disectomy at L5-S1 at 31 where they took a thumb sized portion of disk out. Had a slight re herniation and a revision surgery which caused way more pain about a year ago. Since then each month is worse than the one before. My question is why does the littlest bit of physical therapy, clam shells, nerve flossing etc make me flare up AND if i need to strengthen my muscles and stretch how can i do it without causing flare ups? Or Should I just push through them ? The flare ups happen on my sciatic nerves in both legs which goes down to my heel. I have little to no mobility and have been like this for 1.5 years. I want to give this a good try before submitting to a fusion.

MRI results
-Subtle grade 1, 3mm Retrolisthese of L5 on S1

-There is diseccation of the L5-S1 disk with mild to moderate narrowing of the disk space

-Stable mild- moderate stenosis

-Straightening of the normal lumbar lordosis

[Donald Corenman, MD, DC]

#30617

If everything is OK, flair-ups should not occur 1 1/2 years out from a microdiscectomy. Is your pain lower back pain or buttocks pain or both? If both, how much is lower back and how much is buttocks/leg? Does the pain get worse with stretching the leg (hamstring stretch) or with standing?

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.

[pec5002]

#30621

I agree, pain is mostly on buttocks and down the legs, I actually have no back pain at all. When stretching and shortly thereafter the pain actually goes away, but a few hours later it comes back from worse and stays there. It is tricky because I need to work my muscles but everything bothers it. I also am 33 and dont want a fusion

[Donald Corenman, MD, DC]

#30628

A new MRI would be helpful.

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.

[pec5002]

#30634

So the MRI results I put there was from 3 weeks ago, ive had this pain for about a year now on and off when I try PT. I thought there was something new going on but the MRI basically said there were no changes. That’s what is confusing, I am trying to avoid a fusion.

As a second part of the question, one Dr I spoke to told me he would do an artificial disk at L5/S1 but a different doctor told me that if anyone ever recommends an artificial disc I should run away from the office.

[pec5002]

#30635

I transcribed the whole MRI for you from earlier this june (well after i started feeling worsening pain) this was ordered becuase I was in more pain

MRI Lumbar Spine with and without contrast

6/4/2019

History: 33 year old male, 2 prior lumbar spine surgeries, pain radiating down both legs

Comparison: 6/19/18 – MRI with and without IV Contrast

Findings:

There is a straightening of the normal lumbar lordosis. There is no compression fracture or acute marrow edema

There is a subtle grade 1, 3mm retrolisthesis of L2 L5 on S1
The conatus terminates at the l1-2 disc space level

There is a desiccation of the L5-S1 disc with mild to moderate narrowing of the disc space

Contrast enhanced images demonstrate no abnormal enhancement of the conus or nerve roots within thecal sac

Visualized portions of the kidneys are symmetrical. The psoas and pasaspinal muscle are also symmetrical

T2-L1: Normal disc, no focal disc herniation normal facet joints
L1-L2: Normal disc, no focal disc herniation normal facet joints
L2-L3: Normal disc, no focal disc herniation normal facet joints
L3-L4: Normal disc, no focal disc herniation normal facet joints
L4-L5: Normal disc, no focal disc herniation normal facet joints
L5-S1: Left L5 hemilanitomy defect. Nonenhancing residual and or recurrent central/left lateral recess disc herniation resulting in stable mild to moderate central and left lateral recess stenosis when compares with postoperating MRI from 6/19/18. Stable appearance of enhancing granulation tissue with the epidural space. Mild stable facet arthrosis

Impression:

1) As compared to prior 6/19/2018 MRI lumbar spine with and without IV contrast no significant interval change
2) Stable appearance of nonenhancing residual or recurrent central left lateral recess L5-S1 disc herniation resulting in stable mild to moderate stenosis
3) No new disc herniation or worsening stenosis
4) Subtle grade 1, 3mm rerolisthesis of L5 on S1

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