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  • seb_nied
    Participant
    Post count: 24

    Hello Dr. Corenman,

    I’ve been writing in this forum in the past and again I’m finding myself hitting a wall in my recovery.

    Just to briefly summaraze my clinical history:
    – 32M, 188cm, 70kg
    – Suffered of L5-S1 herniation in November 2020 which caused partial muscle atrophy and slight loss of function in my calf
    – Microdiscectomy surgery in December 2020
    – Some time in January it appears I had a small reherniation and my leg pain came back
    – From March to now I started doing physiotherapy regularly, my leg pain has decreased but I started having back pain (stabbing, burning pain localized on the L5-S1 area). Currently my pain is 70% back and 30% leg.
    – Pain usually increases with activity and with anything that loads axially the spine (sitting, standing, walking). Unfortunately I am still limited to short periods of these activities (up to 45 minutes at best). Any sports activities are usually aggravating the pain.

    I spoke with 2 neurosurgeons already and I’ve got two different opinions:
    – The first one said that the disc is severely degenerated but it will surely stabilize with time. If I cannot live with it then he suggested a TLIF so it will be possible to decompress the nerves while doing the procedure.
    – The second one proposes another decompression, cleaning the area where the disc has reherniated, taking some material from the facet to give more space to the nerve. If this fails to relieve back and leg pain then do an ALIF. If it relieves the leg pain then try to live with it and as the first doctor said it will eventually stabilize with time.

    From what I understand decompression is not effective in relieving back pain, and there is a chance that this might result in further surgery. On the other hand I know fusion should be the last resort.

    Thanks a lot for your answer.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    In general, decompression is effective for leg pain and fusion is effective for lower back pain with some exceptions. If you have failed therapy, continue with unacceptable limitations and have a level that is generating leg pain from continued root compression, a TLIF (from a surgeon with good hands) is the way to go. If the nerve is not too compressed, an ALIF with posterior fixation is also acceptable.

    Dr. Corenman

    seb_nied
    Participant
    Post count: 24

    Thanks for the answer Doctor.

    How much do you think a successful TLIF depends on the surgeon ability?

    In my country we have public healthcare but unfortunately the best surgeors are not working in public hospitals. I have a very good surgeon who proposed me a TLIF but this would involve having the surgery privately.
    The option I got from the public provider is a microdiscetomy and then an ALIF if the MD fails again.
    The main concern I have is that a MD will just create more scar tissue and nerve inflammation and eventually lead to chronic nerve pain even after an eventual fusion. This makes me wonder if I should even “bother” trying the microdiscectomy because the chances of having the fusion afterwards are anyway quite high as I do not have much of the disc left and the nerve was severely compressed from the first herniation.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    The TLIF is a “tricky” operation but can have great results in the right hands. The surgeon has to be obsessive about handling the nerve roots and the assistant is also important as he or she retracts the nerve roots and has to be very gentile. Ask the surgeon for a list of his last 5 patients he or she operated on and would consent to talk to you. Of course, if a patient was having a poor post-operative outcome, the surgeon might not offer to allow you to talk to this patient.

    If the surgeon elects to do an ALIF, then at least he or she stays out of the canal and generally doesn’t affect the nerve roots.

    Dr. Corenman

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