Recurrent Herniation L4-L5 post Microdiscectomy/Laminotomy

///Recurrent Herniation L4-L5 post Microdiscectomy/Laminotomy
Recurrent Herniation L4-L5 post Microdiscectomy/Laminotomy
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  • AvatarDalbot81
    Participant
    Post count: 4

    Hello Dr. Corenman,

    So my wife was in an MVA in 10/2016 and as a result had some trauma to her L-Spine. She had been dealing with back pain for a while, but earlier this year developed radicular symptoms in her left leg and glute. She had an MRI that showed small bulges at L3-4 and L4-5 from 8/2018 but the symptoms onset earlier this year. Her ortho doctor prescribed PT which didn’t work and then she had 3 epidural injections that only provided minimal relief.

    In August of this year she had microdiscectomy with laminotomy and it really seemed to help. For about 6 weeks she was feeling so much better other than some tingling and numbness. Then about 4 weeks ago the pain came back worse than before. The doctor ordered another MRI and it appears that there is a pretty significant recurrent herniation that looks pretty fierce (pics included of the T2 Sag shot from 8/2018 as well as the one from 11/2019). We have our visit with the doctor next week but she’s pretty worried that ESIs won’t do much for it since it is worse than it was before. Any thoughts/guidance would be much appreciated.


    MRI August 2018

    AvatarDalbot81
    Participant
    Post count: 4

    Also I figured I would add in the notes from the MRI report:

    L4-5: Postoperative sequela with left laminectomy defect. There is disc bulge at this level with soft tissue signal intensity extending below the disc level on the left down to the mid L5 level. Increased relatively severe canal narrowing. Neural foramina patent.

    IMPRESSION:
    Postoperative sequela at L4-5 with left laminectomy defect. Disc bulge at this level with soft tissue signal
    intensity extending below the disc level on the left most suggestive of disc extrusion with increased severe canal stenosis. This could be correlated clinically for left L5 radicular symptoms.

    AvatarDonald Corenman, MD, DC
    Moderator
    Post count: 7138

    Yes, there is a very large recurrent disc herniation at the same level as the prior operation (a recurrent disc herniation). This recurrence occurs with a frequency of 10-20%. I would consider another microdiscectomy if the symptoms warranted it.

    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.
    AvatarDalbot81
    Participant
    Post count: 4

    Thanks for the feedback Dr. Corenman. We are really concerned with the herniation after the first procedure and the L3-4 above it being almost completely non-existent with that vertebral endplate damage that eventually she will be looking at a possible multi-level fusion. I know that’s usually considered on the third herniation. She’s still young (36) so obviously we would want to avoid any hardware at this early age but we fear it may be inevitable.

    AvatarDalbot81
    Participant
    Post count: 4

    Figured I would add the following from her XR from February of this year (six months pre-surgery)in case that helps your review…

    She also recently was prescribed an oral dose of steroids that really didn’t seem to help much if at all.

    FINDINGS:
    5 non-rib-bearing lumbar type vertebra. No osteolytic or osteoblastic lesion is identified. No evidence of fracture or spondylolysis. Straightening of lumbar lordosis. No evidence of abnormal motion with flexion or extension. Moderate to severe disc space narrowing with mild endplate spurring at L3-4. Mild disc narrowing at L5-S1.

    Xray

    • This reply was modified 2 weeks ago by Avatar Dalbot81.
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