[Donald Corenman, MD, DC]

#23360

I can’t give you a percentage as to success rate as I would have to take a complete history, perform a physical examination, carefully peruse the images and possibly order extra tests such as SNRBs. By lower back pain. I assume that you mean central (midline) pain and not pain localized to only one side. Scar tissue can occasionally cause lower back pain but more commonly, the disc causes lower back pain.

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.

[Micronick]

#23401

Hi Dr Corenman

I have had another MRI with the following results with reference to my two bottom discs:

L4/L5: Previous discectomy and right-sided hemilaminectomy. Findings to suggest subtle disc bulging and a
small central to right subarticular disc protrusion, The suspected small right dominant disc protrusion is contacting but not definitely compressing the traversing right L5 nerve root. Mild left lateral recess narrowing, without nerve root compression. T2w Signal
increase within the posterior aspect of the annulus fibrosus is thought to be a postsurgical finding. Mild
bilateral facet joint degeneration. Disc height loss. Subtle left sided facet joint effusion. Mild, probably slightly
oedematous changes along the surgical pathway within the posterior soft tissue. No circumscribed fluid
collections are noted.
L5/Sl: No relevant disc hernia or disc protrusion. A small right extraforaminal annular fissure is noted. Mild
degenerative changes of the facet joints and probably congenital mild asymmetry of the joints. Mild
narrowing of the bilateral recesses, without nerve root compression. Disc height loss and disc dehydration.

CONCLUSION
Moderate disc degeneration at L4-L5 and at L5-Sl. Evidence of previous L4-L5 diskectomy with findings to suggest mild, DO. resioual, DO. recurrent disc
bulging and a small right dominant disc protrusion, contacting but not definitely compressing the traversing
right L5 nerve root.

Your opinion would be very welcome

[Donald Corenman, MD, DC]

#23406

OK-you note your symptoms to be “60% leg pain and 40% back pain”. You have a “small right dominant disc protrusion is contacting but not definitely compressing the traversing right L5 nerve”. A prior surgery with a recurrent or residual fragment can cause leg pain as if the nerve is scarred, this small fragment can compress the root. The root cannot “get out of the way” of the fragment due to the scarring.

You can try a selective nerve root block of the L4-5 level. If you gain good temporary relief (see pain diary), then this root is implicated in your pain. A microdisectomy has a reasonable chance of reducing your leg and at least some of your back pain. Remember that good pain relief from the injection does not guarantee that the nerve compression is causing the pain. The pain could be generated by chronic radiculopathy (see website). I would give you a 75-80% chance of pain relief with surgery based upon the information here.

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.

[Micronick]

#23472

Many thanks for your reply Dr Corenman

Given the MRI results would an endoscopic type surgery be beneficial as min evasive?

Do you use a gel or substance to help revent scar tissue impacting the nerve after the surgery?

I presume early mobility post surgery would help prevent the nerve being tethered by further scar tissue?

Thanks in advance

[Donald Corenman, MD, DC]

#23475

An endoscopic surgery will not be as effective as a microdiscectomy whether through the tube or a small open procedure. I do use an amniotic membrane to try and prevent adhesions from occurring if warranted. Early mobility (nerve flossing) can be helpful in preventing adhesions.

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.

[Micronick]

#23506

Hi

I am scheduled for a revision microdiscectomy in a couple of weeks. One question is after the surgery and a night in Hospital I will travel back home by either train (2hrs) or car (4hours). Do you have any recommendations re this travel?

Many thanks

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