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  • Alex
    Participant
    Post count: 4

    Thank for answering questions on your forum. The information has been very valuable and wanted to express my gratitude in advance.

    I recently had a hemilaminectomy and microdiscectomy on my l4-l5 area. This injury had been around for awhile but recently got worse this year. I was diagnosed with a disc bulge which was slightly worse on the right side vs left.

    From what I understand, the surgeon told me he did the rift side and also removed thickened ligamentum. I asked about the left side and he said it was not bulged as much and the microdiscectomy procedure it would be difficult to decompress both sides. The good right side didn’t have as much sciatica so I just trusted that judgement.

    Post surgery my bad side (right) has been pain free but I have been experiencing tingling and sciatica now often on the left (good side). It has been about a week post OP and I mentioned it to the surgeon and he said it wasn’t anything to worry about. No issues with incision site.

    No motor weakness at all. Is this anything to be worried about right now or is it common? Admittedly if I had the same results on both legs I’d be happy but now the opposite leg is having issues and the treated one is completely fine.

    Thanks again.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    I would have disagreed with your surgeon about the opposite side. It is certainly much more work to do both sides than a simple one-sided decompression. It is great that the operated side is now symptom-free and it well may be that the opposite side is “adjusting” to the surgery. It eventually also might well be symptom-free soon. Give it six weeks for the post-operative period and then assess your symptoms.

    Dr. Corenman

    Alex
    Participant
    Post count: 4

    Thanks for the response. Given that it is still early I am going to let it run its course for healing first.

    I also had a question regarding fusion vs artificial discs. Does the same risk of adjacent segment disease run the same risk as a fusion? It seems on the surface the artificial disc is a obvious solution to replacing a damaged disc with mobility.

    The surgeon did initially say that the disc was damaged and long term if it continues to be an issue a fusion or artificial disc replacement could be an option.

    The main concern I have esp with a fusion is that it will eventually damage the rest of the discs and become a cascade of future surgeries

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Artificial discs (ADRs) in the lumbar spine can be effective but not as well as you might think. In addition, if the ADR fails, there is no safe ability to revise it. See: https://neckandback.com/treatments/artificial-disc-replacement-adr-for-lumbar-spine/
    Adjacent segment disease can occur at about a 2.5% rate per year which means in 10 years, there is a 25% chance of a breakdown above or below.

    If your pain is strictly buttocks and leg pain and lower back pain is not an issue, I would stick with the simple decompression surgery.

    Dr. Corenman

    Alex
    Participant
    Post count: 4

    Wow that’s quite interesting to learn about. I didn’t realize also they are under more stress in the lumbar level. I equated a disc replacement to a hip or knee replacement which have been used for quite some time. I can see now the desire for a fusion since it has been utilized for quite some time.

    I will be patient with the process in the meantime. I suppose I will see where things are when I see the surgeon again in 6 weeks. I did call the office and he called me back relatively quick and stated again that it was probably fluid build up and it may take time to resolve. I had another surgery a long time ago and the doctor wouldn’t respond after the surgery unless I had an appointment. He always had an assistant relay his message.

    There was something else I was curious about. I had a surgeon put in this request initially and it was denied by the insurance. His office was impossible to get ahold of anyone and I could never get a call back which is why I just left and went to the second one who did my surgery.

    It was listed as a code CPT 62287

    Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar.

    Is this not generally acceptable for a procedure? The letter said it was considered experimental.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    A percutaneous discal procedure is “deflating the tire” when the problem is the “jelly” (Use jelly instead of air) in the tire already has come out and is causing compression of the nerve. Taking more “jelly” (air) out of the tire simply deflates the tire even more without taking the mass compressing the nerve root off of the nerve. I would not endorse this procedure.

    Dr. Corenman

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