Viewing 6 posts - 7 through 12 (of 14 total)
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  • Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    You currently have “fibrosis within the right 1.3-4 neural foramen with tiny, nonenhancing, disc herniation in combination with postoperative fibrosis impinging upon the exiting right 1.3 nerve root sheath”

    That with the right sided symptoms and the comment “noted there is almost no good disc there following a previous microdiscectomy + discitis. The levels were almost bone on bone” along with no significant findings at other levels leads me to believe that this L3-4 level is the pain generator. I agree that an ADR is not appropriate and that a TLIF or OLIF type fusion is the way to go.

    Just to make sure, I would use a diagnostic SNRB block at right L3-4 then keep a pain diary to see if the symptoms temporarily clear.

    See:
    https://neckandback.com/treatments/transforaminal-lumbar-interbody-fusion-tlif/
    https://neckandback.com/treatments/far-lateral-lumbar-spine-fusions-direct-lateral-interbody-fusion-dlif-extreme-lateral-interbody-fusion-xlif/
    https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/
    https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/

    Dr. Corenman

    jayd10033
    Participant
    Post count: 69

    Thank you. Surgeon recommends an XLIF, I am considering it.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    XLIF is acceptable. Make sure the approach surgeon is good.

    Dr. Corenman

    jayd10033
    Participant
    Post count: 69

    Last question (for now!) — you read the MRI results, and it looks like the infection activity has died down and gotten better. That said, how much higher is the risk of re-infection from the original agent with an XLIF surgery in the same spot? Could it be dormant anywhere and re-activate, etc.? If TDR is contra-indicated, that leads me to believe there is some risk, but how high?

    Also, should I ask for or will the surgeon put me on any oral steroids following this knowing my history that they wouldn’t have if I had never had discitis? Would you?

    The previous surgery and infection was almost a year ago to the day from this planned procedure in February.

    Thank you,
    Jay

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    It would be highly unlikely but not impossible that there could be bacteria present. I am not a fan of artificial discs in the lumbar spine under any condition but certainly in this situation, an ADR is contraindicated. An XLIF is one of the cures for an infection as a fusion creates an environment unfavorable for an infection.

    Dr. Corenman

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    It would be highly unlikely but not impossible that there could be bacteria present. I am not a fan of artificial discs in the lumbar spine under any condition but certainly in this situation, an ADR is contraindicated. An XLIF is one of the cures for an infection as a fusion creates an environment unfavorable for an infection.

    Dr. Corenman

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