[Bikingenjo]

#35449

I posted a while back about my MD a few months ago with recurrent symptoms (lower back pain that was exacerbated when leaning backwards or sitting, radiating glute). I had an MRI done and it shows stenosis around where my post microdiscectomy bulge is. This seems to be the source of my pain. But I was wondering, what is this stuff between my bulge and my canal?

https://i.redd.it/l0d2h37gnifa1.jpg

Is there a surgery that can help clear up the space and decompress my s1 nerve?

Thank you

[Bikingenjo]

#35450

IMPRESSION: MRI of the lumbar spine demonstrates:

Previous left laminectomy at L5-S1. Unchanged left-eccentric disc bulge and posterior annular fissuring, with left lateral recess narrowing and disc contact on the descending left S1 nerve root. Moderate left facet arthropathy. Mild-moderate left and mild right foraminal narrowing. No thecal sac compression.

[Donald Corenman, MD, DC]

#35452

By the radiologist’s description, “left lateral recess narrowing and disc contact on the descending left S1 nerve root”, it sounds like a redo surgery at this level could be helpful. I must remind you that radiologists can describe things differently than a spine surgeon so collaboration with a spine surgeon should be taken.

A selective nerve root block would be helpful to insure the root is the cause of your symptoms. See:

https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/
https://neckandback.com/treatments/diagnostic-vs-therapeutic-injections/
https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/

Dr. Corenman

[Donald Corenman, MD, DC]

#35453

By the radiologist’s description, “left lateral recess narrowing and disc contact on the descending left S1 nerve root”, it sounds like a redo surgery at this level could be helpful. I must remind you that radiologists can describe things differently than a spine surgeon so collaboration with a spine surgeon should be taken.

A selective nerve root block would be helpful to insure the root is the cause of your symptoms. See:

https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/
https://neckandback.com/treatments/diagnostic-vs-therapeutic-injections/
https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/

Dr. Corenman

[Bikingenjo]

#35455

Thank you so much for your reply as always. It is a big help. I saw my surgeon today and we are going to do another surgery – microdiscectomy, laminectomy, and foraminectomy to decompress the nerve in 2 weeks. He also mentioned he would try to clean up the scar tissue around S1.

The only thing I am worried about is removing so much bone matter. I’m 26 years old, is there real risk to my health/spine stability etc after doing those 3 procedures at l5s1?

[Donald Corenman, MD, DC]

#35456

I did not understand this is your third decompression. Generally, I would do a TLIF fusion of L5-S1 as third time decompression surgeries at the same level have a greater chance of failure (up to 50%) and fusions are a “one and done” type of procedure which prevents the disc from being a problem again.

Dr. Corenman

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