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  • dapalumbo
    Member
    Post count: 3

    My Question has to do with the recommended surgery. Why only fix one damaged disc and not the other? The Othopaedic suggested a Discectomy on the L5-S1 disc. What are my surgical options to repair or replace both discs?

    35 Active Male,

    Never had any back injuries just knee and shoulder, infact pre-employment x-ray illusrated no issues. No history of disease or other problems. Injured spine from trauma at work.

    IN Sept. 2011 MRI of Spine

    L4-L5 minimal disc buldge with PA tear and central Disc protrusion
    S1 root impinged & central canal narrowings bilateral neural foraminal narrowing

    L5-S1 minimal disc buldge with PA tear and left Disc protrusion
    S1 root impinged L paracentral narrowings.

    1st TX: 1 Epidural with PT along with medication
    Returned to work in December although never was 100%. Found myself missing days starting the new year and by May 17 Ive missed all my sick days and 2 weeks of vacation, I needed another MRI.

    June 2012 MRI Findings w/ contrast
    L4-L5 disc buldge with moderate superimposed central herniation. S1 Root Impinged

    L5-S1 disc buldge with moderate superimposed Left paracentral/subparticular herniation. Inferior extrusions w/ fragment extending to left lateral recess. S1 root impinged & central canal narrowings bilateral neural foraminal narrowing

    Other Findings: Degenertive Disk disease at L4-L5 L5-S1 with disc herniations at these levels Both herniations appear incresed LPC herniation has inferior extrusion or sequesteration impinging upon the transfersing S1 root. Endplate changes with disc desication seen at L4-L5 L5-S1

    TX as of 8/14:
    2 Epidural injections
    Medications
    Auquatic therapy
    Othopaedic surgeon recommended Discectomy of L5-S1

    I am meeting with a Nuerosurgen tomorrow for a second option. This is a work related injury therefore I want to be sure it’s taken care before I return.

    I have dull aching pressure pain to the left of spine and about an inch higher on the right side. I can’t get comfortable and don’t sleep very well. I feel sharp pains felt in lower abdomen w/ burning sensations in saddle area and behing the knee. My left leg pain shoots from my butt down in the middle through the back of leg to the back of knee; the pain then wraps around calf to front of shin to the interior lower leg then to feet. My pain is associated with numbness (pins and needle feeling) as well as circulation problems at toes. My Toes will turn blue in color. I have difficulty voiding yet Caudia Equinis was not diagnosed yet the problems stems from the injury.

    My right leg pain had just started within the last month. I have a burning sensation in the saddle area. with hip issues , tingling in toes. Pain Not as bad as left.

    Pain Scale: If 10 is losing a limb then Id say a 6-8 depending on time of day. I can handle pain well yet its constant and it hurts.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    Your new MRI notes an L4-5 central herniation. You description is difficult to understand. Central herniations cause central canal narrowing (central stenosis). This will cause symptoms of neurogenic claudication (see website) but you do not complain of this disorder. If however, the hernation is off to one side, this herniation can selective cause nerve root compression. You note an “S1” nerve compression at this level but I believe you mean an L5 compression. If this is true, which side is the compression on?

    You have an L5-S1 herniation on the left. This explains your left leg pain. If you have undergone significant treatment with poor results, you might be a candidate for a microdiscectomy. I cannot comment on the levels to be addressed surgically as the L4-5 level needs to be described further.

    Dr. Corenman

    dapalumbo
    Member
    Post count: 3

    Dr.Corenman,

    I first would like to thank you for taking the time to read and answer my post. I also appologise for the issues with the post. Im in a lot of pain and just miserable, and with an inability to stay focused as well as not being able to sleep; I’m a mess.

    You are absoulutely correct and the L5-S1 herniation impinges the S1 and the L4-L5 would impinge the L5. The MRI report combines both herniated disks in one sentence then states the impingement. The S-1 is the only root impinged in the 6/12 MRI. I do have a side by side comparison of my 9/2011 and 6/12 MRI’s on Disk as well as the MRI reports in PDF. I can email or post them with priveliges if you like? I just need to know how to post a file. Sorry for the mistake.

    I just returned from my appointment with the Neurosurgen. He is concerned with my symptoms as well and has reordered the MRI. He feels there is another issue which he has noticed yet no mention in report. He feels I do need a discectomy on the L5-S1 disc yet will wait for the MRI to decide on any other surgical treatments.

    Thanks for your help,
    Dave

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    You can send any MRI that you would like to be reviewed by calling (970) 476-1100 and asking for one of my nurses.

    Dr. Corenman

    dapalumbo
    Member
    Post count: 3

    Dr. Corenman,

    Thank you again for helping me.

    I just received my report on my 3rd MRI and will call to have the information sent to you.

    It seems the L5-S1 is still herniated with an annular tear, yet is not impinging.
    – Still very concerned

    The L4-L5 is a broad herniation compressing the Thecal Sac.

    Is this why my I have bowel and urinary problems as well the other symptoms I mention in my 1st post?

    Dave

    I would like you to look at when you can. I appreciate all your help.

    Dave

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    If you had a massive herniation that filled up the spinal canal and caused cauda equina syndrome, this could cause your bowel and bladder symptoms. Cauda equina syndrome is very rare and many people with even huge herniations do not develop it. You have seen a neurosurgeon who was not concerned by your report so I have to assume that you do not have this syndrome.

    Bowel and bladder symptoms can be caused by many different disorders. Prostatic hypertrophy, pain, medications, pelvic wall dysfunction (rectocele and cystocele in a female) are some of the other potential functional modifiers.

    I await your films.

    Dr. Corenman

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