Hi Dr. Corenman,
I just wanted to provide an update. I ended up having the microdisectomy done in August. I ended up doing the original MD surgery with surgeon B. (I think it is a natural human tendency to go with the surgeon who gives you the “best” news (least invasive)). Unfortunately, I didn’t really get any relief and feel like I am back to square on. Lots of right leg tingling, and sometimes pain in foot and calf. Lots of R gluteal pain and pain on the R SI joint. Surgeon B seems somewhat flumoxed on my symptoms now and I’ve lost confidence in him. Thus I returned to surgeon A, who was initially concerned about the pars defect. He reviewed my f/u MRI- thinks I reherniated and/or adequately was not decompressed on L5/S1.
I am also learning that different surgeons seem to be interpret imaging very differently and also have a different read on the radiologists reports. Is this normal?
This was the CT (April 2023):
1. Bilateral L4 complete spondylolysis with no osseous bridging and no evidence of L4
anterolisthesis. Mild diffuse disc bulge L4-L5 disc space with no significant central canal
narrowing or neuroforaminal stenosis.
2. Redemonstration of previous L5-S1 right hemilaminectomy and medial facetectomy and
redemonstration of what was proven to be prominent enhancing epidural fibrosis obscuring the
axillary portion of the right S1 nerve root. There is minimal/mild increase in mild to moderate
central canal narrowing at this L5-S1 level specifically in the region of the right anterior
lateral epidural recess.
Per Surgeon B; I have 5mm of spondlyolisthesis at L4-L5 as well as significant dis height loss at L5-S1. He is recommending L4-S1 ALIF with posterior instrumentation to repoair the pars fracture and address central and forminal stenosis. Obviously this is a big surgery and I am hesitant to get another surgery. I also want to be back to some activities I miss and be without nagging discomfort and pain. Are there any other approaches you would recommend? It sounds like trying another decompression at L5-S1 is off the table and for a “permanent” fix he is recommending a fusion secondary to spinal instability. My understanding is that both levels need to be fused secondary to the state of L5/S1.