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I’m 13 months post fusion at L5/S1 (after two discectomies and two reherniations in the two years prior). My motor strength has completely returned since surgery, but at about the six month mark I began having recurrent pain in my right back and leg, with the worst of it on the outside of my foot. The pain can be almost absent for weeks at a time, then become triggered and really impact my quality of life.

I had an MRI (results: At L5-S1, compatible with successful fusion surgery. Fairly extensive epidural enhancing scar tissue is again noted adjacent to the right S1 nerve sleeve) and an EMG (There is electrodiagnostic evidence of chronic right S1 radiculopathy, with no evidence of ongoing denervation.), and have been told that I have irreversible damage to S1 causing the pain.

My question is–is it normal for this kind of post-op irreversible pain to be dormant for a while (sometimes many weeks) and then flare up and be almost completely debilitating? I am on neurontin, which doesn’t help much during a bad flare. The pain seems worst when I’m doing a lot of physical activity, so I’m trying to wrap my mind around what exactly is causing this–inflammation or true damage? They are talking about the possibility of a spinal cord stimulator and I wondered your thoughts on those?

Hello Dr. Coreman,
I’m a 54 year old male. My symptoms include grip strength loss bilaterally, worse on right side. Numbness right hand pinkie and index finger, neck and upper back pain and headaches. This started about 2 years ago. The grip strength issues seemed to vary and improve up and I got by, but now within the last 2 months my symptoms have worsened and my right hand is becoming un-coordinated and slower than my left hand. My right fingers are also weaker. This has me very concerned. I have gotten a few of opinions, 1)foraminotomy of the c7t1 right side, 2)m6 disc at c7t1, 3)laser surgery (anterior approach) c6c7 and c7t1. Also, I’m awaiting a nerve study as one doctor pointed out to see if it’s even worth operating on at this point. I uploaded my MRI as well. What surgery would you recommend, if any, to address this issue, and can the c8 motor nerve recover in your opinion.
Thank you.
FINDINGS:
Evaluation of fine anatomic detail is partially limited secondary to motion artifact; within these limitations:
Craniocervical Junction / Posterior Fossa: Normal.
Alignment, Vertebral Body Heights, and Curvature: Vertebral alignment is unchanged, including slight reversal of normal cervical lordosis and mild levoconvex curvature.
Vertebral body heights are maintained.
Marrow Signal: There is no evidence of a suspicious focal marrow replacing lesion. There is mild bone marrow edema along the C7-T1 vertebral body endplates, which is likely reactive.
Disc Spaces: Multilevel degenerative changes, including loss of intervertebral disc height, loss of intervertebral disc T2 signal intensity, and a posterior disc-osteophyte complexes.
Spinal Cord: No evidence of a spinal cord signal abnormality.
Level-By-Level:
C2-C3: Uncovertebral and facet hypertrophy. No significant spinal canal or neural foraminal stenosis.
C3-C4: Uncovertebral and facet hypertrophy. No significant spinal canal or left neural foraminal stenosis. Mild-to-moderate right neural foraminal stenosis. These findings are not significantly changed.
C4-C5: Posterior disc-osteophyte complex and facet hypertrophy. Partial effacement of the ventral CSF space. Mild spinal canal stenosis. No significant neural foraminal stenosis. These findings are not significantly changed.
C5-C6: Posterior disc-osteophyte complex and facet hypertrophy. Partial effacement of the ventral CSF space. No significant spinal canal or neural foraminal stenosis.
C6-C7: Posterior disc-osteophyte complex (slightly eccentric to the left), facet hypertrophy, and ligamentum flavum thickening. Partial effacement of the ventral CSF space with mild flattening of the left ventral cord. Mild spinal canal stenosis mild-to-moderate right and mild left neural foraminal stenosis. These findings are not significantly changed.
C7-T1: Posterior disc-osteophyte complex, facet hypertrophy, and ligamentum flavum thickening. Partial effacement of the ventral CSF space and mild flattening of the ventral cord. Mild spinal canal stenosis. Moderate-to-severe right and moderate left neural foraminal stenosis. Slightly progressed on the right neural foramen; otherwise not significantly changed.
Miscellaneous Findings: None.
IMPRESSION:
Multilevel degenerative changes of the cervical spine, as detailed, including moderate-to-severe right and moderate left C7-T1 neural foraminal stenosis.