BillL

Dr. Corenman:
Thanks for the response and no problem about the delay. This lateral canal or extraforaminal area was what I feared. I believe the surgeon went in via laminotomy since he had to also access the subligamentous rostrally migrated fragments as well. And is it possible that even that intraspinal location was a bit “blind” as well? Perhaps missed fragments in that location are less likely since I presume the L5 root more likely to be compressed there and inconsistent with recurrent symptoms?

If a gadolinium contrast MRI is done, how soon would this be accurate enough to distinguish post op changes vs compression whereby a decision to re-operate could be made if pathology seen? (Without going in too quickly yet not waiting many months).

Finally, my surgeon has suggested before that he is a bit uncomfortable with the lateral approach discectomies in general stating less distinct landmarks and potential nerve injury etc.(I’ve seen your online lateral access videos however which look slick). Assuming your suspicion were verified and a far lateral fragment (or bulge abutting the L4 root) persists then would a lateral approach creating a second annulotomy weaken the annulus and predispose to reherniation, right sided collapse and even fusion (the latter being my great fear)? That said, I would think that a lateral approach would be best even if this requires a surgeon comfortable doing so with a minimally invasive dilator system).

Thanks.