Forum Replies Created
Donald Corenman, MD, DCModeratorDecember 2, 2022 at 1:06 pmPost count: 8436
Cervical foraminotomies can be quite effective in the right circumstances. If there is herniation, it is more effective. If it is nerve compression from foraminal collapse due to uncovertebral joint spurring, less effective. Recovery before non-strenuous work can be 2 weeks or even less but some patients can take up to 4 weeks, the same time as an ACDF or artificial disc replacement.
Dr. CorenmanDonald Corenman, MD, DCModeratorDecember 2, 2022 at 10:16 amPost count: 8436
It’s not uncommon to have root swelling after a surgical decompression causing recurrent leg pain.
The possible causes of increased leg pain after a period of relief post-microdiscectomy surgery are inflammation of the nerve, seroma, recurrent herniation and infection with much more rare conditions like facet fracture.
Inflammation is common after decompression of the root. A compressed structure that was injured will “swell” and become congested. Oral steroids and time are the best treatment.
Seroma is a common condition. Fluid exudes from surgical sites and can build up and congest and compresses the nerve root. Seromas typically resorb after some time but occasionally need to be aspirated by needle. This is diagnosed by MRI and treated by needle aspiration.
Recurrent herniation occurs in 15% of patients and normally increase pain significantly. Recurrent weakness and a “tighter” leg (SLR) are common. If the recurrence is not too large, sometimes an epidural injection can be helpful. A redo microdiscectomy is not uncommon in the face of a recurrent herniation.
Infection should be rare at less than 1% of all surgeries. Interestingly, many patients do not have fevers or chills but have increased back pain that translates to leg pain eventually. Lab tests are the beginning for diagnosis. Diagnosis is by lab tests and patient symptoms.
Dr. CorenmanDonald Corenman, MD, DCModeratorNovember 29, 2022 at 2:26 pmPost count: 8436Donald Corenman, MD, DCModeratorNovember 29, 2022 at 2:26 pmPost count: 8436Donald Corenman, MD, DCModeratorNovember 29, 2022 at 2:12 pmPost count: 8436
Putting the injection in on the opposite side will have a poorer success rate. Typically, a large volume transforaminal injection on the same side would yield the best success rate (TFESI) without the risk of a dural leak. You might be surprised how effective it is.
Dr. CorenmanDonald Corenman, MD, DCModeratorNovember 29, 2022 at 7:40 amPost count: 8436