Qhorsegal2

I have been meaning to give an update for a couple weeks. I guess now is as good a time as any!

We were able to go back in on April 4th for another surgery with his original surgeon. She went in approximately an inch to the left of his original incision. This time into the intracanal space between L4/L5. She said she found a very small sequestered fragment, and some stenosis which she removed. She also had to remove a piece of the lamina on the right side. She said that she followed the nerve through the entire space and made sure she had it completely free. She did not do a fusion, but said we would need to be aware of any severe back pain later on which may indicate instability in the area. If that occurs we will have to revisit the idea of a fusion.

He had immediate relief from nerve pain upon waking from surgery, but much more surgical pain than the prior operation. It was wonderful to know that the surgery seemed to work this time! He continued to improve daily, so much that 2 weeks post-op he was walking a mile and a half every morning with no nerve pain. We had a glowing report from the surgeon that week, and she said he could likely return to work by the end of May if he kept improving at this rate.

The next week he started Physical Therapy, and began to have some nerve pain recurring. The second week of therapy brought more nerve pain, but not continuous. The last two days have been worse though. I am at a loss. I am praying this is normal healing, and possibly swelling causing more nerve irritation because of increased physical activity.

I have not witnessed him doing anything which would cause re-injury…but I know it doesn’t necessarily have to be a bending, twisting, lifting over-use to create a new fragment.

Any thoughts on this Dr. Corenman? Could this be a normal part of healing, or would you be concerned with the change in pain levels if it was your patient?

I just found some paperwork that shows his original diagnosis as: Right L4 Radiculopathy – L4-5 disc herniation.

Surgery – Right L4-5 far lateral diskectomy.

Thank you so much for your reply. I’m sorry I did not update sooner. We were in the hospital 4 days after the above post. His surgeon came in on day 3 and said she did think there may be a sequestered fragment in the L4 region, but that the surgery to explore the area may result in destabilzation of the spine, and fusion. His first surgery was to the right of the spine, I believe the far lateral position. He received a nerve block on 2/6/18 which improved the pain slightly and lasted about a week. He just had another on Monday, 3/11/18. This one only gave relief for 1 day.

We are now at the point of making the decision to allow her to go in and explore the area again to see if there is another fragment. Are we making the right decision? He has been out of work for 3 months and our short term disability is now down to 60% of salary. Our experience has been so atypical that I’m scared we are making a bad choice. He needs this to work, and there is no guarantee it will. The surgeon doesn’t seem convinced that the surgery will relieve his pain. I don’t know if this is simply because she has to prepare us for that possibility, or if she truly doesn’t think it will work.

Have you seen very many cases where there was a far lateral herniation AND a central herniation?

I want to thank you for providing this forum for people like my husband and I. It is a wealth of knowledge and comfort to many people. Even if I don’t get another response from you I am thankful for your commitment to helping people in need. You have gone above and beyond what most surgeons would.

Thank you!