Thecarter

Hi Dr. Corenman,

This issue has been on my mind the last couple of weeks and I’m leaning towards the MRI, even if it’s for peace of mind. I did just want to run something by you please.

I’ve discovered what motion produces the glute pain. The glute pain on the affected (left) side is felt when I’m standing and I raise my left leg inwards in, knee bent, to put the left leg into underwear/shorts/pants. It’s faint but I feel it and it’s for less than a second.

I told my family doctor about these symptoms because I was also feeling pain to the touch on that trochanteric bump on my left leg. She doesn’t believe it’s a reherniation, she thinks it’s trochanteric pain syndrome. She recommended I work on strengthening the abductor muscle.

The sports physiotherapist I’ve been seeing for 4 months believes that it’s a strained ligament in the glute. His reasoning for this is the pain was not produced by the straight leg raise. Sitting, standing and walking does not provoke the pain.

To confuse me even more, I’ve noticed the left side of my left foot feels numb periodically through the day. I don’t know if it’s my mind playing tricks on me because my thoughts are about this 24-7.

What do you think is happening? It really throws me for a loop to think this is a herniation. I’ve taken the last 7.5 months so conservatively that I’m not even picking up my toddler children yet, no running, twisting, bending. Am I being naive to think that this isn’t a herniation? Just doesn’t make sense to me when you see people doing load bearing squats or deadlifts a month after surgery and they’re fine.

Once again, thanks for your time and expertise. This forum is amazing.

Dr, an update, from my MRI with contrast findings. If you could please explain the following, I’d be very appreciative :

T12/L1, L1/2, L2/3 and L3/4 disc spaces are preserved.
L4/5: Status post left L4/5 laminectomy. There is mild symmetrical circumferential disc
bulge with a small central disc protrusion indenting the anterior thecal sac as before. The
degree of subarticular zone stenosis previously identified has improved. There is no spinal
canal stenosis. The AP diameter of the CSF space is widely patent measuring 1.4 cm. In
the left laminectomy bed, there is mild enhancement which demonstrate intermediate T2
signal is suggestive of scarring and fibrosis. No discrete fluid collection. There is minimal
mass effect of the dorsal left thecal sac but the spinal canal remains patent. No mass effect
on the nerve roots. No significant abnormal epidural enhancement.
L5/S1: There is metallic susceptibility artifact seen in the posterior aspect of the L5/S1 soft
tissue. Note is made of L5/S1 laminectomy and discectomy. The previously seen left
paracentral herniated disc and extrusion has completely resected. There is mild to
moderate posterior disc height loss. There is persistent very mild central broad based disc
protrusion indenting the anterior thecal sac but no spinal canal stenosis. The disc does not
appear to be contacting the spinal canal. The subarticular zones are also patent. There is
mild increased enhancement in the left epidural space in the surgical bed but there is no spinal canal stenosis. Mild enhancement of the left facet joint is also identified but no
significant joint effusion. Minimal enhancement is seen in the posterior subcutaneous fat
and posterior to the spinous processes at L5/S1 level.
There is mild edema in the left paraspinal muscle in keeping with recent surgery. The rest
of the paravertebral soft tissue is within normal limits.
The conus medullaris terminates at L1 with normal signal intensity and morphology.
IMPRESSION:
1. The L5/S1 left paracentral disc protrusion and extruded disc has been resected. The
L5/S1 disc height is decreased, with very mild central broad based disc protrusion without
spinal canal stenosis or neural foraminal narrowing. There is mild enhancement in the left
posterior epidural without compressing the nerve roots.
2. L4/5 left laminectomy also identified. The previously seen mild to moderate lateral
recess stenosis has improved. There is moderate enhancement in the left laminectomy bed
suggestive of scarring. No large fluid collection identified. This does not impinge the nerve
roots nor cause spinal canal stenosis .

Thank you for your time Dr. Corenman.
Just a few follow-up questions, if you don’t mind:

– what is an average time frame to allow the nerve to calm down? Is the straight leg test a good indication of surgery success?

– Symptoms are there but not comparable to pre-surgery. Would a reherniation cause significant symptoms?

– I requested a different medicatio; however, the surgeon advised that Naproxen 500 is a good one and wanted me to continue with it and do 4 weeks of physiotherapy. He then wants to see me to assess and potentially order a new MRI. If any nerve pain is lingering at that time, do you feel I should be persistent about an MRI?

I appreciate your time and insight. Thank you from Canada.

PS: you should consider a donation option on your site. I know that your insight calms a lot of patients worldwide and it likely takes away a portion of your time.