Travis21

I insisted on MRI with contrast and the radiologist interpretation states I have a herniated disc at L4-L5. Unclear if this is residual or a recurrence.

I am open to a revision discectomy but am curious as to why I reherniated so quickly (9 days). The onset of pain was slow and gradual, no acute injury experienced.

I’m 40 y/o, non-smoker, non-diabetic, overweight but not obese. I do have an acquired leg length discrepancy due to advanced arthritis in right knee.

If there is a possibile underlying cause for the herniations, makes sense to address that prior to revision.

Any rule outs suggestions before proceeding with revision?

Here are MRI results. Sounds like contrast would have been helpful, which I suggested but was told not necessary:

“Persistent left paracentral disc eccentricity at L4-L5 level likely represents the discectomy site. There appears to be residual central disc extrusion at L4-L5 level. In addition soft tissue attenuation at the left lateral recess cannot be fully characterized without postcontrast imaging. As mentioned above could represent evolving granulation tissue versus residual/recurrent migrated disc fragment.

Left laminotomy at the L4-L5 level is present. There is a residual central left paracentral disc eccentricity which could represent the discectomy site. Intermediate signal in the left lateral recess is of unclear etiology. Postcontrast images would be helpful to distinguish between postsurgical changes/evolving granulation tissue versus recurrent or residual migrated disc fragment.

Moderate disc space narrowing at L4-L5 level is stable. The remainder of the discs preserved at height. The vertebral bodies appear normal in height and marrow signal characteristics.

At T12-L1, L1-L2, L2-L3 level the central canal and the neural foramina are patent.

At L3-L4 level the central canal and the neural foramina are patent.

At L5-S1 level there is suggestion of bilateral L5 pars defect and stable mild anterolisthesis of L5 on S1. The central canal and the neural foramina are patent.

The conus medullaris appears normal in signal intensity and morphology. It terminates at upper L1 level.”

Does residual mean something left behind from the original surgery or does it refer to new herniation?

Any questions you would suggest for my neurosurgeon?

Thank you for your reply.

If MRI fails to show reherniation, what are other potential causes of this new sciatic pain?

I did not have pain going into surgery, though I did have pain in June that lasted about 4 weeks. Surgery was to address weakness with ankle dorsiflexion and in my big toe.