Vin

Hi Dr. Corenman,

Thank you so much for your response!

Just to be clear, the numbness, spasms and tingling start just above my lower lumbar, by feel, I would say T9-T12 and go down both sides of my spine, into my buttocks, sphincter, groin, scrotum, genitals and down the backs of both legs and into the bottom of both feet.

When I push to urinate or have a BM, I get an increase and shooting numbness, tingling down the back of both legs and into both feet when I push.

The numbness, pain and tingling waxes and wanes but is always the worst when I stand or sit for more than 10-15 minutes and when I lay down at the end of the day.

Also, in regards to sexual function, there is not erectile dysfunction but any sexual activity increases numbness everywhere, groin, genitals, back of legs, buttocks, scortum, sphincter etc. So I have not been sexually active at all.

I will keep you posted on the Thoracic MRI results but something just feels terribly wrong, I mean, residual pain and numbness, weakness down my right leg I can accept due to the repeat herniations on that side but all of this numbness and tingling in both legs, buttocks, genitals, scrotum, sphincter, and down lower back staring just above the lumbar is troubling. It is progressive and I have a lot of tightness and pain in hamstrings and feet.

If the Thoracic does not reveal anything, I will definitely send my imaging and fill out your questionnaire to see if you can identify a cause.

If I were to send you my imaging, is there any other testing that you would like to see done? Discography, EMG, Flexion X-Rays etc.? If I pay your fee for a thorough consult, please let me know if you require or would like to see anymore tests done prior to a consult. I could give you my GP contact info in private and you could forward requests to them for further tests. I have full OHIP coverage here in Ontario, Canada.

Regards,

Hi Dr. Corenman,

Can you please let me know your thoughts on my CT Scan / MRI Reports overall and also let me know if anything stands out as reason to why I would be getting numbness / sciatica in both legs and feet along with transient numbness in genital / rectum area as well as lower back pain across my entire lower back, both right and left sided?

Thanks again very much. I truly appreciate your responses and insight.

As per my CT Scan Report.

Findings:

The evidence of surgical intervention at lumbosacral level is noted with disk space narrowing and vacuum phenomenon. Limited right sided laminectomy.

Abnormal soft tissue density is seen occupying the right anterolateral aspect of the spinal canal contiguous with the residual, degenerate disk, obliterating the fat surrounding the right S1 nerve root.

Indentation of the anterior aspect of the dura at and below the level of the disk for about 18mm from presumed sequestered residual disk / postoperative reaction.

The left S1 nerve root is spared and nothing significant shown at the more superior levels. The degree of soft tissue reaction is consistent with the intervention with no particular concerns of infection.

*Postoperative sequestered disk material / haematoma / granulation tissue on the right side at the site of intervention obliterating the space around ipsilateral S1 nerve root and indenting the anterior aspect of the theca but not critically so. The left S1 nerve root is spared.

Given the clinical concern and to more precisely depict the extent of spinal canal compromise arrangements are in place for urgent MR scan.

As per MRI Report

Findings:

The MR scan confirms CT findings of abnormal sequestered disk material indenting the right anterolateral aspect of the theca at the operated level (lumbosacral) with extension inferiorly almost to the level of S2.

*The MRI scan has been reassuring and excluded the necessity for critical urgent decompression surgery. However, neurosurgical consult should be planned as soon as possible.

Hi again Doctor!

So I have the results of the MRI / CT Scan. It seems that I have a sequestered piece of disc at the postoperative level (l5 s1) that is within close proximity but inferior to S2. (Right side). That is paraphrased off memory as I do not have the report in front of me atm. I will post word for word later tonight and perhaps you can break it down for me.

My neurosurgeon bumped me up when I called with this report from the hospital so I see him early next week.

I suppose a microdiscectomy revision will likely be in order.

What is your thought on Microdisectomy revisions? I have read conflicting opinions. Some surgeons opt to go straight to fusion to avoid another possibly failed microdiscectomy and thus avoiding accumulation of fibrosis, as this could potentially end up being 3 surgeries (ie. 2 failed microdiscectomy and then a l5 s1 fusion).

Other Doctors say to always try 2 Microdisectomy before going to a much more invasive fusion and do not mention much at all in regards to the accumulation of scar tissue with a worst case scenario 3 surgeries.

1. What is the successful outcome percentages of Microdiscectomy revision surgery? Does the reherniation rate increase from the 10% chance of reherniation with the first Microdiscectomy procedure? Or is it still 10% chance with revision surgery?

2. What are your thoughts on going straight to fusion vs microdiscectomy revision?

3. With either surgery, do you ever have patients wear braces? I also read mixed opinions, some Doctors swear by them to keep the patient conscious of no BLTing…others say it restricts natural motion/ movement and increases chances of significant fibrosis.

Any input or insight is welcome and very much appreciated!

I will of course ask my surgeon these questions but also have a high regard for your opinion.

Thanks!