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  • WKBW
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    Post count: 6

    Once again, thank you vey much Dr. Corenman for your time. You’ve been extremely helpful!

    WKBW
    Participant
    Post count: 6

    Dr. Corenman,
    I met with my neurosurgeon today to review my new MRI results of a symptomatic large recurrent disc protrusion at L5-S1, exactly where my first one was. Per your suggestion this included a discussion regarding my previous lumbar CT scan report from Feb. which stated I had a “Left L5-S1 spondylolysis” along with a SBO defect at S1, which you referred to as a “floating facet”. (See previous post for exact details). He explained that it was, in actuality, an intact (non-fracture) elongated pars that likely developed along with my SBO.

    He then said that due to his previous pre-op concerns regarding these two findings, he checked the stability of my spine during surgery and made note of it being “quite sturdy”. In regards to the thinner bone area, he further explained that he will enter through the same incision and only remove a little more bone to give him a slightly bigger window. Consequently, he and I feel confident that a revision microdiscectomy is the most appropriate choice for me at this time.

    We briefly discussed the possibility of other pain generators, but the fact that my symptoms are so similar to before and were completely resolved following the first surgery, he feels sure this revision will have the same affect with a more long-lasting result. There’s never a full guarantee or a crystal ball, but do you agree with his thinking?

    Also, I know that each surgeon has their own post-op instructions/guidelines, but do you offer your patients (going through revision microdiscectomy) any additional instructions that you feel would help prevent another reherniation? If so, I would appreciate any suggestions.

    Finally, thank you so much for helping me with my recent situation. Your willingness to take the time to read my story and give quick responses to my questions, has been remarkable! I’m lucky to have found your forum, been educated by the vast “free” information you have available on your website, and most of all, to have had the benefit of your knowledge and experience. Thank you for selflessly giving back to all of us here.

    WKBW
    Participant
    Post count: 6

    My understanding from the neuro is that the pars defect is actually an “elongated (stretched?) pars”. Prior to surgery he explained that this would actually make the laminectomy easier as it is thinner bone than normal. Does this make sense, and does it mean that he would have removed a portion of the dysplastic area during surgery? Could this add to it not being visible on the new MRI?

    I will discuss my options for surgery with my neuro and take your advice regarding the CT. Thank you!

    WKBW
    Participant
    Post count: 6

    Hello, again, Dr. Corenman

    Per your request, here are portions of the notes from my recent MRI (5/20/20). I copied what I believe are the most important.

    “The lumbar lordosis is well maintained without subluxation, spondylolysis or spondylolisthesis. There is no scoliosis. The lumbar vertebral bodies demonstrate minimal spondylitic change in the lower lumbar spine with small Schmorl’s node along the inferior endplate of L5. Lumbar bone marrow signal is benign. No compression or other fracture identified. Marrow signal and morphology of the upper sacrum appear normal.”

    “The L5-S1 level demonstrates postoperative changes of a left-sided laminectomy. There is a large recurrent left-sided L5-S1 disc herniation at this level directly compressing the left ventral aspect of the thecal sac with direct compression of the left S1 nerve root sleeve. There is normal appearance of the right-sided articular facets and right-sided ligamentum flavum. The left-sided spondylolysis at L5 identified on the CT is not identified on this MR.”

    “The lumbar nerve roots of the cauda equina are normal. No epidural hematoma or collection. Benign postoperative signal in the posterior paraspinous soft tissues. Retroperitoneal soft tissues are normal.”

    “Impression:
    1. Sequela of left L5 laminectomy with large recurrent left paramedian disc herniation directly compressing the left S1 nerve.
    2. Minimal degenerative changes at L3-4 and L4-5, stable in comparison to prior studies.”

    Since the MRI I have not had any discussion with my neurosurgeon. My appt. is on 5/26. Over the past few days I’ve been achieving some occasional relief of left low back/left leg symptoms by taking Motrin 400mg po q6h tid. Pain level 3-5 down to 1-2. However, I also need to take Colace tid with it (prone to constipation) and have a history of chronic superficial gastrtis so can’t live on these meds for long.

    As you previously mentioned, do you think that getting standing 4 view
    X-rays would still be beneficial? Any need for another CT?

    Are there other conservative treatments you would recommend I try before a revision microdisectomy?

    In your experience, if revision surgery is necessary, what is the success rate?

    What do you consider my best options to be at this point? Thank you, again, for any advice or guidance you can give.

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