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Help me decide on second microdiscectomy

phenom34pphenom34 Posts: 27
edited 06/11/2012 - 8:52 AM in Back Surgery and Neck Surgery
I posted a couple weeks ago but didn't get much input. I had a microdiscectomy on l5s1 about a year ago for some sciatica and genital numbness on one side. Im in my 20s with no other health problems.
I had a bad flare up about a month ago and the pain, numbness, etc got real bad. I scheduled appointments with a few docs to go over options.

Most in concern is my genital numbness, i am also getting back/buttock pain that isnt too bad but noteable, also i have tingling in the same side foot. It seems as though i have symptoms of cauda equina syndrome which according to every website is a huge medical emergency to decompress, but none of the surgeons even seem alarmed.

My doctor does not seem to think that a second surgery would help but he will do it if i want. I also decided to get a 2nd and 3rd opinion who also didn't think that would help. Ive done physical therapy and also saw someone for manipulative medicine which only seem to be aggravating the problem. Since Ive seen him i think i had another flare up and it seems to only be getting worse.

They all seem to think that s1 doesn't supply the genitals, however my mri does say that there is central canal stenosis (what I would say is the definition of cauda equina syndrome)

My most recent MRI says:

l5-s1: "Decreased T2 weighted signal at the central/right paracentral ventral epidural space, most consistent with protrusion. This is slightly larger than prior study (5 months ago), This shows some curvilinear enhancement most likely representing postsurgical scarring versus annular fissure. Moderate foraminal stenosis reidentified bilaterally."

I also received a sacral one that was unremarkable.

The one before that mentioned "6.6 mm disc protrusion resulting in mild-to-moderate right central canal stenosis and obliterating the right lateral recess, likely compressing right s1 nerve root"


  • All I can say is that with 3 doctors saying the same thing, they can't all be wrong. It also sounds like part of your problem might be from scaring. I don't know where you live but you might want to do something like go to UCLA or Mayo. Look for some place like that close to you.
    ALIF April 2011 but it turns out I broke before it barely fused.
    L4-L5 posterior fusion December 2013
  • Can you describe the approach that was used in your microdiscectomy?

    What provoked the flare ups?
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • Are you saying that central canal stenosis is cauda equina syndrome? Take a look at the Spinal Stenosis Health Center here on Spine Health for more information about stenosis. For more information on CES, please review the article on Cauda Equina Syndrome.

    It sounds like the three doctors that you have seen do not think its CES. I see you have done some PT recently, but was it with someone that specializes in lumbar issues? I've personally found that if you go to a general physical therapist, the approach is just that, general. Whereas, if you go to someone that specializes in the back, better results may be achieved.

    Just some food for thought.

  • My first microdiscectomy was a percutaneous microdiscectomy from the back. It was a very easy recovery from what i remember.

    It is aggravated by anything that is strenuous and sitting long periods of time. In these cases i feel a pinching sensation in the genitals and foot. When i lay down for a long time it seems to go back to baseline-ish.

    I don't know what caused the two big flare ups i just awoke like that. I honestly haven't done anything strenuous for weeks.

    Yes, i do think that the disc is somehow pinching my cauda equina or my s1 nerve happens to innervate the genitals too.

    Currently in pt as we speak doing stuff for back and pelvis actually just to see if that possibly might help. It seems to be aggravating it more.

    My surgeon will do a revision if i want but he wanted me completely informed that he doesn't think it will do much and of course there are the usual risks involved.

    For some reason, i am highly optimistic about doing it again, but Im scared to death as I see way too many horror stories online.
  • Just wondering of your symptoms? I do have the same problem. Will be going for second surgery tomorrow.
  • If 3 dr,s saying that surgery in question wont help then i would listen to what they say,

    But i would make them look further to confirm whats causing the pain in case it could be from another level all together, You want to be as close to 100% as posible before having another surgery so they dont do the wrong surgery just to make you happy and if it gets worse they will just fall back on what they originaly said,

    Surgery can make a person worse especialy if it was not needed at that level. Is the risk worth it? Iff too much is removed from the disc and disc now cant be saved then now total removal of the disc will be the next step with fusion hardware,

    Good luck on what ever you decide to do,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
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