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Howdy Duty, Re-herniation L4-L5 plus new hern. at L3-L4...

Howdy --

That first part of the subject line is a 1950's television joke (for any youngsters in the audience...) - I make the joke in apology for the length of this post...

In June 2006 I had a laminectomy at L4-L5 to deal with what surgeon described as a large (he said 'Lima bean sized') extrusion impinging on nerve root. Prioir to surgery experienced severe nerve issues at right foot - weakeness, heel drop, tingling, referred pain, etc.

May-June 2009 after worsening pain, an MRI showed bulges at L3-L4, L4-L5, and the usual: degenerative disk disease, ostoarthritis, mild narrowing, some scar tissue from 2006 surgery at L4-L5.

Then in June 2009 - steroid injection, followed a few days later by sudden and terrible pain near same site - ER x-rays showed mobility (slippage) of L4 vertebra, frontwards & backwards, around 4 mm. Consultation with original surgeon - he suggested that the amount of mevement did not rise to the level at which surgery would be required. Slippage has continued since - a bony kind of 'click' or 'give', though without the pain of its first occurance. Seems likely the pain prior to the injection was the precondition leading to the first slippage.

PT on and off during flareups since 2006, but mostly a positive outcome. I lived ina largely normal way, albeit with cautions and transitory problems.

Then in January 2012 I took a fall on some interior steps at work - it meant occupational medicine for starters. Hit the top step edge right near 2006 surgical site then bounced down several more steps. Fall resulted in immediate and severe pain at specific spots near site of 2006 surgery. Neurologic symptoms returned to right foot/leg, Occupational medicine did x-rays to rule out cracked vertebrae, but no followup MRI. Symptoms abated to a degree and after several weeks of followups, I was released from occupational medicine - meaning I could take the issue to my own doc. Moved forward despite recurrent symptoms: they'd get bad, then ease - I didn't want to hit the panic button...

Finally in June, 2012, increasing issues including recurrent specific site pain and neurologic symptoms took me to my own doc who, after hearing of the January incident, immediately ordered an MRI.

MRI showed a re-herniation at L4-L5 (smallish - around 3 mm.) plus scar tissue. Additionally, MRI showed new herniation (first-time) at L3-L4 (around 8mm.) that was impinging nerve root at that level. First othropedist who saw the MRIs said we were 'past conservative treatment', if for no other reason than the passage of time since the January accident.

So I'm seeing my original surgeon from the 2006 surgery tomorrow. Not sure what to expect yet.

What are the issues around the re-herniation at L4-L5, the slippage of L4, and the new herniation at L3-L4? What do folks think? Maybe the extrusion at L4-L5 is smallish because there was such a major extrusion in 2006 (not so much jelly left in the jelly donut).

I'm wondering what the combination of re-herniation, slippage, and fresh herniation at a second level add up to. Surgery? Maybe a redo of the clean-out of 2006? A new laminectomy to deal with the nerve root impingement at L3-L4?

Or are we looking at fusion at L4-L5 - or at both L4-L5 and L3-L4? Or some combination of these - to deal with the instability?

What do folks think? What should I ask? This surgeon is smart, quick, likes to be reassuring, but can be a little perfunctory or even dismissive. Meetings with him tend to be short in duration....

Thanks all --
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