Question: Who to see about chronic pain after lumbar herniated disc surgery?

Several years ago, I had surgery for a lumbar herniated disc at L5-S1. After surgery, I still had pain in my right foot when standing or walking. The spine surgeon said the pain would go away with time, although it never did completely go away.

I continued to have varying degrees of discomfort. Even up to five years after the surgery, I have severe episodes of pain in my right calf and the right side of my right foot.

I had been told that my condition was caused by scar tissue at the site of surgery that was compressing the nerve. What type of spine specialist should I see to analyze my condition?

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Doctor’s response: MRI can help with choosing treatment for chronic pain after herniated disc surgery

Unfortunately, treating chronic pain is often a trial and error process. Most of the information you will need to continue treating your symptoms should be visible on your MRI scan.

The key thing to look for in the MRI scan is not only whether or not there is a recurrent disc herniation (there probably isn't one at this point) but the health of the disc space itself. If the disc is collapsed and the cartilaginous endplates have eroded, it would signal continued disc degeneration.

As the disc space collapses, it can irritate the nerves in this region, including the L5 and the S1 nerve roots. Fusing the disc space with an anterior approach (from the front) can alleviate this nerve irritation. If there is a great deal of degeneration in the disc space and your pain is severe, a spine fusion is probably your best bet.

The type of physician I would recommend seeing is a spine surgeon (either an orthopedic surgeon or a neurosurgeon) who is fellowship trained in fusion surgery and specializes for the most part in spine surgery.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.