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Dr. Andrew Rynne

Family Physician

Exp 50 years

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I have sciatica with pain in my right buttock, ham

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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3289 Questions

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Posted on Fri, 1 Feb 2019 in General Health
Question: I have sciatica with pain in my right buttock, ham string and calf. There is no lower back pain. Recent MRI showed at L4 L5 there is a new small broad central protrusion. Also there is moderate to severe bilateral facet hypertrophy resulting in moderate central canal stenosis at L4 L5. I am considering a minimally invasive micro disectomy because other things like epidural injections and physical therapy have not worked.
1) Can a minimally invasive micro disectomy be done just to fix disc protrusion etc without removing or drilling through the lamina?
2)Are there any other procedures where there is no drilling through lamina or bone removal from the spine.
Thanks.
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Follow up: Dr. Erion Spaho 0 minute later
I have sciatica with pain in my right buttock, ham string and calf. There is no lower back pain. Recent MRI showed at L4 L5 there is a new small broad central protrusion. Also there is moderate to severe bilateral facet hypertrophy resulting in moderate central canal stenosis at L4 L5. I am considering a minimally invasive micro disectomy because other things like epidural injections and physical therapy have not worked.
1) Can a minimally invasive micro disectomy be done just to fix disc protrusion etc without removing or drilling through the lamina?
2)Are there any other procedures where there is no drilling through lamina or bone removal from the spine.
Thanks.
doctor
Answered by Dr. Erion Spaho 2 hours later
Brief Answer:
During microdiscectomy no significant bone is removed.

Detailed Answer:
Hello again and thanks for asking me directly.

I have read your questions and here is my advice.

1- Minimally invasive microdiscectomy removes the disc, (herniated or protruded) without the need for significant bony removal of the lamina or the other bone parts of the column. It does not affect the stability of the column.

2- The techniques that aim to remove the herniated or protruded intervertebral disc are the ones that need no drilling, only small bone parts may be necessary to be removed for correct exposure. All other procedures ( laminotomy, laminectomy, foraminotomy, etc., include removal of bone parts from the vertebrae.

The amount and the extension of bone removal are guided by the extension of the stenosis and the need for sufficient exposure and decompression during surgery.

Hope you found the answer helpful.

Let me know if I can assist you further.


Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Erion Spaho 0 minute later
Brief Answer:
During microdiscectomy no significant bone is removed.

Detailed Answer:
Hello again and thanks for asking me directly.

I have read your questions and here is my advice.

1- Minimally invasive microdiscectomy removes the disc, (herniated or protruded) without the need for significant bony removal of the lamina or the other bone parts of the column. It does not affect the stability of the column.

2- The techniques that aim to remove the herniated or protruded intervertebral disc are the ones that need no drilling, only small bone parts may be necessary to be removed for correct exposure. All other procedures ( laminotomy, laminectomy, foraminotomy, etc., include removal of bone parts from the vertebrae.

The amount and the extension of bone removal are guided by the extension of the stenosis and the need for sufficient exposure and decompression during surgery.

Hope you found the answer helpful.

Let me know if I can assist you further.


Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Erion Spaho 2 hours later
Thank you for your detailed answer.

I just found out that there is a laser technique called PLDD that can be done with local anesthesia for sciatica.

1) What are your thoughts about PLDD.

2)Is it done under local anesthesia ?

3)What is the downside risk of PLDD ? What is the realistic worst case scenario?

Thanks.
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Follow up: Dr. Erion Spaho 0 minute later
Thank you for your detailed answer.

I just found out that there is a laser technique called PLDD that can be done with local anesthesia for sciatica.

1) What are your thoughts about PLDD.

2)Is it done under local anesthesia ?

3)What is the downside risk of PLDD ? What is the realistic worst case scenario?

Thanks.
doctor
Answered by Dr. Erion Spaho 21 hours later
Brief Answer:
Your questions answered below.

Detailed Answer:
Welcome back.

I have gone through your new questions and here is my explanation:

1- I think that PLDD is worth to be tried in carefully selected patients since it requires no general anesthesia. There are several small studies that support its use, but lacks a large serious study about PLDD efficacy compared with microdiscectomy.

2- yes, it is done under local anesthesia, mainly in an outpatient setting and under imaging guidance.

3- the risks include discitis, neural structures damage, increased numbness and are found to be rare.
Other points to consider are the need for surgery, radiation, possible recurrence, new site back pain.

Discitis is a rare possible complication after PLDD that is considered worst case scenario.

Hope this helps.

Feel free to discuss with me if you have any other questions.


Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Erion Spaho 0 minute later
Brief Answer:
Your questions answered below.

Detailed Answer:
Welcome back.

I have gone through your new questions and here is my explanation:

1- I think that PLDD is worth to be tried in carefully selected patients since it requires no general anesthesia. There are several small studies that support its use, but lacks a large serious study about PLDD efficacy compared with microdiscectomy.

2- yes, it is done under local anesthesia, mainly in an outpatient setting and under imaging guidance.

3- the risks include discitis, neural structures damage, increased numbness and are found to be rare.
Other points to consider are the need for surgery, radiation, possible recurrence, new site back pain.

Discitis is a rare possible complication after PLDD that is considered worst case scenario.

Hope this helps.

Feel free to discuss with me if you have any other questions.


Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Erion Spaho 20 hours later
I had stenosis all along but the pain came after the small broad central disc protrusion at L4 L5.
1) Does a MRI show where the disc is touching the nerve?
2) Does small broad central disc protrusion tend to heal over time? How much time?
3) My pain is managed ok by lidocaine and voltaren gel in less than half the allowed dosage. In your opinion, should I go for surgery ?
Thanks.
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Follow up: Dr. Erion Spaho 0 minute later
I had stenosis all along but the pain came after the small broad central disc protrusion at L4 L5.
1) Does a MRI show where the disc is touching the nerve?
2) Does small broad central disc protrusion tend to heal over time? How much time?
3) My pain is managed ok by lidocaine and voltaren gel in less than half the allowed dosage. In your opinion, should I go for surgery ?
Thanks.
doctor
Answered by Dr. Erion Spaho 6 hours later
Brief Answer:
Your questions answered below.

Detailed Answer:
Hello again and thanks for being on follow up.

About your new questions:

1- yes, MRI gives detailed information for anatomical relations and in the case of herniated disc it shows the point of contact with the nerve.

2- a protruding disc is very likely to be symptoms free after a couple of months in general.

3- since your pain is managed easily and there are no neurological deficits, surgery is not indicated.

Surgery is reserved only in cases of worsening of symptoms, any neurological deficit, or failure of conservative treatment after few months.

So, in your case, my opinion is- no surgery as of now.

Hope I helped you.

Greetings.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Erion Spaho 0 minute later
Brief Answer:
Your questions answered below.

Detailed Answer:
Hello again and thanks for being on follow up.

About your new questions:

1- yes, MRI gives detailed information for anatomical relations and in the case of herniated disc it shows the point of contact with the nerve.

2- a protruding disc is very likely to be symptoms free after a couple of months in general.

3- since your pain is managed easily and there are no neurological deficits, surgery is not indicated.

Surgery is reserved only in cases of worsening of symptoms, any neurological deficit, or failure of conservative treatment after few months.

So, in your case, my opinion is- no surgery as of now.

Hope I helped you.

Greetings.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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