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Dr. Andrew Rynne

Family Physician

Exp 50 years

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I have spinal stenosis at L4 L5. One year back,

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Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 11507 Questions

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Posted on Thu, 24 Jan 2019 in Bones, Muscles and Joints
Question: I have spinal stenosis at L4 L5. One year back, I developed sciatica in my right leg. MRI showed small broad central disc herniation at L4 L5. I have tried physical therapy with some improvement. I have taken 2 epidural steroid injections. I use lidocaine cream 5 percent on my right leg.I use about 5 mg per day total on my butt, hamstring and calf combined.
1) Can this daily use of 5 mg lidocaine 5 percent hurt me in some way?
2) I am looking at minimally invasive spine surgery. They will have 1 inch diameter incision in the back and then almost 1 inch through the lamina. Are there surgeons who can do smaller incisions through the back and lamina? Is that advisable?
3) Suppose I have surgery done and then couple of years later, I need surgery again at the same L4 L5 level. When they go through the lamina, will they use the previous incision in the lamina or create a new hole?
4)With time, will the body grow bone in the lamina hole to fill it partially or completely?
Thank you.
doctor
Answered by Dr. Praveen Tayal 7 hours later
Brief Answer:
You can go with the surgery.

Detailed Answer:
Hello,
Thanks for posting your query.
1) Daily use of lidocaine only locally on the skin will not hurt you in any way. It is a safe option. The medicine is minimally absorbed thru the skin thus almost no systemic effects.
2) A spine surgery through one inch hole is minimally invasive surgery. You can go ahead with it and get the nerve decompressed.
3) In case you need a repeat surgery then most of the times incision is made just next to the same area as the area of surgery is very small.
4) The body grows the bone again and heals the lamina gradually. No need to worry.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Wishing you good health.
Regards.
Dr. Praveen Tayal.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Praveen Tayal 2 hours later
Thank you for your pointwise reply.
1) Even though 1 inch hole is minimally invasive, are there doctors who use smaller hole say half inch or less? Is that advisable.
2) I understand that the hole in lamina can create spinal instability. Is it not better to use the same hole for repeat surgery? Wont two holes create risk of more spinal instability?
3) If 5 mg of lidocaine cream daily is enough for my pain relief, should i still have surgery or keep using lidocaine cream. I understand sciatican can resolve itself over time.
Thank you.
doctor
Answered by Dr. Praveen Tayal 11 hours later
Brief Answer:
Details below.

Detailed Answer:
Hello.
Thanks for writing again.
Smaller holes can be used for surgery but that decision depends on the degree of herniation, your body mass index and personal preferences of the surgeon. You can consult regarding this from your general physician who knows most of the doctors in your area.
A hole created in first surgery heals in 8-10mm weeks. During the second surgery sometimes it is difficult to recognize the previous area of hole. It depends on the type of surgery that might be needed in future.
If you feel symptomatically better after using the local ointment then you can avoid surgery for now and start with regular physiotherapy that can help in long term improvement of your problem.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal 1 hour later
Thanks for your reply.

Need clarification: you wrote hole heals in 8-10mm weeks.what does mm mean? Also when you say hole heals,does that mean bone regrows to reduce/eliminate size of hole.

Also you wrote hole size is affected by BMI. Higher BMI needs bigger hole? My BMI is 24.

Thanks.
doctor
Answered by Dr. Praveen Tayal 9 hours later
Brief Answer:
Bone heals in 8-10 weeks.

Detailed Answer:
Hello.
The hole heals in 8-10 weeks time. mm was a misprint. BMI does not affect the size of the hole but it affects the healing time and the surgical approach needed and micro invasive surgery may be difficult in obese individuals. It is best to start with a regular physiotherapy to have a long term relief from this problem.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal 11 hours later
When you say hole heals, does that mean bone regrows to fill the hole? Thanks.
doctor
Answered by Dr. Praveen Tayal 2 hours later
Brief Answer:
Yes the bone regrows.

Detailed Answer:
Yes. The bone regrows to fill the gap and the bone heals.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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