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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes a leg pain, even after a lumbar decompression surgery?

Answered by
Dr. Ishu Bishnoi

Neurologist, Surgical

Practicing since :2007

Answered : 830 Questions

Posted on Mon, 11 Jun 2018 in Brain and Spine
Question: I have had a discectomy followed by laminectomy withun 1 week of each other. To then end up with an ALIF procedure. My question is now looks like an infection although labs, biopsy cultures plus inefectious disease doctors believe not an infection. What else could it be from? that makes images mimick infection
Answered by Dr. Ishu Bishnoi 24 minutes later
Brief Answer:
Need more information

Detailed Answer:
Hi xxxxx4491, thanks for asking from HCM.

I can understand your concern. I read your question and got the information that

- You have undergone procedures disectomy and laminectomy and ALIF.
- You are still having some complaints about MRI appearance of your spine which looks like an infection.

Your history is incomplete. I need more information to guide you further

- AT what level procedures were done?

- What are your present complaints?

- Can you please post your current MRI images, so that I can examine them?

- Is there any fever, pus discharge from wound site?

Hope you will understand my point. If you have any doubt, do let me know.
Thanks. Take care
Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Ishu Bishnoi 27 minutes later
L5-S1 where it was. I am a MRI tech and have put off surgery long as I could. Pain was horrific from time I woke up recovery from Discectomy. The pain was unlike any before bc never ended. It was sharp, stabbing, burning, numb all into one, at times it would bring me to my knees. After explaining that to dr. an MRI was done bc this was not just post op pain. There were residual bone fragmnets left from when he broke the disc space from first procedure. A very long story short after I felt something still was not completely right bc pain starting to come back and now RT groin area felt weak, strained. I was able to get another scan and bones look to be like an infection, discitis? or even to me a type of fracture on Sag stir images from what I was taught. I have since had biopsy and NOTHING has grown. I have had 2 pic lines placed but have had reaction both times. Never had any sign of infection period. Even after all this infectious disease group drs do not feel this is infection but my surgeon just seems to think it is ONLY from images appearance only. Even during ALIF he did more samples for cultures. NOTHING.. I am trying to upload all my images may take a minute. My question is I am asking you to step away from osteomyelitis or infection. Consider what else this could be from or give this appearance bc I am done with antibiotics and need another suggestion.

Thank you
Answered by Dr. Ishu Bishnoi 19 hours later
Brief Answer:
possible causes and need images

Detailed Answer:
Hi xxxxxx4491, welcome back.

Thank you very much for providing me the detailed description of your complaints.
I was waiting for your images. If possible please upload, so that I can have a look.

You have been severe pain even after getting decompressive surgery done. As infection, discitis have been ruled out, there might be chance of

- Compression still present at same level or another level

- The implant exerting pressure on exiting or traversing nerve roots

- Failed back syndrome due to severe inflammation of dura/arachnoid and its adhesions with surrounding tissue. It is called "arachnoiditis". It is one of the most common cause of failed back syndrome.

My suggestion is

- Kindly get NCCT lumbar spine also. Correlate your bone and spinal canal with MRI findings. If bony alignment or graft is not proper, you must consult the treating doctor.

- Nerve conduction velocity and EMG will help you in confirming it as a case of neurological damage.

- If there is extreme pain on stretching back (mostly on flexion) and you feel a current like sensations travelling from operative area till feet, it could be arachnoiditis. Check it also.

Please let me know after all this. Meanwhile send me the images.
If you have any doubt, do let me know.
Thanks. Take care

Above answer was peer-reviewed by : Dr. Vaishalee Punj
Follow up: Dr. Ishu Bishnoi 2 hours later
The ALIF has helped tremendously. It's just that he still feels it's infection although everything is negative. That's why I was wanting another alternative besides infection.

Another question. What's your normal post op period?? I truly feel and believe from first surgery discectomy til 1 wk later laminectomy
The fracture was there then
Answered by Dr. Ishu Bishnoi 23 hours later
Brief Answer:
Post operative stay time and other possibilities

Detailed Answer:
Hi Cxxxxxo4491, welcome back.

ALIF has helped you a lot. Are you having pain now? If yes, then look for the above mentioned causes.
If not and you are doing fine, why are you worried about MRI findings anyway? Because everything is negative in your case. You can wait for 3 months and repeat your MRI. If any reactive, non infective findings, it will disappear or decrease by this time.

I keep my patient for 10 days. It is done to teach them rehabilitation, take care of wound and spine stability. After discharge, I call them after 14 days, then 1 month till 6 months. I repeat CT spine (if fusion is done) or MRI spine (if laminectomy/disectomy/decompressive surgery) after 6 months to find out about spine.

Sorry for the delayed answer. I was busy in managing two emergency surgeries.
Hope it will help. If any doubt, do let me know.

Take care.
Above answer was peer-reviewed by : Dr. Yogesh D
Follow up: Dr. Ishu Bishnoi 41 minutes later
My dr is just determined its osteomyelitis and I feel it is not. I feel it collapsed or compression fracture that mimicked infection on my images. I just needs other alternatives that I could get him to explore
Answered by Dr. Ishu Bishnoi 14 minutes later
Brief Answer:
Other differential diagnosis

Detailed Answer:
Hi xxxxx001, welcome back.

The differential diagnosis of collapsed vertebrae -

- Osteoporosis due to vitamin D deficiency/calcium deficiency/long term medication use

- Compression facture due to chronic weight bearing

- pathological fracture due to hemangioma/bony tumor/secondaries

- chronic osteomyelitis due to tuberculosis or fungal

- Other autoimmune diseases like rheumatoid arthritis, Paget's disease.

Please discuss above mentioned differential diagnosis with your doctor. You have not uploaded images yet. If possible, upload it.
If any doubt, do let me know.

Thanks. Take care
Above answer was peer-reviewed by : Dr. Yogesh D
Follow up: Dr. Ishu Bishnoi 10 hours later
I am having problems uploading images to this. I have worked with it all day
Answered by Dr. Ishu Bishnoi 7 hours later
Brief Answer:
its okay

Detailed Answer:
Hi xxxxxxx4491, welcome back.

Its okay. You can contact HCM customer care and take help. They will cooperate with you. I will wait. Please let me know any updates or doubts.

Thanks. Take care.

Above answer was peer-reviewed by : Dr. Nagamani Ng

The User accepted the expert's answer

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