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My name is***** am an Orthopaedic Surgeon and I may be able to help answer your questions about the spinal surgery your sister had.
May I ask how old your sister is?
How long before the surgery, did your sister have symptoms for?
Did she have pain going down the leg? Did she have any numbness/weakness in the foot and ankle?
Did the symptoms get better at all after surgery?
I will also ask further questions as we go along on this chat if that is OK.
Thank you for that information and Thanks for attaching the MRI scan sagittal view. I understand your concern about the disc protrusion seen at L5-S1 level. There could be a number of reasons for this post op:
1. MRI changes take a long time to resolve. While the disc fragment that was in the canal could have been removed with a micro discectomy, the change may not be apparent on the MRI scan for a long time, sometimes upto a year.
2. It would have helped to see the axial cut of MRI to see where exactly the disc protrusion is and how it is pressing on the nerve.
The Microdiscectomy is primarily done for leg pain (radiculopathy) rather than back pain. The disc itself is degenerated as seen on this scan (reduced disc space and darker on MRI) this would mean that some back pain remaining or worsening after surgery may be expected, however the sharp pain radiating down the leg is expected to resolve after surgery.
3. The retrieval of disc fragment may be incomplete. Or the removal is complete, but there may be a recurrence of disc protrusion after surgery.
The question to ask the surgeon then is:
1. Is he repeating the same surgery that is already done, ie just removing some more softened disc material? OR,
2. Is he fusing the disc space between L5 and S1 after further decompressing the canal?
And the choice of surgery would depend on the exact symptoms your sister is experiencing and clinic findings on examination.
Does she experience more leg pain or more back pain currently?
May I suggest that the best way forward would be, to speak to the current surgeon explaining your anxiety about having the second operation and asking him questions until you are satisfied you have the right answers. Spinal surgeries are complex and there is always a risk (however small) that things may turn out completely as expected.
If there are trust issues, then the next best step would be to get a second opinion in person asking your GP to refer you to another local spine surgeon.
In the meantime, symptoms would need managing with anti-inflammatory medications, local hot water fomentation, and physiotherapy (this really helps when done right)
That does sound like she is in a lot of pain and I am really sorry to hear that.
Fusion surgery is never the first choice in a simple disc prolapse surgery. Fusion at one level, puts an extra strain on the next level above, with chances of that level undergoing more wear and tear (degeneration). However fusion is sometimes necessary to relieve symptoms and when done right, it works wonders.