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Post Laminectomy

had a laminectomy last year for severe spinal stenosis. I was still having pain and a clicking feeling in my lower back. The doc ordered a MRI which showed no stenosis but fluid around facet joints L5-S1. I received a facet block injection that gave me no relief and then an epidural injection and no relief. Just had a MRI this past Saturday which showed

Laminectomy changesL5-S1 more to right. Mild muscular atrophy and enhancement in the right para sacral muscles more than the left.
Facet Joints: Mild sclerotic arthropathy at L4-5 and L5-S1.
L4-5: mild signal loss and bulge. Mild stenosis.
L5-S1:Laminectomy changes more to right. Signal loss and bulge to the left. Mild left foraminal stenosis. I also have DDD. Why has the stenosis come back at different levels and what else can be done to help reduce pain
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Avatar universal
Thank you so much for the information.
Helpful - 0
7721494 tn?1431627964
The stenosis is caused by DDD.

There are many factors in where it will appear -- the location of the disc injuries and bulges or extruded disc material, weakness in the spinal ligaments that support the cord caused by your first decompression surgery, your individual spinal anatomy, etc.

Unfortunately, spine surgery sometimes leads to more spine surgery because the initial surgery sets off a "cascade of destabilization." This does not mean that you shouldn't have had that initial decompression surgery -- I imagine it helped reduce pressure on the lower nerve roots and prevented damage to other areas of the cord.

But rarely do I talk with someone who has had only one spinal surgery.

It is wise to delay surgery until all other conservative means of treatment have failed.

These days, many physicians will not prescribe opioid pain medications, and because this effective treatment option is removed, many people are left with the sole option of surgery. This is wrong.

Find a pain management physician who will treat your pain.

Also, find a pain management physician who will treat your facet syndrome. The facet joints are highly innervated and can cause pain all over the lower back. This is why for some, ablating the innervation to the diseased facets can relief a good percentage of low back pain.

Finally, you've got some muscle atrophy opposite your laminectomy site. This may be due to loss of motor function to these muscles as a result of the wrong nerve being severed during surgery. PT may help you regain control of these "para-spinal" muscles, so core strengthening work may help stabilize your spine and reduce pain.

It's worth a try, don't you think?

Find a good pain and spine doctor -- a board certified DABPM (diplomate from american board of pain management.)
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