Bone Fragment on S-1 Nerve Root

50 year old female.  12/27/04 L5-S1 laminectomy  for degenerative disk disease and herniation.  Pre-op pain left- sided sciatica. Post-op: hidious right-sided sciatica, 10 times worse than left.  Pain starts in lower right back, both buttocks, right thigh, calf, outer side of foot and 3 toes.  Lots of pressure in the back, cannot sit, stand or walk for any length of time without increasing pain levels.  Had to quit job of 19 years in pathology (administrative, not technical).  EMG/NC in May diagnosed abnormal elecrodiagnostic studies consistent with a right S-1 radiculopathy.  A lumbar myelogram this past week revealed: L4-5: bulge with broad based far right lateral herniation abuts and deviates the exiting right L4 nerve root sleeve.  Facet and ligamentous overgrowth centrally without significant stenosis.  L5-S1: "soft tissue in the ventral epidural space surrounding the descending S1 nerve root sleeves.  In addition, on the right there is an elongated high density focus seen just lateral to and slightly effacing the descending right S1 nerve root sleeve.  It appears to represent a small fragment of bone and may be irritating the descending right S1 nerve root sleeve.  Additional note is made of a cyst at the S2 nerve root level, which does fill with contrast in a delayed fashion, measuring 1.1 x 1.1 cm". Can the bone fragment be easily removed and what would the name of the procedure be (I would like to educate myself before returning to the spine neurosurgeon on 11/4/05).  Is it possible for the S1 nerve to regrow after 10 months of being irritated?  

Thank you!!

[CCF-Neuro-M.D.-PW]

Unfortunately one of the potential effects of having disc surgery is a retained disc or bone fragement which seems to be the case in the report. I cannot be sure if the L4 root compression is causing symptoms based on your note (would cause pain medial leg and foot, weakness of knee flexion, decreased knee jerk). The S1 root does seem to be causing probably most of your symptoms, and with a retained fragment usually necessitates further surgery. The cyst is probably incidental and does not need to be removed. THere is no special name for the procedure of removing a fragemnt apart from teh surgical approach ie anterior/posterior laminectomy etc. The nerve if irritated only should recover and does not need to 'regrow'
Good luck

[Tatertot3]

Opps!  Appointment with neurosurgeon is 11/1, not 11/4.

Thanks - Tatertot

[Tatertot3]

My appointment has been rescheduled for 11/2.  Neurosurgeon on call at hospital - called in for two emergencies today.  

Thank you - TaterTot3

[orazio]

Hi,
In '98 I suffered a blown disc at the L5/S1 level which resulted in Cauda Equina Syndrome.  My L5/S1 nerve roots did not recover, but from the data that I have read and the docs that I have talked to, nerve roots and the nerves themselves may recover after a period of 6 months to a year.  It's kinda like a wait and see.

[Tatertot3]

Doctor:  Thank you for your quick response and, of course, this formum.  It's such a wonderful resouce for all.

Neuosurgureon believes the myelogram bone fragment finding is really calcification. He reviewed a pre-surgery MRI and indicated it revealed a "small dot" off the S2 cyst and believes that is what the radiologist is seeing on the myelo.

Yes, I do have the L4 symptoms of pain medial thighs and foot.  No problems with the knees though.

Neurosurgeon does not recommend surgery. He did recommend two local physicans that I may want to try for a second opinion, which I will.  Neurosurgeon considers them the "BEST" when it comes to spine neurosurgery.  

Thanks again for sharing your expertise with us layman!!

TaterTot 3

  

[Tatertot3]

Thank you Orazio for your comments as well!