Q. In Febuary, I had a percutaneous disectomy on L-5. I had lost the feeling in my left leg and foot. Three weeks after my surgery I got great relief from the pain and all the feeling back in my leg and foot. Now, I am having the same pain as before. My leg and foot has started going numb again. My doctor did another MRI and it showed a broad based bulge at L-5 with an annular tear. My doctor says this is normal for the MRI to show this when actually it is scarred tissue. I'm not so sure I agree with him this time. The pain is there and it is real. My questions is: Is it normal for this to happen after surgery and is a tear in the annulus serious?

A. The discs are shock absorbers between the vertebrae, and their normal anatomy provides space between adjacent vertebrae so that nerves can exit from the spinal canal and reach their destinations. Disc problems can occur due to aging or trauma, in which a break or tear occurs in the tough outer layer of the disc (the annulus) and allows the softer inner material (nucleus pulposis) to protrude. This protrusion causes physical pressure of the disc on the exiting nerve, and pain can be felt along the entire course of the nerve.

Standard initial treatment for a known or suspected disc problem is to reduce activity, at least avoiding activities that put undue stress on the spine, medication to reduce inflammation and pain, and sometimes directed treatment such as physical therapy. About 80% of such cases show significant improvement over 3 months. In those that fail to improve, further studies are usually needed such as you describe, the use of CT or MRI or nerve studies to get a better picture of the anatomy involved. This can then lead to more specific intervention such as epidural steroid injection, heat-based techniques to shrink the abnormal tissue, or surgery to remove the damaged area of the disc. Finding the correct treatment for an individual is often difficult, and pain management is critical throughout the course of treatment. In your case, the surgery was done as you were experiencing loss of function due to pressure on the nerve, that could have become permanent if not treated.

The MRI can indeed be difficult to read and interpret after surgery due to inflammation and scarring. And the healing process after surgery can well take 6-12 months including careful rehabilitation efforts. I'm sure your doctor will carefully follow your progress during this time!

HELPFUL WEBSITES:

http://www.nlm.nih.gov/medlineplus/backpain.html

http://www.americanspine.com/index.html

http://orthoinfo.aaos.org/brochure/thr_report.cfm?Thread_ID=10&topcategory=Spine

MEDICAL ARTICLES (AVAILABLE THROUGH YOUR LOCAL HOSPITAL LIBRARY):

When You Have a Herniated Disc. American Family Physician. 59(3): 587-588. February 1, 1999.

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