OpenHealth Q&A

Seeking Orthopedic Insight for Complex Condition

Subject: Male, 31 years old, height 5'7", weight 220 lbs. For the past year, I have been dealing with persistent pain across my back, legs, feet, and knees, stemming from October 2022. My medical history includes two significant surgeries: - On September 14, 2023, I underwent a planned left microdiscectomy at the L4/L5 vertebrae along with an L4/L5 laminectomy. - On October 26, 2023, I’m scheduled for revision surgery involving posterior spinal decompression at the same levels. Prior to the initial procedure in September, I lost my capacity to walk but retained normal bowel functionality. Despite multiple treatments, including injections, ablations, and the installation of a spinal cord stimulator, none have provided relief. Currently, my symptoms include: - Increased pain persisting for two days, where it usually eases overnight. - Discomfort localized in the lower back, left knee, and left foot, alongside intermittent tingling sensations in my inner thighs and extending to the lower buttocks and upper hamstrings. The findings of my latest MRI report are summarized as follows: **Findings:** - The lumbar spine consists of five non-rib-bearing vertebrae, with the last functional disc believed to be L5-S1. Alignment, height, and signal intensity of the vertebral bodies are normal, showing no signs of acute fracture or lesions threatening the bone or spinal cord. **Disc Level Evaluations:** - **L1-L2:** No significant stenosis or foraminal narrowing detected. - **L2-L3:** Mild dehydration of the disc, but no notable stenosis or narrowing. - **L3-L4:** Mild dehydration of the disc with a moderate-sized right foraminal/extraforaminal protrusion, associated with a disc annular fissure. This has led to mild to moderate foraminal narrowing affecting the exiting right L3 nerve, but there is no significant stenosis. - **L4-L5:** Previously noted posterior decompression is evident, including laminotomy/partial laminectomy on the right side. A diffuse disc bulge is noted, along with worsening central/right paracentral extrusion and severe narrowing of the bilateral subarticular recess, causing compression of both descending L5 nerves. Mild to moderate thecal sac stenosis is also present, along with minimal foraminal narrowing. - **L5-S1:** Minor disc bulge with mild bilateral facet hypertrophy. No significant stenosis or narrowing in the subarticular recess, but mild foraminal narrowing is noted, with contact affecting both exiting S1 nerves. The surrounding paraspinal soft tissues appear normal. **Impression:** 1. At L4-L5, there's worsening of the previously identified diffuse disc bulge along with significant subarticular recess narrowing impacting the bilateral descending L5 nerves, with mild to moderate thecal sac stenosis. 2. L3-L4 shows moderate foraminal protrusion with potential impact on the exiting right L3 nerve due to mild to moderate foraminal narrowing. 3. There is evidence of dehydration across multiple lumbar discs and minimal degenerative changes. 4. No acute osseous abnormalities are detected. I am reaching out for guidance on how to proceed. Could this latest episode be a severe flare-up, or might it indicate a deeper issue?

Answers (1)

2/18/2026, 1:20:50 AM

OpenHealth AI

It sounds like you’re facing significant challenges with your back pain and the ongoing complications following your surgeries. Your recent MRI findings suggest some ongoing issues at multiple levels of your lumbar spine, particularly at L4-L5, where there is notable compression affecting the nerves. This can definitely contribute to the pains, tingling, and discomfort you are experiencing across your back and legs.

Understanding Your Situation

The symptoms you're describing, especially the increased pain that has persisted for two days, along with a history of surgeries and ongoing discomfort, could indeed relate to a flare-up possibly caused by inflammation or irritation of the nerves due to the changes observed in your MRI. The fact that your pain usually eases overnight suggests that it may be related to your activity during the day.

Next Steps

Here are some prioritized actions you can take to manage your symptoms in the immediate future:

1. Pain Management:

   • Consider utilizing over-the-counter pain relievers such as ibuprofen or acetaminophen, as advised by your doctor. This can help reduce inflammation and ease your discomfort.
   • If you haven’t already discussed this with your healthcare provider, exploring prescription pain management options may also be worthwhile.

2. Activity Modification:

   • Engage in gentle, low-impact activities that do not exacerbate your pain, such as walking or swimming. Avoid any movements or positions that trigger discomfort.
   • Limit prolonged sitting or standing; when sitting, use ergonomic furniture and take regular breaks to stretch and change positions.

3. Heat and Ice Therapy:

   • Applying a heat pack can help relax tight muscles and relieve discomfort; 20-30 minutes at a time is usually effective.
   • Conversely, ice can help reduce inflammation and pain if applied to the affected areas for short intervals.

4. Physical Therapy:

   • If you aren’t already seeing a physical therapist, consider starting a tailored rehabilitation program. This can focus on core strengthening and flexibility, which might help alleviate some load off your spine.

5. Monitor Symptoms:

   • Keep a detailed record of your pain levels, activities, and any changes in symptoms. This will not only help you track what worsens or alleviates your pain but also be valuable information for your doctors.

6. Communication with Your Surgeon:

   • If your symptoms remain severe or worsen, it’s critical to communicate this to your orthopedic surgeon before your scheduled surgery. They may want to evaluate your symptoms further or adjust your treatment plan based on how you are managing.

Conclusion

While it might be easy to feel overwhelmed given the history of surgeries and persistent pain, taking these proactive steps may help you better manage the current situation. It's vital to approach your care with a focus on gradual improvement while maintaining open communication with your healthcare team. Let me know if you have further questions or need additional clarification on any aspect!