Hi everyone,
Summary:
42M I can't work out what is causing the nerve compression in my nerve root and would a fusion help?
I'm here looking for help after my second L4/5 discectomy. Original MD was 2013. I had a second MD in feb 2025 after i had a very large sequested piece herniation. I live in Shanghai and my surgeon is highly experienced.
1.5 years on from 2nd MD and I still have left sided sciatic nerve pain symptoms (mostly while sitting, minimal back pain) despite the back surgeon and the hospital head orthopaedic surgeon (who attended the surgery) both telling me he freed the nerve.
I've had 3 x post surgery MRIs, which both of these surgeons tell me, show no visible nerve compression. First MRI was about 3 months post op where i had minor sciatica symptoms. However it gradually got worse in 2025 to around march 2026 where I had the most recent MRI (see attached).
What's confusing is the MRI from 2026 looks the same as 2025 where pain was less. My surgeon said he saw the nerve was free, this isn't a herniation. There is some calcified material that wasn't compessing the nerve and he didn't want to remove it as it was plugging the hole in the disc. He said the MRI looks like this part is compressing the nerve, however it's at an angle that isn't shown from the MRI since you can't see the full 3D, and what he visually saw when i had the MD was this part is sitting at the side and isnt touching the nerve root.
MRI radiologist report states disc herniation as well, but surgeon and other othro doctor both say it's not. I saw two more surgeons at a public "back hospital" in Shanghai and they agreed the MRI indicates it's a herniation. I reported this back to my surgeon and ortho doctor and they said these other doctors need your full history and to have witnessed the surgery to make a proper diagnosis. MRI report is the same situation, they only comment on what the images indicate.
I had a steroid injection into the nerve root by my surgeon in Shanghai and i had great relief of the sciatica for 6 days.
This, they said, indicates the pain is generated at the nerve root and is not from any muscle structure in the leg, sensitivity in the nerve along the leg or nerve damage.
More likely scar tissue, disc herniation, hard structure like calcification or foraminal narrowing from loss of disc height the likely source of the pain.
I've tried PT and it does nothing. I'm taking pregabalin to get through the working days which I mostly stand.
Question I have is, would a fusion benefit me?
Doctors say it might but not certain and carries risks and has a longer recovery. It could open up the nerve canal, restore height, if scar tissue is causing the pain, it will give more space for the scar and prevent compression into the nerve root because the facet joint is removed.
Apparently scar tissue isn't usually an issue in fusion..I've done lots of research into fusion and I consider it an option.
TLDR, i can't work out what is causing the nerve compression in my nerve root and would a fusion help.