CkellyMemberAugust 1, 2013 at 11:33 amPost count: 2
Hey Dr Corenman
Love the website its one of a kind
Here is my question for you i have 2 level ddd with large herniation’s L4 right side with only in the last month weakness in my quad/kneecap i can feel not as strong and pain at the tear drop and about the knee, is that the fermoral nerve ?
and L5 left side which happened 23 months ago and had me admitted for a week surgeon looked at mri and scans and didn’t warrant surgery as tho i had pain it died off and no foot drop but there was a clear lose of muscle size but i could still flex and take my body weight on that calf singular
now fast forward to present i worry about the new knee issue and sent my scans to a few neurosurgeons in mainland Europe (i am based in ireland) and all came back with 2 level adr using either the m6 L or cadisc L disc
so my question is at L5-s1 is the much degree of movement as my irish surgeon thinks along the lines of hybrid fuse that segement and adr above and also would i get more size back in the left calf after decompression ?as about 40% is still there in the inner section as the outer is still full size
also Dr Corenman during all of this i along with my brothers got diagnosed with myostatin which seems to have caused the spinal issues as all of us had ddd in one or more levelsDonald Corenman, MD, DCModeratorAugust 1, 2013 at 11:08 pmPost count: 8465
I alway find it useful to break the problems down into the respective parts and then determine what surgery could be helpful for each individual component.
Lumbar DDD or degenerative disc disease can cause lower back pain. I notice your complaints do not involve back pain but do involve leg pain and weakness. Do you have lower back pain as a significant component of your symptoms or only leg pain and weakness?
If no lower back pain and only leg symptoms are your complaint, then an artificial disc replacement (ADR) or fusion is probably not necessary (unless there is vertebral instability along with nerve compression in which case an ADR would be the wrong choice.
An L4 right sided disc herniation with quadriceps muscle weakness would have to mean that the herniation is in the far lateral position (outside the canal on the side of the spine) as this is the only place at this level that could compress the L4 nerve root. If the herniation is in the typical posterolateral position, this would compress the L5 nerve which does not supply the quadriceps and I would have to question the diagnosis. The femoral nerve (L2-L4) supplies the quadriceps muscle.
Let us assume for the time being that you have significant lower back pain as a part of your compliant and that you would be a candidate for ADR or fusion. You can read my opinion of lumbar ADRs on this website and you will see that I am not a fan of this procedure in the lower back. Could you have a hybrid procedure for this problem? The answer is yes. I do this all the time for the cervical spine and this would also apply to the lumbar spine.
I am unclear as to what the disorder “myostatin” is. Is this the muscle disorder that is obtained by taking statins for high cholesterol?
Return of muscle diameter after a nerve injury is not common. Why you would have calf atrophy is unusual as the calf muscle is an S1 nerve and your prior L5 nerve problem should not cause severe atrophy in the lower leg (it is connected to the tibialis anterior muscle in the lower leg which is a small muscle and atrophy will not cause a significant size difference).
There are many unanswered questions here.
Dr. CorenmanCkellyMemberAugust 4, 2013 at 7:42 amPost count: 2
Hey Dr. Corenman
You are correct i don’t really have any back pain just leg pain from the herniated discs which is like a lighting bolt some days and dull the ache the most of the time but my calfs is in spams and left inner caif is lost muscle size
but no foot drop cant still walk on tippy toes and take full weight of my body on that leg, but as soon as it hernated the L5-S1 disc 2 years ago that was instant the weakness calf but my irish surgeon didnt want to do anything and mri then and now didnt show other pain factors, they gave me a Nerve root block i block and it worked great bar cramp no to the left S1 nerve root and no pain till now as the Disc above a blown and causing spams in quads
But like i said recently i am getting quad and knee pain, tender to touch, and new mri of 2 weeks ago the german and english surgeons said 2 level adr, But i am thinking hybrid as correct me if i am wrong is there much movement of the L5-S1 disc ? or would fusing that cause Si joint issue further down the line ?
“myostatin” sorry its a rare genetic disorder which gives me muscle hypertrophy and all the males in my family have it as in brothers and the neurosurgeon thinks its a factor in our spinal problems as the muscles are alot stronger than the support structures can take ? curious what you think as it has left to tendon injuries also in the shoulders
And sorry to pick your brain but is there an natural supplement i can take to help my nerve injury ? and is there any chance of the S1 nerve root recovering or is it dead the connect i mean to the calf as parts of it still move just sections of it dont, but i have full use of the foot and leg just bar the deep cramp
and on the hybrid surgery would you do the fusion ALIF ? with the adr above or what is the best way ?
last comment dr as i know your busy but also when i feel my left calf i get like a shock is that neuroma ? as in its sensitive to touch ?
its a wee bit funny to look at as due to my disorder i am muscle bound so one skinny calf looks odd in shorts so just so i know with decompression now that wont get any better ? or will at least stop the string pulling like feeling i get in my leg from the herniation ?
And thanks in advance love your form and what your doing its a pity ireland is like 3rd world in medicine compared to germany and the usaDonald Corenman, MD, DCModeratorAugust 4, 2013 at 10:38 amPost count: 8465
Not being able to toe walk is an indication of gastroc/soleus weakness which is an S1 nerve injury. I have a policy of decompressing a lumbar nerve root that demonstrates weakness as soon as feasible as recovery is generally not good without a decompression. Other surgeons and maybe other country policies may be different.
A fusion (or ADR) is a procedure used for lower back pain and not for leg pain. Leg pain is generated by nerve root compression which generally does not require fusion or ADR.
See the section under “Nerve injuries and recovery” and then “Nerve damage and healing” to fully understand how nerves heal.
By “myostatin”, I assume you mean myostatin related muscle hypertrophy. This genetic disorder I have only a little experience with but this should not be related to your herniations or weakness.
If you have continued compression of your nerve, you need a decompression (microdiscectomy) and not a fusion or ADR.
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