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  • sol1234
    Participant
    Post count: 8

    Hello Dr. Corenman – Thank you so much for this service. 32 y/o Male. Herniated discs at l4/l5 and l5/s1. Very active typically. The former being the culprit here, the second less severe. It’s been re-agitating a couple times a year for the past 2-3 years. Symptoms – chronic lower back pain that I function with but takes away from my physical activities immensely. I have some sciatic pain in my hips and buttocks, and a few weeks ago had tingling in feet and then testicles (which has now subsided – at first was afraid of cuada equina syndrome, but no other symptoms for that). Sciatic pain is not nearly as painful as lower back pain, and seldom goes all down my leg.

    Met with my neurosurgeon yesterday, and he won’t recommend a path of treatment, but said he would perform a microdiscectomy if that’s the path I wanted to go. I prodded him “what would he do?” and he wouldn’t play ball. While it would take care of the sciatica symptoms, he believes the lower back pain would still be there (though said there’s a chance it could improve). My concern is potential cuada equina, or permanent nerve damage if I don’t get the surgery done. Also, winter is slower for me and I could afford to be recovering work-wise in these months.

    I’ve been having these symptoms for 3 years now, just confirmed the herniations / DDD / moderate to severe spinal stenosis a month ago.

    Microdiscectomy scheduled for a few weeks from now, but I’m having big second doubts if it won’t address the back pain. Any advice? At the end of the day don’t I need to get that disc fragment removed? So it stops pushing on my nerves and spinal cord?

    MRI picture of herniation: https://i.imgur.com/68usOJvl.jpg

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    I would agree with your neurosurgeon regarding the potential for symptom relief. Microdiscectomies work well for nerve pain relief (buttocks and leg pain from nerve root compression) but don’t work as well for lower back pain (LBP). This does not mean they are totally ineffective for relief of back pain but the results are much less consistent regarding LBP. If you don’t have motor weakness and the symptoms are tolerable, you could continue to manage your disc disorder without surgery. If you find the buttocks and leg symptoms not tolerable, consider the decompression surgery. There is, in addition, a 50-60% chance of some back pain relief.

    Dr. Corenman

    sol1234
    Participant
    Post count: 8

    Dr. Corenman, thank you for the reply. The information is incredibly valuable. Sorry to follow up again, but the decision is made a little harder just based on these flare-ups happening a couple times a year, and lasting about two months. With limited knowledge you have on my case, and the MRI image, do you think there is a significant chance I’m contributing to permanent nerve damage by having the disc compressing the nerve roots so much? Since this is clearly not something that is going to go away on its own, would you think it’s possible to live a life with that much compression, or is it something that is likely going to have to be removed in the future? Thank you again, as I’m sure you know in the patients you see that back issues cause tremendous worry; you are doing all of us a great service.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    I can’t open the images as this site does not support unknown hyperlinks.

    If you do not have muscle strength deficit due to nerve root compression, there is no rush to surgery. There are some studies indicating that successful surgery in your position has better results if symptoms have been present less than six months prior to surgery but in reality, there is probably no pressing issue for surgery.The question in your case for surgery or not is really how impaired you feel with these episodes lasting 1/3 of the year (“flare-ups happening a couple times a year, and lasting about two months”). Also, if the diagnosis is correct (something that needs a work-up hopefully performed correctly) and whether the surgery is appropriate for the disorder you have.

    Dr. Corenman

    sol1234
    Participant
    Post count: 8

    I’ll try one more time to attach the image below:

    null And the direct link from a reputable host source: http://silvercometawa.org/mri.jpg

    If that doesn’t work, thank you again, you’ve been more than helpful! Have a great day!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    The images come through however the sagittal (side view) image shows a good-sized herniation but the axial images (bottom-up) are of a normal level below the herniation.

    Dr. Corenman

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