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  • nikolaus
    Member
    Post count: 11

    Damn, my heart aches as much as the back. Terrible thing we can go to the moon but can’t fix ones back. Usually people write long messages, I will try mine to be short.

    33 years old, thin body, sports all my life. I have a big left para-central disc herniation at L4L5 and a small left para-central bulge at L5S1. No motor weakness, no neurological signs. Pain on left leg and to lower back. To cut a long story short, last set of physical therapy was a complete disaster. Within a weekend my body responded with severe antalgic scoliosis. I could not walk at all for 3 months. No pain killers would help. Now I am 7 months with antalgic scoliosis but the pain has subsided a lot. However, my spine is out of position.

    I am asking for your help because doctors seem to disagree.

    I do not have any muscular weakness nor any neurological damage although I was in a lot of pain for approx 3 months. So doctors keep saying it is my choice whether to go for an operation or not.

    My questions are the following:

    Can generally antalgic scoliosis because of disc herniation become permanent if operation is delayed? Can it cause damage to the neck?

    Two of my discs are black (L4L5 and L5S1). Will microdiskectomy lead inevitably to instability and need for fusion later on? Since I am 34, what are my **real** chances that the microdiskectomy will become a permanent life time solution?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    I can’t fix heartaches but I can fix backaches!

    Your pain apparently caused an antalgic scoliosis. This is an unconscious maneuver to relieve the pressure on the nerve root by leaning to one side or the other. Interesting enough, this scoliosis can last quite a long time even if the disc herniation is surgically removed. Many patients will align back to normal after the surgery but a small percentage maintain the curve for 3-6 months.

    You report no neurological signs but I think that the physical examination was not complete. With the significant pain you demonstrated, I have no doubts that there were signs of root compromise that were not documented.

    A microdiscectomy will not cause significant increased degenerative changes if the surgery is performed for significant leg pain. The disc has already torn through and through and some of the nucleus has extruded out. The surgery only removes the protruding portion of the disc and any loose fragments within the disc space through the present hole in the disc.

    If you have leg pain that interferes with your life and have failed conservative care, a microdiscectomy needs to be considered. You have a 90-95% chance of being happy with your choice.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    nikolaus
    Member
    Post count: 11

    Thank you very much for your fast response. Your help values a lot to me.

    As far as I can understand, the antalgic scoliosis thus cannot become permanent. Some claimed that the brain may get used to sending incorrect signals to the body and the scoliosis become permanent even after surgery.

    Maybe I wrote something wrong though. I am not sure I used the medical term correctly. I do have neurological pain (positive lasek, in fact during the 3 months I couldn’t raise my left leg more than 5 degrees,even the slightest movement caused huge pain). By writing “I do not have neurological signs” I was expressing that I do not have weakness or absence of reflexes. I guess that’s a mistake so I wanted to fix this.

    You write: “If you have leg pain that interferes with your life and have failed conservative care, a microdiscectomy needs to be considered. “

    Well, the “conservative care” is what brought the scoliosis into my life, so I wish I could say that conservative care was a success to me :( I have tried mckenzie, pilates, swimming, physical therapy, strengthening exercises, all before of this mess. nothing stopped the progress of this condition ..:(

    Anyway, I’d like to ask something else. Again, thank you once again for spending time to answer my messages. So…

    Would persistent (chronic = almost 8 months) antalgic scoliosis (but NO huge leg pain anymore) be a good reason enough for microdiscectomy?

    I mean, I did have a LOT of leg pain. But either I am healing or the nerve has adapted to the pain because I do not feel a lot of leg pain anymore. I feel dull spread burning pain in my lower back which scares the shit out of me because according to what I read in the net I may not be a good candidate for microdiscectomy. I think this pain is caused by inflamation near the injured area.

    Also, will microdiscectomy (if it is successful) stop the inflamation in the lower back? It is possible? Or that burning feeling and sensitivity in the lower back will stay for life?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    Continued antalgic scoliosis by itself with not much in the way of symptoms would not be an indication for surgery in my opinion. There is a caveat however. Practice holding yourself in a normal balanced posture in a mirror and learn to hold this position. Correct yourself whenever you find yourself out of balanced posture. If you develop more leg pain with this new correct posture, you would be a candidate for surgery as the antalgic position was protecting your nerve root.

    Dull burning pain in your central lower back may not originate from a disc herniation. However, if the nerve is still irritable and the pain is not central but off to the side somewhat, this might still be nerve root pain. A selective nerve root block that temporarily relieves this pain might indicate that a microdiscectomy may help relieve your symptoms.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    nikolaus
    Member
    Post count: 11

    K,

    Thank you very much.

    Your answers were clear and helpful.

    brandon8
    Member
    Post count: 2

    Hi Dr Corenman,

    About a year and half ago I tweaked my back by lifting a light box and tossing it to my left. I had severe back spasms which eventually went away. I was ok but still noticed a tilt that resulted from this injury. I would do stretches to try to straighten it out but tilt never went away. I’m tilted to right, left hip higher. I started feeling really tight pull from my left QL muscle and decided to see a sports therapist to help with my tilt and tight QL. He told me my tilt was due to muscle imbalance and he attempted to re-lengthen my quads, hamstrings, and psoas. It was pretty painful.

    I was seeing the sports therapist for about a month then one day I came home after walking and felt a really bad sharp pain down my left buttock and now feel it on my left calf and shin. I couldn’t take two steps without feeling sharp intense pain on my left buttocks. I was referred to a chiropractor, he took x rays and determined that I have a herniated L5 disc. He advised me to get treatment 5 times a week, pain has subsided a bit, I would say about 45% better. He performs manually decompression. I can now walk around without my crutches but cannot walk too far because my left buttocks and calf will have nerve pain.

    Do you think this is progress? Or is my body naturally trying to heal? Pain is felt on my calf and top of my foot now, is this a phase of progression? My chiropractor informed me that I have a antalgic tilt from nerve being compressed. Other than getting pain free and resolving my disc issue, will my tilt straighten out without surgery? I’ve had this tilt for about 18 months now.

    Please let me know your thoughts. I’m considering surgery depending on now I feel in the next 30 days and if I know for certain that surgery is the only way I can correct the antalgic tilt.

    Thank you in advance,

    Brandon

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