I read your articles about the above topic and have several questions.
1. Am I correct in understanding that in the case of an L5 herniation in the presence of chronic radiculopathy that it is unlikely that an L5 discetotomy will enable the nerve root at L5 to have a good outcome ? If so, is this because the constant irritation of that never itself damages it and merely shaving off some of the corresponding disk doesn’t do anything to prevent past damage.
2. Even after an L5 operation can one get calf muscle weakness and drop foot on both or either feet ?
In other words, a discrete compression due to lifting something too heavy does not necessarily call for an L5 discetotomy even in the presence of new muscle weakness and perhaps initial inability to dorsiflect from the ankle ?
I have always wondered about the relationship between ongoing nerve damage and decompressions.
Thanks for addressing my questions.
The L5 nerve root typically supplies the big toe elevator (EHL) and the foot elevator (tibias anterior-drop foot). This nerve does not service the gastric/soleus group (calf raises-tip toeing).
Chronic radiculopathy or irreversible nerve injury cannot be fully known in a short period of time. This is why decompression of the nerve in the early period is important. Even if the decompression is late, there is still a chance of symptom improvement (pain and paresthesias) even if the nerve is chronically injured. Surgery should be sooner than later if there is motor weakness present.