gazpachoMemberDecember 1, 2012 at 2:57 amPost count: 1
Dear Dr Corenman,
I noticed that there doesn’t seem to be a good prediction on whether motor weakness / numbness will disappear after surgery. I had a large disc herniation at L5/S1 surgically removed 10 days ago. Prior to surgery, I was unable to stand on the left toes for two weeks, and the outside of the left foot was numb for the same amount of time. Pain increased until the point where it was unbearable, until surgery was performed. After surgery, the radiating pain was immediately gone, whereas motor weakness / numbness remained. I was told to be patient and give the nerve “enough time” to recover.
The question is: is there a correlation between the length of time the motor nerves were “pinched off” and the time they take to recover? Is it all luck? Is there any kind of statistics that could give me hope?
Thanks in advance.Donald Corenman, MD, DCModeratorDecember 2, 2012 at 9:52 pmPost count: 8465
You have asked the “million dollar” question. There is really noting in the literature that can answer this question and I am now gathering statistics on this subject to come up with some answers.
Generally, in my opinion, surgery should be performed sooner than later in the presence of lower extremity motor weakness. There are no guidelines that are helpful. I have never stratified motor weakness patients into making some wait one week, some wait two weeks and some wait six weeks. I try to get all of them into surgery within ten days of diagnosis and even sooner.
Now in the study I am currently undertaking, there are patients who have initially seen me from three days to three months after onset of motor weakness so I do have some variation of presentation to time of surgery. Hopefully, I will be able to use this data to determine some type of findings regarding time of injury to time of surgery.
Dr. CorenmanLlimMemberJanuary 3, 2013 at 2:43 pmPost count: 1
Hi dr corenman,
My father resides over seas and has a slowly deteriorating weakness/ numbness in legs over the past 15 years, with his right leg being worse. His legs would be come number after short period of walking. In last 2 months, he had an episode of severe lower back pain after which his whole lower half of his body is now experiencing numbness even without moving. He has severe lumbar stenosis based on his MRI in L3-4-5 area. And moderate stenosis in L 2-3 area. He does have congenitally narrow spinal cord space to begin with. I have his MRI n X-rays taken 2 months prior together with your lumbar history form in soft copy and wanted to know if i can email them to you for surgery opinion. He is interested in x stop procedure combined with some other “minimally invasive procedure” which I’m not sure would be the right surgery for his case. He is also wondering if spinal cord stimulation implant can help with his lower leg numbness. He is currently waiting for me to get a few opinions on surgery options before he make the trip over for physical consultation and surgery in us. My concern is whether he has enough time to try out less invasive type surgery due to his current symptom escalation. I did speak with your medical assistant and am sending out cd copies of his MRI etc for your review. I’m just real worried about how delays will affect the ability of his nerves to recover. Thank you!Donald Corenman, MD, DCModeratorJanuary 4, 2013 at 2:08 amPost count: 8465
With severe lumbar stenosis, there is a danger of developing chronic radiculopathy or arachnoiditis (see website for those two conditions) but the risk is not very high. Depending upon the severity of the stenosis, the risk is somewhere between 10-20%. Time of continuing compression may lead to a higher risk of those two conditions but there has never been a study to demonstrate that time dependancy.
I do use the X-stop but that is never my first consideration as it does not open the spinal canal. The X-stop is reserved for very sick patients who cannot tolerate an anesthetic and need to be awake for the procedure.
Spinal cord stimulation is reserved for those patients who have chronic radiculopathy or arachnoiditis. Your father would only be a candidate for stimulation if he already underwent the surgical decompression and had continued symptoms which is unlikely.
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