[Donald Corenman, MD, DC]

#6623

Motor weakness for the L5 nerve would be gluteus medius, peroneal, extensor hallicus longus (EHL) and tibialis anterior weakness. EHL weakness is not that important as it is not a very important muscle except in certain unusual occupations.

The major weakness of L5 that would affect day to day life would be weakness of tibialis anterior. This causes foot drop; the inability to keep the foot up on heel strike during gait. This is tested simply by walking on your heels while keeping the feet up off the ground. If you cannot keep the ball of the foot from touching the ground while doing this test, there is weakness.

S1 weakness would affect the gastroc-soleus group (calf muscles) and the hamstrings. Testing this is simply by toe walking. If while walking on your toes, the heel on the affected side drops (it doesn’t have to touch the ground), there is weakness.

In either case, this is an indication of the need for decompression sooner than later.

Cauda equina syndrome is another matter entirely. This is caused by a massive herniation that compresses the entire canal and causes bowel and bladder dysfunction. This is an urgent matter but by the description of your herniation, you do not have this syndrome.

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.

[malikfida]

#6725

Sir,
continue with prevoius comments, sir i have consult orthopaedic spine
surgeon upon examination and investigation he arrived at conclusions
that there is spinal instability in lumbar region in lateral radiograph in flexion and
extension there is upward and downward movement of L5 L5 vertebrae,
now he put me on lumbar built for three months and certain lower back
exersices, moreover the surgeon says if this therapy fails then we have to
go for surgery in order to fix the spine by rods and screws. sir plz let me know
about ur valuable suggestions? thanks alot.

[Donald Corenman, MD, DC]

#6729

If you need a lumbar fusion (the rods and screws) this would be for three potential problems; back pain as the major pain complaint, a third disc herniation at the same level or instability. By your description, you pain appears to be more buttock and leg located than back pain. If this is true, we can rule the first reason for fusion out.

You report this is your second disc herniation at this level (at least second surgery), so we can rule the third disc herniation reason for fusion out.

The last reason for fusion is instability. Instability can cause disc herniations to occur. The flexion/extension views are valuable to determine this problem. If the vertebra move 3mm or more on flexion vs. extension, instability is present and a fusion may be warranted. The exception is for a preexisting isthmic spondylolisthesis (IS). Even without instability, a disc herniation in the presence of IS requires a fusion.

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.

[malikfida]

#6736

SIR,
lastly and finaly could u examine my MRI and radiographic images? how is it possible?
moreover sir is it possible that i may talk with you on phone? because i will be highly satisfied and this will aid in developing absolute diagnosis.
wish u all the best.
THANKS

[Donald Corenman, MD, DC]

#6738

You could ship copies of your images to my office. These would have to be copies as I do not ship them back. You can call my office at (970) 476-1100 and ask for my nurses to gain shipping instructions.

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.

[malikfida]

#7265

Hey Doctor,
Sir previous history is of mine, I have a query regarding my L5S1 disc second herniation
I have consulted the neurosurgeon and orthopaedic spine surgeon they both differs in their opinion the neurosurgeon advised resurgery disc excision while the spinal orthopaedic concluded lumbar spine instability thats why he suggest dissectomy along with lumbar fusion, My query is what your opinion regarding my case.
Regards

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