[Ha66is]

#4634

I write in desperation, as my dear wife is I what seems like unforgiving, unrelenting pain with specialist ‘availability’ here in Sydney seeming like unfathomable weeks away.

My wife has endured 7 days of right buttock/ thigh and whole leg pain and outer foot numbness/ tingling; an ambulance assisted hospital visit and, what seems like, unending pain relief and anti-inflammatory treatment. She is a strong woman Dr. and the pain that she is in is unimaginable for me.

Yesterday (15th June) she had a MRI and resultant radiologist report diagnosing: –

• Lumbar Vertebral Alignment is normal
• The lumbar cord is normal
• No Mass is seen in the central lumbar canal

At the L5-S1 level there is a sizeable right paracentral focal disc protrusion/ extrusion extending for approximately 7mm posteriorly from the vertebral body margin. This causes significant indentation of the central right S1 nerve root. The left S1 nerve root is normal as are the l5 nerve roots.

At l4-5 level there is generalized mild disc bulge, this causes mild canal stenosis and mild bilateral lateral recess narrowing at the upper L5level. The L4 roots are normal.

At levels higher up, disc hydration is satisfactory with no canal or foraminal stenosis apparent.

She continues in significant pain and having some very general practitioner advice to take it easy and see of it improves with a surgical opinion being needed if necessary in weeks. As it happens, and as previously stated, and specialist we have phoned will take weeks to see her.

We are naturally, although perhaps unreasonably, apprehensive of surgery although she is at a stage where ‘ a gun’ has been requested; one assumes in jest but one never knows ☺

I/ we are desperate for answers/prognosis, as waiting the weeks without foreseeable improvement seems like a significantly inequitable thing to have to do.

Would you be kind enough to offer advice?

May thanks in advance and best regards.

[Donald Corenman, MD, DC]

#4635

Your wife by your account has a significant but typical disc herniation of L5-S1 right that is compressing the right S1 root. (See web site for lumbar herniated disc information). This can create excruciating pain as you and your wife are unfortunately well aware of.

If there is no weakness of the muscles, then this condition can be treated with medication, injections and therapy. If these treatments are ineffective or the patient is in extremis (severe pain and cannot obtain relief in any position) then surgery is required. Do not be apprehensive regarding surgery. 90- 95% of the time, the patient awakens without leg pain and breathes a sigh of relief.

The one important issue for immediate treatment in my book is whether she has weakness of the gastroc/soleus group of muscles (the calf muscles). The easy way to test these muscles is to have your wife tip toe for about 10-15 feet. It will be painful but have her try to do this action and ignore the pain for a very small instant. Watch her heels as she tip toes. The calf muscles hold the heels off the ground when tip toeing. If she cannot hold the affected heel off the ground on the painful side no matter how hard she tries, she may have weakness of this group of muscles.

Surgeons may differ on this but most of us feel that weakness of a major motor group is cause for surgery sooner than later as the motor nerve has the best chance for recovery with timely decompression surgery.

I understand the national health insurance issues in Australia make timely visits to a physician sometimes difficult, so try to contact a surgeon and have a conversation as soon as possible. If your wife has weakness, try and push up the timing of this visit.

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.

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