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  • bensonjacoba
    Member
    Post count: 1

    Hello Dr. Corenman,

    First off, thank you for taking the time to respond to all our queries.

    History:
    Since 2004, on & off, i have had back pains which was treated with Physiotherapy and traction.
    In 2006, my left leg fell numb all of a sudden after 2 days of excruciating pain. The doctor’s refused to conduct a surgery. I was on complete bed rest (23 hrs traction & 1 hour physiotherapy) for 29 days. My left leg became better and i was back to work after a month.

    Recent History:
    On Aug 8, 2012 I had radiating pain on the left leg going downwards. The next day, my left foot (ankle downwards) fell numb and loss of ability to push towards the body. I opted for traditional ayurvedic treatment. The pain went away, but the numbness and Foot drop remained. Its been 3 months, i have no pain (touchwood) but my foot is 50% numb, i am unable to rise the foot towards my body (i can lower it) and my toes dont have the strenght to push up.I have absolutely no pain or radiating pain on any part of my body, only minor strain at the back due to excessive lifting of my 3 year old son.

    MRI dated November 14, 2012
    – Normal Curvature & Alignment of Lumbo sacral spine
    – At L5-S1, there is reduced disc height and signal intensity on T2 suggestive of the desiccation accompanied by type II end plate degenaration. Its disc shows large and broad central subligamntous extension which is touching the theca and moderately pressing bilateral preforaminal S1 nerve roots.
    – Normal marrow signal od examined vertebrae
    – Vertebral bodies and appendages are normal
    – Facet joints appear normal
    – Normal appearence of Spinal cord,cauda equina and filum terminale
    – Spinal ligaments and para spinal soft tissue is normal

    Neurosurgeon’s Observation & Treatment Plan

    The doctors advised that due to the numbness on the feet for the past
    3 months without any healing a lumbar micro discectomy (on Nov 26) will be performed to chip out the herniated portion of the disc only, which will reduce the pressure on the nerve. Surgery is advised for avoiding permanent damage to the nerve which may further cause loss of bladder and bowel control. She also mentioned that they cannot guarantee the removal of the numbness & foot drop.

    After reading the above,
    a) Would you advise a MDisectomy
    b) If i choose not to go ahead with the surgery, will i lose the ability to withold my bladder/bowel movement
    c) Any other suggestions ?

    Thanks doc for your time.

    God bless.

    Cheers,
    Ben

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    In general, it is my opinion that with substantial motor weakness due to lumbar nerve root compression, a decompressive surgery needs to be performed. What concerns me is that after three months of presence of foot drop (weakness of the tibitalis anterior muscle), the chance of useful return of motor strength is questionable. Nonetheless, I would generally advise a decompression surgery (microdiscectomy or equivalent) to allow the best chance for return of motor function.

    There is no chance based upon your MRI findings that you will develop bowel and bladder function loss. The herniated disc or spur is “touching the theca” which simply means that the sack of nerves (thecal sac) is being “touched”- not compressed. It takes significant compression of the entire thecal sack to cause malfunction of your bowel and bladder.

    One concern is that the tibialis anterior muscle is normally controlled by the L5 nerve (and less commonly, the L4 nerve). The report notes the S1 nerve is compressed which would not cause foot drop but would cause calf weakness. This weakness would cause difficulty with push-off of the foot- not foot drop. The surgery that is planned is being performed to decompress your left S1 nerve root. Make sure the surgeon has this question worked out before you agree to surgery.

    Dr. Corenman

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