[Andrea_Mih]

#32073

Hi Dr. Corenman,

Firstly, thank you so much for this forum and your website. The world is lucky to have people like you who are willing to spend their time and share their expertise with others.

I’m hoping to get your feedback on microdiscectomy surgery. I have a large L4-5 disk herniation and have had varying degrees of sciatic pain since August 2019.

On October 1st 2019, around the time my symptoms began to worsen, I had a lumbar spine MRI. The exact wording on the report is:

“Large right para-central disk herniation compressing the proximal right L5 nerve root against the adjacent facet and causing posterior displacement of the right-sided nerve roots. The epidural canal is capacious. The conus is anatomic. Neural foamina are patent throughout. There is no spinal or lateral recess stenosis.”

As stated above, my sciatic pain over the last 6 months has ranged from severe (I went to the emergency room after a coughing fit in January 2020, couldn’t sleep for more than an hour or 2 at a time in October and November) to moderate (I am now walking about 40 minutes at a brisk pace, albeit with a slight limp and am able to sleep an average of about 4 hours at a time).

My back does not hurt. All of my pain is in my right leg, mostly my right buttock and sometimes in my calf and thigh. For about a month now I have had pins and needles in my right foot when sitting or walking too long and I have lost some sensation in the big toe on my right foot. My reflexes are normal and an EMG that I had done in December 2019 showed no significant nerve damage. I can now raise my leg to about 45 degrees during a straight leg test in the seated position (I was at 5 degrees at the end of October). I can sit on a chair for up to 20 minutes. Although there are many times when I can’t manage for more than 5.

One aspect of my condition that has not improved one iota since October is lying down. I can’t do it at all, not even for 5 minutes. The minute I lie down in bed I feel a sharp pain in my right buttock. The pain increases in intensity the longer I stay laying down and it eventually becomes unbearable. And so, for the last 5 months, I’ve been sleeping on a recliner.

I have been told that I am a candidate for a microdiscectomy but I am reluctant to proceed with the surgery as my pain, for the most part, is moderate. However, I am deeply troubled by the fact that I cannot lay down in a bed to sleep.

I’m an otherwise healthy and active 35 y/o female and desperately want to get back to my life pre-herniation. What are your thoughts on having surgery in the absence of severe leg pain when standing/walking/sitting but excruciating pain when laying down?

Thank you,
Andrea

[Donald Corenman, MD, DC]

#32076

You have a large HNP compressing the L5 root. You apparently have not had a microdiscectomy and are trying to use time to allow hopeful resolution of your symptoms You note; “I am now walking about 40 minutes at a brisk pace, albeit with a slight limp and am able to sleep an average of about 4 hours at a time”.

Some things you mention concern me. At six months out, you are not able to sleep more than four hours. In addition, you have a “limp”. I worry that you have foot drop due to compression of the L5 nerve root (you can’t walk on your heel on the right side without the foot slapping on the ground).

You also have acute pain when you lie down (“One aspect of my condition that has not improved one iota since October is lying down. I can’t do it at all, not even for 5 minutes. The minute I lie down in bed I feel a sharp pain in my right buttocK”).

I think you need surgery now (and probably did so 6 months ago). You first need a new MRI to make sure the fragment has not migrated and to have a “map” for the surgeon to know where to go to get to this fragment. There is a slight possibility that the fragment has migrated out of the canal or shrunken down to a very small size.

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.

[Andrea_Mih]

#32221

Hi Dr. Corenman,

Thank you for your response.

I’ve arranged to have the surgery on May 1st, the earliest available date.

That said, my symptoms since I last wrote to you have improved. I do not have any tingling or numbness in my leg anymore and my gait is normal. My glute still aches if I sit or sometimes if I walk for too long, but I can now do both for longer without symptoms. I even see an improvement lying down. Although admittedly not enough of one to allow me to sleep comfortably yet. I can lie down on my left side for several hours. But again, not without that ache in my butt… Lying flat on my back and on my right side is still a definite no.

Given the recent improvement of my symptoms I’m wondering if it’s still a good idea to proceed with the surgery.

My herniation is about 12mm in size, is postponing the surgery playing with fire? Is there a real risk that if I don’t have surgery in May I will damage the nerve permanently?

Also, with respect to the risk of re-hernaition after surgery, (my doc says it’s around 10%), am I just as likely to re-herniate if I don’t have the surgery?

I should mention that I don’t feel the need to take any pain medication, to give you an idea of my pain level…

Thank you,
Andrea

[Donald Corenman, MD, DC]

#32229

I think a new MRI is necessary if you want to consider surgery. However, if your strength is improved and you note no deficit with activity (including sports activity if you want to be back to “normal”), then you don’t need surgery.

The risk of recurrent herniation is about 10-20%.

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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