Viewing 6 posts - 1 through 6 (of 14 total)
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  • Jerome0374
    Member
    Post count: 2

    Dear Dr. Corenman.

    Ever since I got a herniated disc in my L5 S1 area, I’ve been getting these excruciating pain in my
    right leg. This usually happens whenever i try to do a 90 degree angle with my body (ex: bending over, sitting with my legs straight out). My doctor said it was the sciatic nerve that was pinched by the disc. This all happened due to kicking in karate. I don’t know if I should get surgery for it or go back to physical therapy. Going to physical therapy did help a lot, but the pain is still there that goes down my right leg and stop below my knee cap. Is this related to the herniated disc problem I have? Or it’s a different one?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8653

    The S1 nerve is compressed from the front with a disc hernation. The S1 nerve travels behind the pelvis and attaches to the foot. The nerve acts like a cable on a pulley (the pelvis). When you bend forward or you raise your leg up, you lengthen the nerve. This pulls the nerve into the herniation which causes increased leg pain.

    You probably feel better when you stand up or bend backwards. These two actions reduce the nerve stretch and therefore reduce the leg pain.

    Surgery is indicated for three reasons; bowel and bladder involvement (rare and you do not have this-called cauda equina syndrome), motor weakness (which is also somewhat rare and you don’t note weakness), and finally pain that you cannot tolerate.

    You fit into the third category. Then, timing of surgery is the question. In my practice, conservative measures are instituted for three months. These measures are therapy, medications, injections and activity modifications. If the patient has substantial improvement, then we continue on this path. If the patient has unacceptable improvement, then we tend to go to surgery.

    By the sounds of your current complaints, you have continued unacceptable pain that you call “excruciating” when you bend your back or leg. This sounds like a surgical situation. There was one study that indicated surgery prior to six months from onset of event has a better success rate than after the six month period.

    I have operated on many patients with pain from an HNP after this six month period with good results but there probably is some increased percentage of chronic radiculopathy (see website). Whether you want to undergo surgery is going to have to be your decision.

    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.
    Jerome0374
    Member
    Post count: 2

    Is there any chance that you might know of what type of surgery they will do? Will they fuse my spine together or take out some parts of the disc due to the leg pain?

    Thank You Dr. Corenman.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8653

    If you only need the nerve root decompressed, then a simple microdiscectomy is all that is required.

    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.
    Anglosaxon
    Member
    Post count: 6

    Dear Dr Coleman

    Thank you for setting up this website.

    I damaged my back (spasm QL) in Aug 13 and partially recovered via, painkillers and some chiropractor help. In early Sept 14 after going for a jog, my hamstring gave me some problems resulting in gradual severe pain from sitting down. After seeing a chiropractor and sports masseur and no relief, I was referred for an MRI and now have been diagnosed with a disc herniation and sequestered fragment that is impinging on S1 nerve.

    The fact 5 months have passed do you think I should go straight for a Disectomy? and not mess with conservative treatment and injections.

    Is there any possibility of recurrent of the disc herniation?
    What happens to those part of the disc when the soft tissue being removed would it regrow or remain as empty ?

    Will I recover in time to go skiing within 2 months?
    Thank you

    Donald Corenman, MD, DC
    Moderator
    Post count: 8653

    If you have a disc herniation without motor weakness, I would try the epidural steroid first. If you have motor weakness, I would go with the surgery.

    Recurrence of disc herniation is about 10% with or without surgery. The disc will not regrow and the space will remain empty. However, the disc will narrow to fill in the empty space like letting some air out of a car tire.

    An epidural injection might allow you to ski in two months. A surgery if performed today will also allow you to ski in 2 months.

    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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