[Donald Corenman, MD, DC]

#32583

“A question about nerve budding. does exercise encourages this process? i.e the more you try to activate those dormant muscle cells the more chance they can bud with a nearby active cell”? Yes.

“If we are talking about some axonal damage with the myelin sheath still intact does the distance (from l5) plays a role in this situation”? I would assume distance on the sensory side also matters logically but I have never seen a paper on this subject.

You could have a tarsal tunnel syndrome along with the prior radiculopathy. It would be unusual but nonetheless, a possibility. See https://neckandback.com/conditions/tarsal-tunnel-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.

[rypz79]

#32603

Hello Dr. Corenman,

I’ve checked all the symptoms and compared the affected dermatome areas it’s very unlikely that we are talking about TTS.

The only thing that botheres me in this situation apart from the discomfort of numbness and pain is the idea that it will persist.

“A decompression surgery of the nerve (microdiscectomy of the lumbar spine or lateral recess decompression) will generally take the pressure off the nerve and in 90-95% of the cases the nerve will recover”

is very encouraging.

The question is how do you define recovery:
is it full, partial or just an imporvement from the the pre-op status?

Do “low grade” symptoms are the thoughest to heal or just the opposite it means that the nerve is much intact and very likely to fully heal?

Does numbness differs from pain in terms of nerve damage and repair?
Is this pain called neuropathic or somatosensoric pain?

And last question is the “time table” for this kind of nerve repair is up to 12 months in which diminishing negative symptoms is the only indication for it’s progression?

Thank you very much Dr. Corenman

[rypz79]

#32719

Hello Dr. Corenman,

4.5 months post-op I think things are starting to improve a bit. I can walk almost without pain for some distance but there could be a flare-up here and there it’s not normal 100%.

My primary physician (not the surgeon) sent me to do an EMG+NCT test and as you predicted in your article for these situations the answer was negative “there is no indication for foot neuropathy or right lumabar radiculopathy”.

The problem I’m facing now is that I still cannot put much pressure on the sole of the foot barefoot toe-tips even without weights start causing me pain and numbness in the area of contact with the floor.

I need/want to strengthen my quads the muscles around the knee and the gastrocnemius muscles should I persist with the pressure going through the neuropathic pain (there is no other way to work these muscles) or wait with it and stop at any signal of pain?

Thank you very much Dr. Corenman

[rypz79]

#32812

Hello Dr. Corenman,

I’m now ~6 Months post-op , still got loss of sensation (I can best describe it as touching something with a burned blistered skin) in the area of the balls of the foot which alternates with stabing pain & soreness in the same area.

The dorsum of the foot also feels somewhat numb (though it’s sensitive to touch heat/cold)
IDK but I think the two are connected though the latter doesn’t bother me at all.

Now what has happened is I started to feel my lowerback sometimes it feels stiff and sometimes it feels like burning and itching in the area of the surgery. I cannot sit prolonged times or with my right leg over the left one or lie free on my right side. I think It’s flaring the nerve. That’s so exhausting and irritating mentally and physically to have to deal with postures and time to get up to sit down. 1 year ago I sat or lied down how I wanted when I wanted.

Bought an inversion table to further decompress my spine and I’m also carefully dead-lifting 45lbs it’s really the best way to strengthen those lower back muscles.

3 Q’s in your permission:

1) Does strengthening those lower back muscles will help me sit prolonged times without having back pain? if so how do I know when they are strong enough?

2) Does inversion/traction therphy helps (maybe indirectly) in the nerve regeneration process by increasing the intervertebral space i.e the more room it has the more it can heal?

3) Is the prognosis of Axonotmesis “usually good in terms of recovery. Rate of recovery depends on the distance from the site of injury, and axonal regeneration can go up to 1 inch per month. Complete recovery can take anywhere from 6 months to a year” is valid in my case also? I still got to go six more months (at most) to complete the recovery process?

Thank you so much Dr. Corenman

[Donald Corenman, MD, DC]

#32813

Normally, there is some “numb” regions that might not fully resolve with root decompression. Typically, the numb patches shrink in size over time. Painful sensation (called allodynia) is the result of not only poor nerve root recovery but damage to the nerve root itself.

You then note; “Now what has happened is I started to feel my lowerback sometimes it feels stiff and sometimes it feels like burning and itching in the area of the surgery. I cannot sit prolonged times or with my right leg over the left one or lie free on my right side”. Disc discomfort is not uncommon after a herniated disc occurring about 10% of the time. You need a good physical therapy program and possibly a course of oral steroid or injection (ESI).

Your questions:

1) “Does strengthening those lower back muscles will help me sit prolonged times without having back pain? if so how do I know when they are strong enough”? Strengthening the core and stretching the hamstrings are the keys to recovery. You are strong enough when the pain abates.

2) “Does inversion/traction therphy helps (maybe indirectly) in the nerve regeneration process by increasing the intervertebral space i.e the more room it has the more it can heal”? Traction can be temporarily helpful but generally is ineffective in the long term.

3) Is the prognosis of Axonotmesis “usually good in terms of recovery. Rate of recovery depends on the distance from the site of injury, and axonal regeneration can go up to 1 inch per month. Complete recovery can take anywhere from 6 months to a year” is valid in my case also? I still got to go six more months (at most) to complete the recovery process”? The problem here is this is an academic argument as it is impossible to tell what type of injury has occurred. You can tell after the fact by the timing of recovery.

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.

[Donald Corenman, MD, DC]

#32814

Normally, there is some “numb” regions that might not fully resolve with root decompression. Typically, the numb patches shrink in size over time. Painful sensation (called allodynia) is the result of not only poor nerve root recovery but damage to the nerve root itself.

You then note; “Now what has happened is I started to feel my lowerback sometimes it feels stiff and sometimes it feels like burning and itching in the area of the surgery. I cannot sit prolonged times or with my right leg over the left one or lie free on my right side”. Disc discomfort is not uncommon after a herniated disc occurring about 10% of the time. You need a good physical therapy program and possibly a course of oral steroid or injection (ESI).

Your questions:

1) “Does strengthening those lower back muscles will help me sit prolonged times without having back pain? if so how do I know when they are strong enough”? Strengthening the core and stretching the hamstrings are the keys to recovery. You are strong enough when the pain abates.

2) “Does inversion/traction therphy helps (maybe indirectly) in the nerve regeneration process by increasing the intervertebral space i.e the more room it has the more it can heal”? Traction can be temporarily helpful but generally is ineffective in the long term.

3) Is the prognosis of Axonotmesis “usually good in terms of recovery. Rate of recovery depends on the distance from the site of injury, and axonal regeneration can go up to 1 inch per month. Complete recovery can take anywhere from 6 months to a year” is valid in my case also? I still got to go six more months (at most) to complete the recovery process”? The problem here is this is an academic argument as it is impossible to tell what type of injury has occurred. You can tell after the fact by the timing of recovery.

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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