[Donald Corenman, MD, DC]

#34331

“There is still pain when walking with flipflops or non-cusioned shoe/clog.” I assume this is lower back pain and not buttocks, leg pain. If you have continued unilateral leg pain, do you have foraminal collapse or lateral recess stenosis? That is, do you still have mechanical compression of a nerve root?

If you have lower back pain, can I assume the disc above is healthy?

TLIFs work generally well for bony compression or discal back pain. You should lose only minimal range of motion (if any at all). See:

https://neckandback.com/conditions/isolated-disc-resorption-lumbar-spine-idr/
https://neckandback.com/conditions/foraminal-collapse-lumbar-spine/
https://neckandback.com/conditions/lateral-recess-stenosis/

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]

#34435

No, the pain is in the foot itself when I’m with my  thong flipflops it’s usually starts after 5-10 minutes of walking between the 1st and 2nd finger and going in strait line all over the dorsum of foot. I think it’s getting better with timw but it’s a very slow and unstable process.

I don’t have forminal collapse and I can’t tell if my forminal stenosis is lateral recessed or far lateral but from the symptoms you suggested it looks like far lateral (at the exit)

I do think there is still mechanical pressure on the nerve root when sitting in certain posture for certain amount of time I start to get “electric signals” and pain in my foot. my guess is that it shrinks the foramen just enough (probably matter of millimetres) to start “choking” the nerve.

My IDR is in bad shape. It got worsen since my discectomy & laminectomy op.
I often get those inflammatory cascades which feels like a burning sensation in the exact spot of the surgery. pain also occurs when I’m bending down several times without any support or not sitting straight 90° (e.g riding a bicycle) It’s burning and painful and as you described can take hours even with NSAIDs to subside that’s why I use a strong back brace even though I’ve strengthen my core a lot.

My L4-L5 is has also started to degenerate on rough assumption It’s 70-80% intact compared to the 20-30% of my L5-S1 where under 50% you’ll start to get DDD symptoms.

I don’t understand, there isn’t any ROM loss compared to the degenerative state my disc is (not compared to a healthy disc) or there is some sort of compensation made the body/physical therapy in time?
Is that also true for two level lumbar fusion usually L4-L5-S1?
then what’s the point of ADR(s) surgery  apart from the much quicker recovery time?

Thank You Dr. Corenman

[Donald Corenman, MD, DC]

#34436

By your description of foot pain with standing or walking (assuming you have no intrinsic foot condition), you do have mechanical entrapment of the root at the L5-S1 level. Since the disc is 70-80% collapsed, you have lost significant foraminal space as the disc height makes up at least 50% of the foraminal height. Degenerative discs also form osteophytes (bone spurs) which further narrow the exit hole. You have lost some ROM due to the collapsed disc but since there is so much functional ROM in the lower back, you probably did not notice.

Two level fusion will increase the loss of ROM but you might not have to include L4-5 if your symptoms are generated exclusively from L5-S1. Nonetheless, L4-5 can become symptomatic in the future so you have to factor in that in 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.

[rypz79]

#34544

Dr. Corenman

I’ve pin pointed the paraesthesia & walking problem I have limited force to exert on my metatarsal area before pain arrives and start to get stronger.
The more I can spread my feet on the ground the more I can walk (there is no pain walking barefoot in the house though I “feel” the the incorrect signals coming from it) I wish It just “simlpe” numbness and not accumulated pain.

One more question before I see the surgeon If the concurrent MRI scan will see ANY impingement still pressuring the L5 nerve root is there still a possibility that it can heal more (less pain & paresthesia) if it will be totally decompressed with fusion, or that more than 20 months pre-op there is no chance that this kind of nerve damage will get any better?

Thank You Dr. Corenman

[rypz79]

#34705

Dr. Corenman

The current situation is that I do have overall improvement in the feeling of the foot but symptoms remain in the L5 dermatome distribution at the dorsum & balls of the foot are very sensitive and carry wrong pulses of pain, numbness and a heat sensation while the foot is to much time in a closed shoe.
This impacts my my ability to wear certain shoes, to run or to hike freely/for distance and to put pressure on my foot while squatting or bending on my toes.

I’m still considering a fusion surgery to completely decompress the nerve.
A neurosurgeon I consulted with told me that low back fusion surgeries are not intended for this purpose but mainly for a  spine instability or deformaty that cause strong back pain and/or movement problems. He said that I might lose more then I will gain from doing a MIS TLIF.
The truth is I also cannot seat freely and when my back bends at certain angle (which should be normal) I start to pressure growing causing pain on leg so I immediately need to straight up back to L/90° posture or stand up to relive the pressure and then sit back again.

From your own experience and medical studies you know and based on the idea that the nerve is not fully “free” i.e. there is still a forminal stenosis and some mechanical pressure at certain postures can a fusion surgery affect Radiculopathy/paresthesia symptoms (almost two years after discectomy & laminectomy) and help fix the sitting problems (probably will transfer the pressure to L4-5 which is relatively OK)?

Thank You
Happy New Year

[rypz79]

#34972

Dr. Corenman

25 months post surgery though I really started doing PT including inversion table 3-4 months or so after the surgery due to the covid19 outbreak.

There has been oveall improvement.
I think the nerve recovered from L5 root down to the foot. I now can sit with my right leg on the left one or lye (put pressure) on my right sciatic nerve without it aggravating my foot paresthesia.

The problem still remains in the foot I can feel somthing is going out there (burning, tingling, stabing pain) but still wearing a tight close shoe or putting pressure on my foot balls is painf and unpleasant. the process didn’t reach all the afferent nerve endings.

Based on the fact that we don’t know exactly what damage have been caused to my L5 NR during those 9-10 months of compression and assuming that we are talking about axonotmesis with these symptomatic findings over this period of recovery time my questions are:

1) From the known medical literature can sensorial (afferent) nerve get atrophied / become scar tissue? I mean can I feel numbness instead of pain or in other words the path to recovery is pain becoming numbness and maybe afterwards correct sensation signals?

2) Does lumbar radiculopathy (sciatica) that causes ONLY foot paresthesia classified as axonotmesis with recovery time greater than 24 months will ALWAYS end with some kind of neurological deficits?

Thank You

[Author]

Posts