[Donald Corenman, MD, DC]

#34974

Generally, after 2 years, you are about as complete in healing as mother nature allows. Your irritable numbness in your foot is probably irreversible but can still change over time. It does not seem like you have CRPS which can rarely occur in poorly healed radiculopathy.

If you had axonotomesis, the residual symptoms do match what would be expected. The upper portion of the root healed but the lower portion remains damaged and “numb”. You could still try an epidural injection around the root to see if there still could be some help with an anti-inflammatory.

See: https://neckandback.com/conditions/complex-regional-pain-syndrome-crps-reflex-sympathetic-dystrophy-rsd-causalgia/

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]

#34984

Donald Corenman, MD, DC wrote:

The upper portion of the root healed but the lower portion remains damaged and “numb”.

1) Then what is more likely to have happened does the compression impcat * time destroyed parts (or “wires” if we take the telephone cable analogy) of the L5 NR so that only the remaining “alive” parts of the nerve did regenerate hence the remaining residual symptoms or the problem is that the afferent nerve endings in the foot have atrophied so they cannot guide the nerve parts (wires) to regenerate into them?

2)”Functional” recovery will be the ability to put pressure (weight * distance) on my right foot balls (plantar flexion) without causing pain aggravation does a Radiofrequency Ablation (RFA) to the foot balls area can completely numb those damaged nerves?

3) Agmatine sulfate. there are some studies (including for NASS) suggesting it might help “alleviating pain and improving quality of life in lumbar disc-associated radiculopathy” have you heard of it? do you think it might help in conjunction with 300mg of pregabalin?

Three months prior to the surgery I did a TFESI SNRB with Betamethasone mixed with Lidocain It did little to no help. I really doubt if it will make a an impact but I’ll give it a try.

Thank you Dr. Corenman
I really hope something will help eventually

[Donald Corenman, MD, DC]

#34986

The reason the foot is numb is that the majority of S1 end sensory receptors are located in the foot. If you examine the leg very carefully, you might find a “line” of numbness down to the foot. RFA to the foot makes no sense as the injury is in the lumbar spine. Killing sensory roots in the foot will not change the numbness pattern. It’s like phantom leg syndrome after an amputation. The foot may be painful but does not exist.
Agmatine sulfate is a supplement, an amino acid. I’m not sure it can help but shouldn’t be a problem to take. Alpha Lipoic Acid is a supplement sometimes mentioned for nerve healing. I can’t hurt to take it in moderation.

Please keep in touch.

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]

#35283

Dr. Corenman

2.5 Years post-op there is a good steady slow improvement on my right foot sensation. Now I know that all the top of my foot was also numb only half of it remains partially numb. I also know that it is the same kind of numbness as in the balls of foot area which I always complain about but you don’t feel it because you don’t walk/press on this area.
I still have problem with sitting on straight chair mechanical pressure sets in shortly after followed by discogenic pain after 1-2 hours. I still cannot put pressure on the balls of my foot, stand and walk freely on them, numbness (which doesn’t bother me) becomes pain that still remains THE major issue as it restricts me from doing physical sports and hiking as I used to do.

two weeks ago I did an MRI the results on L5-S1 were: No demonstration of abnormal contrast medium enhancement after gadolinium injection. a right disc herniation pressing on the sac, pushing the root of S1 in the canal space on the right as well as on the root of L5 out the right foramen. The roots on the left are free. facets are preserved.
Well if there is pressure when lying on the MRI bed it probably increases by several folds when you stand up (I don’t have back pain when standing) and obviously when you sit down.

If I opt to fusion (MIS TLIF) (after a successful surgery, recovery and PT):

1) will I’ll be able to sit more time freely without any mechanical pressure causing discogenic pain? i.e does “no motion no pain” principle applies mainly to vertical disc motion (instead of shock absorption in a normal healthy disc)?

2) From a nerve recovery perspective is there any medical logic of fully decompressing the nerves 3.5 years after the initial damage or to much time has passed and will have no effect on the L5 nerve root damage?

3) Other then stiffness what “new” pain fusion may bring after successfull recovery (6-12 months)?

Thank You

[Donald Corenman, MD, DC]

#35285

You are now 2.5 years out from a microdiscectomy of L5-S1 right with a “new” recurrent disc herniation “right disc herniation pressing on the sac, pushing the root of S1 in the canal space on the right as well as on the root of L5 out the right foramen”. This disc herniation is also compressing the right L5 root in the foramen. You still note symptoms of S1 (and maybe L5) nerve compression or dysfunction.

You also note discogenic pain “I still have problem with sitting on straight chair mechanical pressure sets in shortly after followed by discogenic pain after 1-2 hours” but you do not differentiate this pain from possible radiculopathic pain (nerve pain that appears to be unilateral lower back pain). Is your back pain central (both sided) or only unilateral?

You then have questions.
1. “will I’ll be able to sit more time freely without any mechanical pressure causing discogenic pain? i.e does “no motion no pain” principle applies mainly to vertical disc motion (instead of shock absorption in a normal healthy disc)?”. If you are having discogenic lower back pain and that pain is limited to the L5-S1 level, a fusion (TLIF, ALIF or OLIF) should reduce substantially your lower back and leg pain (as long as a decompression is performed with your fusion). However, if your unilateral lower back pain is nerve and not disc generated, a simple decompression without fusion can be considered.

2) “From a nerve recovery perspective is there any medical logic of fully decompressing the nerves 3.5 years after the initial damage or to much time has passed and will have no effect on the L5 nerve root damage?” Yes. I have found that there can be improvement even years later decompressing a nerve root.

3) “Other then stiffness what “new” pain fusion may bring after successfull recovery (6-12 months)”? In general, fusion makes the back better but not perfect. If the surgery is not performed correctly or the fusion does not fully fuse, continued pain can occur.

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]

#35286

You are now 2.5 years out from a microdiscectomy of L5-S1 right with a “new” recurrent disc herniation “right disc herniation pressing on the sac, pushing the root of S1 in the canal space on the right as well as on the root of L5 out the right foramen”. This disc herniation is also compressing the right L5 root in the foramen. You still note symptoms of S1 (and maybe L5) nerve compression or dysfunction.

You also note discogenic pain “I still have problem with sitting on straight chair mechanical pressure sets in shortly after followed by discogenic pain after 1-2 hours” but you do not differentiate this pain from possible radiculopathic pain (nerve pain that appears to be unilateral lower back pain). Is your back pain central (both sided) or only unilateral?

You then have questions.
1. “will I’ll be able to sit more time freely without any mechanical pressure causing discogenic pain? i.e does “no motion no pain” principle applies mainly to vertical disc motion (instead of shock absorption in a normal healthy disc)?”. If you are having discogenic lower back pain and that pain is limited to the L5-S1 level, a fusion (TLIF, ALIF or OLIF) should reduce substantially your lower back and leg pain (as long as a decompression is performed with your fusion). However, if your unilateral lower back pain is nerve and not disc generated, a simple decompression without fusion can be considered.

2) “From a nerve recovery perspective is there any medical logic of fully decompressing the nerves 3.5 years after the initial damage or to much time has passed and will have no effect on the L5 nerve root damage?” Yes. I have found that there can be improvement even years later decompressing a nerve root.

3) “Other then stiffness what “new” pain fusion may bring after successfull recovery (6-12 months)”? In general, fusion makes the back better but not perfect. If the surgery is not performed correctly or the fusion does not fully fuse, continued pain can occur.

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.

[Author]

Posts