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  • doug goldberg
    Participant
    Post count: 5

    Dr. Corenman thank you for the what has to be the best resource on the internet for neck and back issues.

    Im a 55 year old male, 200lbs, marathon runner. On 24 January I rolled out of bed to what felt like a giant cramp from the top of my left leg to my foot. I could barley walk or stand up. After several days I was able to limp around but had lots of left leg pain and tingling and numbness in my left foot. My Chiro diagnosed piriformis syndrome as the pain and soreness was worst in my left buttocks and hamstring. I also had a very, very sore left calf causing a pretty bad limp. On 2/15 I had an MRI of the low back which resulted in the following findings:

    At L5-S1, minor buldge with a small paracentral disk extrusion and early facet arthropathy are noted. The extruded disk material extends 5-6mm caudally, slightly displaces the descending left S1 nerve root posteriorly and results in mild asymmetric effacement of the left lateral recess. There is a 5-6mm caudal extension of disk material into the left lateral recess.

    I have been getting steadily better. The numbness and tingling has been gone for few weeks now. As of today I have no constant pain, my hamstring and left leg can be stretched fully without pain. I could not do that at first. Im able to walk without a limp now and I can cycle, swim and use the elliptical without pain. In fact I feel better after I do these exercises. I do have a weak left calf though as I cannot do single leg calf raises without assistance from my upper body. I dont seem to have much heel drop when toe walking. Im worried about my calf though. Do you think this will get better with time as well? Ive started an a regime of calf exercises in the hope of getting the strength back. What actions do you think I should take. Thank you so much for this board.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    You have had classic findings for a disc herniation compressing the S1 nerve. For a thorough discussion of this disorder, see “Nerve injuries and recovery” on the website.

    Pain, numbness and paresthesias (pins and needles) are all symptoms that can recover fully after a disc herniation without surgery. Motor weakness is another matter. It seems that the motor nerve is “tougher” than the sensory nerves (pain, proprioception, sensation) and takes more compression to make the motor nerve malfunction.

    Consequently, recovery is not assured without surgery. Even with surgery, motor strength return is not guaranteed but decompression surgery (microdiscectomy) does allow the motor nerve the best chance for recovery.

    No study has been published to my knowledge that indicates a “time period” before surgery will not be helpful but I assume that the more quickly the nerve is decompressed, the better chance it has for recovery.

    That being said, there is no “rule” that requires surgery in the presence of motor weakness. However, if this was my leg and weakness was present in a vital motor group, I would have the root decompressed in a timely fashion.

    Dr. Corenman

    doug goldberg
    Participant
    Post count: 5

    Dr. Corenman thank you for the timely reply. You suggest that I may be well served by considering surgery to decompress the nerve. Although that sounds frightening to me I’m sure to consider your advice. I live in the Chicago area do you know of any reputable neuro surgeons in this area or what may be my best course of action to locate one.

    Thank you again.

    doug goldberg
    Participant
    Post count: 5

    Dr. Corenman one more question is it advisable to consider steroid injections to help the nerve heal?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Steroids do not “help the nerve heal” but reduce symptoms from the sensory side (pain, numbness and paresthesias). This steroid injection makes the symptoms more tolerable but the compression itself is not “removed” so the recovery of motor strength is not affected. This symptom decrease is actually somewhat dangerous as the patient “feels better” thinking there is improvement but the compression of the motor root does not change.

    If the patient has made the decision that they do not want surgery to increase the chances of motor strength recovery, then an epidural steroid injection is warranted.

    Dr. Corenman

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    I do not make physician recommendations at this time. Finding a reputable spine or neurosurgeon takes some investigation. Sometimes a Google search can be effective. Word of mouth is also another way of finding a recommendation.

    Dr. Corenman

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