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  • hilfebitte
    Member
    Post count: 2

    Dear Dr. Corenman,

    today I am writing to you so other readers of this great website can benefit from the discussion. I have submitted my MRI already to your office for reference.
    I have been diagnosed (MRI confirmed) with a large left L5 extrusion. Initially (~4 weeks ago) I had excrutiating pain originating from the L5/S1 lumbar region down into the entire leg, with extreme sciatica which completely demobilized me. Actually only laying down and crawling was acceptable. My night was interrupted with trying to find a position that was acceptable. At the time, a chiropractic assisted with pain treatment in particular electronic stimulation as well as massage. It all helped getting me out of pain and back to work.

    A neurosurgeon advised laminectomy and discectomy as soon as possible based on the MRI and physical examination.
    I do have no reflex on left foot, some weakness in left foot is evident compared to right foot. There is numbness in left foot since 4+ weeks. When I sit a lot (after work-office job) I often feel increased numbness and sometimes burning in the lower left leg/foot.
    The only thing I do not have at all is back pain or any real pain for that matter. I am essentially pain free (no pain medication at all!). I am working and the only thing I feel is aggrevation of the constant symptoms like numbness and cramping in left leg. I don’t consider that pain, altough in fact it is really impacting my life/ability to work/etc.

    The questions I have now are:
    1) Is the nervous system in peril and is it really time for surgery given the limitations described above?

    2) Is a microdiscectomy not a much more appropriate procedure? I am very oposed to a more invasive procedure such as the laminectomy. Or are these the same, what are the differences?

    3) Why do I not have pain and what could that mean? Is it good or bad?

    I greatly appreciate your time and dedication to this post.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8378

    You report a large disc herniation at the left L5-S1 level. You unfortunately developed severe incapacitating pain in your leg associated with motor weakness. I’m glad you received chiropractic care that gave you relief but it would have been better to have seen a surgeon early. Two of the indications for a microdiscectomy are severe incapacitating pain and motor weakness and you did fit both qualifications.

    If you had a disc herniation at L5-S1 with weakness, I assume you have weakness of the left calf muscles (gastrocnemius/ soleus group) and cannot tip toe while walking on that side. You report numbness and paresthesias (pins and needles feeling) in your left leg but no back or leg pain.

    Based upon what you have told me, it appears that you need a microsurgery to remove the compressive disc from the S1 nerve. The fact there is no true pain is not necessarily a good sign as that portion of the nerve may not be transmitting due to possible compression and damage of the nerve root.

    The surgeon advised a laminectomy and discectomy. I would assume that he meant a microdiscetomy which involves a very small laminotomy. If he wanted to do a laminectomy, that might have been overkill but I have not seen the MRI yet.

    Surgeries proposed by different surgeons vary. I have seen fusions proposed for patients that have only needed decompressions, so I do not assume anything anymore. If you have a massive herniated disc that fills the canal and it cannot be removed without severe danger to your nerve roots, there is a very rare occasion that a full laminectomy can be necessary. I can tell you that I have never found it necessary to remove a herniation by that method but I can conceive of a situation where that might be necessary.

    I would assume this surgeon means a laminotomy and microdiscectomy or discectomy (surgical procedure performed with loupes- not a microscope). It is the simplest of all spine procedures that I perform. If he is talented and meticulous as I assume many surgeons are, this procedure should go well without complications.

    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.
    hilfebitte
    Member
    Post count: 2

    Dear Dr. Corenman,

    thanks very much for the response.
    To clarify, I am able to walk and tip toe. Walking on my toes and heels is possible. The weakness becomes visible since I can stand on one (right) leg and tip toe for 10 times without getting tired, however, on the left I am getting tired faster and bearly reach 10 times. The foot still supports going on my toes though as well as climbing stairs.

    Indeed I had contacted the surgeon’s office and unfortunately only his assistance is able to answer the phone. To speak with himself I would have to make another appointment and last time it was a 2+ week wait period. That’s why I haven’t seen a surgeon sooner in the first place. I requested the MRI 3 days after I experienced the disabling pain for the first time. Then I had to wait 8 days to get it approved by the insurance, despite going to the ER where I was rejected. After I finally had the MRI, I needed to wait 16 days for an appointment.

    Anyhow, his assistance specifically told me due to the size of my extrusion a laminotomy and microdiscectomy would NOT be possible and confirmed that he was planning on laminectomy.

    I was able to find larger or comparable herniated disc MRI examples, where a microdiscectomy was performed in various online resources such as youtube videos and strongly feel a second opinion is adequate to ensure propre treatment.

    By all means I am eager to avoid a major laminectomy and will hope for your opinion once you can see the MRI.
    I will travel to Vail if that is what it takes to the get the right and appropriate treatment.

    If you adivse not to wait another day (due to risk of permanent damadge) of course I’d also be thankful for a statement. Sometimes it’s maybe more damaging to wait than to go with the more invasive treatment. I really need help making that call, what do you think?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8378

    By your report, your weakness is very mild so I don’t think there is any significant danger in waiting for surgery within a couple of weeks. Again- a full laminectomy may be unnecessary and even in cauda equina syndrome (massive hernations) I have never found it necessary to perform a full laminectomy. Still- there may be situations that a full laminectomy is required so I don’t want to throw stones.

    IF you want to Fed Ex your films overnight to the office, please call DIana or Sarah at 970 476-1100 and explain your situation. They will put my face in front of the images that day and I will give you a call.

    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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