holleyMemberAugust 15, 2012 at 11:37 pmPost count: 3
Hi, i have L4 and L5/S1 herniations, one is called a Far-Lateral herniation. Constant burning ache in low back, numbness down right leg and right foot, but i cant really say i have “Pain” in my leg. I do feel more weak especially in right lower leg/calf and ankle area, but can stand tip-toe and heel up. Intermittent stabbing type pain behind knee and in hamstring is the only “Pain” i get in my leg. I do get sciatic pain in buttocks on both sides, predominately right. I have had a spine specialist recommend microdiscectomy but am wondering if i have the surgery will he be able to make a visual confirmation of the disc matter actually compressing the nerve, or is this a best guess scenario due to MRI showing herniations. All info i have seen advises surgery “If” leg “Pain” is present. Is Numbness considered the same as pain? If i do not have surgery, am i risking further injury down the road? Do herniations ever get better?Donald Corenman, MD, DCModeratorAugust 16, 2012 at 7:39 amPost count: 8468
You have two herniations- one at L4-5 and one at L5-S1. Which one is the far-lateral herniation?
You feel “weakness” but note no weakness upon muscle testing. You note sciatic type pain but do not note the intensity of pain on a VAS (0-10 visual analog scale).
If your symptoms are tolerable and you have no demonstrable motor weakness, you could be a candidate for an epidural injection and physical therapy (see website for those descriptions).
Numbness is not considered the same as pain. The pain or noceceptive nerves will scream at you if disturbed. The sensory nerves will not cause pain but will cause numbness.
Herniations can get better and about 70% do get better with time, injections and therapy.
Dr. CorenmanholleyMemberAugust 16, 2012 at 8:40 amPost count: 3
Thanks for response! L5-S1 is far lateral. Weakness I feel in right calf especially and right hamstring (Been athletic all my life).Hips hurt often and only get sporadic pain behind right knee and right ankle, but have had weird ache in my vagina a few times since injury-(odd coincidence, it has been constant since about 1pm today 8+ hours now), never lasted this long b4. No incontinence, just ache. As for pain scale, low back burning stays at 5 or so and increases to 7,8 in evenings, depending on how active I am during day. This crotch pain is about 6 constant and raises quickly with sitting, gets better when lying down. Numbness in right lower leg outside front and cold numbness across top of foot,sole and into toes rates a 9 for driving me crazy-uncomfortable.Donald Corenman, MD, DCModeratorAugust 16, 2012 at 7:16 pmPost count: 8468
You have three pain area; the lower back, occasional pain in the right leg and pain in the perineal region.
Herniated discs cause nerve root compression. This will aggravate the nerve and the nerve will cause pain radiation that “feels” like the length of the nerve is painful. This is not your case. Lower back pain is generally not caused by root compression but by degenerative changes of the discs (there are exceptions).
Perineal pain is generally caused by irritation of the pudendal nerve or sacral plexus along with local problems (infection, etc…). Compression of the L5 nerve (in your case) should not cause perineal symptoms.
You may very well want to try an epidural. The steroid affect might help many of your symptoms but I can tell you that there is more to your story than two herniated discs.
Dr. CorenmanholleyMemberAugust 18, 2012 at 4:32 amPost count: 3
Thankyou.I have degenerative issues with L5-S1,& to a lesser ext L4-5.I was at a store in June-employee shoved some carts my way causing me to twist sideways trying to avoid them.Carts hit my rt ankle causing some bruising but i knew something happened to my back and my rt hip hurt.Went to a clinic that eve-told it was probably just soft tissue damage-follow up with primary.Got into primary 3 days later- sent for X-ray of low back and rt hip-didnt show much. 2wks pass, back and hip pain worse, buttocks pain, ankle pain,sometimes pain in hamstring and behind knee,and numbness in right lower leg and foot.Primary refers me to Ortho who ordered MRI which showed herniations, degenerative issues, mild scoliosis. Mild to moderate central canal stenosis but no nerve root compression at L4-5.Moderate right foraminal stenosis-nerve root compression cannot be excluded, mild to mod left foraminal stenosis but no demonstrated nerve root compression.Knowing all this, is the pubic ache something i should be seen for sooner than 2wks from now?
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