[Donald Corenman, MD, DC]

#8020

Regarding central disc herniations, the bulge can cause a number of symptoms and it is the type and intensity of symptoms that need to be addressed.

If the symptoms are mild as many central disc herniations are, nothing needs to be done or a conservative rehabilitation program needs to be started. If the symptoms are more problematic, an epidural injection can be considered.

If the disc herniation is larger and causes central stenosis, the symptoms of neurogenic claudication can occur (see website). In this case a microdiscectomy will address the symptoms.

If the symptoms are lower back pain only (without the presence of the degenerative spondylolisthesis), a microdisectomy can be considered with a success rate of about 50-60 %. With the degenerative spondylolisthesis, a fusion needs to be considered for lower back pain.

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.

[vidhatad]

#8228

Hello Dr. Corenman,

It’s been some time since my last visit to the portal. Thank you for answering my previous post. Since my last post, I’ve seen an increase in my symptoms. Also a further MRI gave the following results:
1. Minor disc bulges at L1-L2 and L4-L5 levels, both indenting the thecal sac.
2. Minor disc bulges at 3- (I have no clue what this 3- means) and C4-C5 levels. However neither is causing any problems.
3. There is not much difference in the Spondylisthesis..the report still notes a mild Spondylisthesis.

The symptoms in my legs seem to have increased over the past week or so. Now I increasingly get mild pain in the sole of my feet, especially at the base of fingers. Also the webbing of the big toe and the next finger sometimes gives an electric shock kind of sensation. Funnily, this happens mostly only in the evenings.
Also, there is increasingly a feeling of pain in the right testicle at times and sometimes in the left of he shaft. However this lasts only for a few seconds and then goes away.
I have a mild burning sensation in my right lateral side of shin and electrical sensation at times.
At times, I get an electrical sensation on the outer side of the right toe, some pain at the base of the same toe and throbbing sensation at the side at times (a vibration kind of feeling).
Also, there is a burning sensation in the sole especially in the nights.

I generally feel better after walking for sometime.

I have a few questions:

1. Do these increased symptoms indicate a worsening of or pinching of L5 or S1 nerve, or are these indications of any problems due to the L1, L2, L3 or L4 nerves?
2. I know a fusion is not warranted at L5-S1 segment, but if there is one required, does this usually lead to adjacent disc degeneration at L4-L5 level?

Regards,
Vidhata

[Donald Corenman, MD, DC]

#8242

Your symptoms sound nerve related but not all nerve related symptoms are from compression. There is a problem called peripheral neuropathy where the nerves become inflamed either from vascular, infectious or immune disorders. The symptoms typically increase in the evenings and the “burning sensation in the sole especially in the nights” is classic for this group of disorders.

The changes in your lower back MRI do not sound to be significant enough to cause the increased leg symptoms.

A fusion can increase the stress on the levels above and below but normally a fusion is designed to stop motion of a painful or unstable segment.

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.

[vidhatad]

#8272

Thank you for the response Dr.Corenman. I don’t think there is any segmental stability in the L5-S1 region as of now and the spondylolisthesis may be an incidental finding – considering I have been a fast bowler (played cricket) for nearly 12 years. The action involved running in and jumping before delivering the ball, which involved major flexion at the lumbar region. Considerig mine is pretty minor – I think this would be incidental.

One more question on the cervical part – could the mild loss of cervical lordosis be a reason for the pressure on the discs and could have led to the discs getting weak and showing bulges?

Also, can exercises (Physio therapy) reverse the loss of cervical lordosis?

Thank you once again Dr. Corenman.

Regards,
Vidhata

[Donald Corenman, MD, DC]

#8273

The spondylolisthesis may be an incidental finding but even if flexion/extension films do not reveal any abnormal motion, this disorder can still be a pain generator. The pannus (region of the old fracture) can cause local back pain and the slip can produce foraminal stenosis which can then cause pain in the L5 nerve distribution.

The loss of cervical lordosis is the result of degeneration of the cervical discs. The vertebral bodies are cylinders and without the discs in-between, there would be no lordosis. The lordosis therefore is due to the trapezoidal shape of the discs. Degenerative changes of the discs reduce the normal cervical lordosis. Of course, there are disorders (herniated discs and central spinal stenosis) that can cause antalgic positioning (adoption of a neck position to reduce pain).

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