[Donald Corenman, MD, DC]

#28700

If your back pain is more one-sided (unilateral) and on the same side as the herniation, you have a better chance of back pain relief with a microdiscectomy. With unilateral pain on the same side as the herniation, the chances are about 70% for acceptable relief. If the back pain is central in nature, the chances of relief with a microdiscectomy are more like 50%

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.

[Naresh]

#28702

I have more of a central pain. I am actually very confused here, i see a lot of patients who have leg pain, tingling, etc which means they have an annular tear with a larger herniation which i do not have. I have a herniation which bothers no nerve. Still i see them doing great after a microdisectomy, which in my case would have only 50℅ chances in relieving my pain although my condition is not worse as them.

[Donald Corenman, MD, DC]

#28708

That is correct. Surgery for a herniated disc (microdiscectomy) that causes leg pain has a success rate of over 90%. A microdiscectomy surgery for central back pain has a 50% chance of good relief (70% if unilateral pain). The reason is about half the time, the herniation causes tension on the posterior annular fibers which is painful. Removing the herniation therefore stops the tension of these fibers and relief is gained. The problem is the other 50% of discogenic pain is pain not due to tension on these fibers but due to abnormal mechanical motion of the disc and this pain can only be resolved by fusion. There is no testing we currently have to determine if this disc pain is one or the other so you either choose a microdiscectomy with the knowledge you have a 50% chance of relief and then consider a fusion if no relief or consider a fusion initially with a higher chance of success (90%). Or you can try to live with the pain as even though this pain is impairing, it is not dangerous.

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.

[Naresh]

#28709

This kind of goes in line with the research i have done from internet. Please correct me if i am wrong.

When a radial annular tear happens inside out but not tearing the outer layers and nucleus stucks into the layers, it gives a discogenic pain and there is no specific known reason for this pain and body does not have any way to heal it and it always remains the same. But when the tear cross the outer layers, where there are very sensitive nerve endings, the nucleus that flows out might irritate these nerves and cause inflammation and hence pain. Hence, in a discectomy, the nucleus and the painful torn outer layers are removed and sealed using RF, which gives relief from this inflammation and reduce pain but the internal tear still remain there and discogenic pain still persists. Discectomy only does half of the work essentially.

If i am right here, i have few questions: how good the sealing of the outer layers is done so that there is not a reherniation again and whats the rate of the reherniation after a discectomy?
How bad can be a discogenic pain? And how to deal with it for lifetime, since i am in my youth now? I believe paracetamol is a medicine which works great to reduce its pain, but would it be fine taking it often whenever there is a heavy pain?
How does it work in disc bulge, because essentially there is not a tear in the outer layers and nucleus does not flow out, and if there is no nucleus flowing out, it would not cause inflammation on the outer sensitive nerve endings, but still a discectomy is prescribed in a disc bulge, how does discectomy work in a disc bulge?

Is there any way, i can send you over my MRI scans, and you can comment on it whether a discectomy would give even a 50℅ relief in my pain?

[Donald Corenman, MD, DC]

#28717

The difference between the two scenarios (50 vs 70% relief) has to do with whether the pain is generated by the annulus or by the nerve root compression. If the pain is one sided (on the side of the herniation), a good percentage of these patients actually have nerve root compression pain that does not radiate down into the buttocks but stays only in the off-midline side of the herniation. The more the nerve is inflamed due to the size and location of the herniation, the more pain will radiate pain down the root’s pathway toward its terminus. Likewise, when improving, the pain centralizes. That is, the pain recedes up the root to its origin (side of the lower back). I see this all the time. If however the annulus is stretched causing local pain, the chance of improvement is only 50% with surgery (multiple factors).

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.

[Naresh]

#28724

Can you tell me what is the source of the pain coming from annulus? Is it due to the annulus being stretched causes the outer layers to stretch where there is herniation, and that causes pain or is it something else?
And is it related to the other 50℅ discogenic pain that we were talking earlier?

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