[Donald Corenman, MD, DC]

#34581

“How long should i give the conservative treatment? Another 6 weeks? If I have another severe flare up within these next 6 weeks, I was thinking that I would move forward with surgery. If i continue to feel better, then obviously no surgery would be necessary”. That’s a reasonable plan.

“With a huge herniation that is greater than 2 cm, does that mean that conservative treatment will take longer than say a 5-7 mm herniation? Do larger herniations suggest that surgery is more likely necessary in the future”? A herniation larger that 2 cm typically would need surgery but there are rare times that the position of even a large HNP would not require surgery if it was not torquing on the nerve root.

An epidural (ESI) is the single most effective treatment (short of surgery) for an HNP. It does not mask symptoms but reduces inflammation.

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.

[KB32]

#34594

Thanks for your responses. I really appreciate it!

Results from my CT scan a couple of weeks ago:

L3-L4: There is mild loss of intervertebral disc space height with a mild disc bulge
resulting in some mild spinal canal narrowing in conjunction with mild bilateral facet joint
OA.
L4-L5: There has been a mini laminectomy on the left with some postsurgical change seen.
There is a left paracentral disc bulge that effaces the left lateral recess at this level
that likely irritates the descending left L5 nerve root which appears slightly flattened.
There is mild narrowing of the neural exit foramen on the left without compression of the
exiting left L4 nerve root. No significant foraminal narrowing on the right.
L5-S1: Mild diffuse disc bulge is present. No significant spinal canal narrowing or
foraminal narrowing.

Question:
1. What does it exactly mean when they describe the left L5 nerve root appearing “slightly flattened”? How severe is this? Is surgery necessary to relieve this flattening?
2. Yesterday I went for a short walk and I started to get some shooting nerve pain into my left calf. I’m almost 7 weeks at this point with symptoms and I feel like I’m not getting better. I feel like I’m in “limbo” and wondering if I should just schedule surgery?

[Donald Corenman, MD, DC]

#34595

“What does it exactly mean when they describe the left L5 nerve root appearing “slightly flattened”? How severe is this? Is surgery necessary to relieve this flattening”? Flattening is a physical description of the affects of compression on the root. Roots are not designed to allow too much compression and flattening of the root can cause intermittent or constant nerve pain and malfunction. The only two ways to relieve this compression are with surgery or if you’re lucky and can tolerate the symptoms, time.

“Yesterday I went for a short walk and I started to get some shooting nerve pain into my left calf. I’m almost 7 weeks at this point with symptoms and I feel like I’m not getting better. I feel like I’m in “limbo” and wondering if I should just schedule surgery”? It sounds like you would be a good candidate for a redo microdiscectomy.

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.

[KB32]

#34660

Hi Dr. Corenman,

I was wondering if you could shed some light on one of my symptoms. When I’m getting up from laying down on the couch, getting out of the car, or trying to get out of bed, my left leg will lock up. I have to reposition myself and sometimes i have to call for my husband to help move me or use a cane for assistance. These severe episodes of muscle tightness also result in a pronounced limp when I walk. Sometimes I can walk normal, but then other times I have a very severe limp and can barely walk.

I am scheduled to have a redo discectomy surgery in a few weeks, but in the meantime I am wondering what exactly is causing this issue? Is it the way I’m lying down or sitting which is putting too much pressure on the L5 nerve root and causing severe compression? Is it that severe compression that causes my leg to “lock up”? Have you come across something like this before?

Also, would a severe limp like this classify as weakness?

Look forward to hearing back from you.

[Author]

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