[MansfieldAthletics]

#4842

I’m looking at getting a microdiscectomy done for an L4-L5 herniation causing lower right back pain and right leg numbness and weakness. I have “drop foot”. Here is my recent MRI report from 08/21/2011:

Final Report – MR MR LUMBAR SPINE WO CONTRAST
MRI Lumbar Spine without Gadolinium
Clinical History: low back pain
Technique: Sagittal T1, T2 and T2 fat-saturated as well as axial T1
and T2 and coronal T2 fat-saturated sequences were obtained through
the lumbar spine.

Findings: There is no acute fracture of the lumbar spine. There are
mild retrolistheses of L4 upon L5 and L5 upon S1. With the exception
of mild discogenic endplate degenerative changes about the L4-L5 disc
space, the marrow signal within the visualized lumbosacral spine is
normal. The conus medullaris terminates normally. The cauda equina
nerve roots appear normal in caliber.

At the L3-L4 level, there is loss of normal intervertebral disc
signal and height with a broad-based disc bulge. There is a
superimposed right foraminal disc protrusion which mildly narrows the
right lateral recess. There is no foraminal or spinal canal
compromise.

At the L4-L5 level, there is loss of normal intervertebral disc
signal and height with a large central and right paracentral disc
extrusion. There is severe narrowing of the right lateral recess.
There is mild spinal canal stenosis. There is no neural foraminal
narrowing.

At the L5-S1 level, there is a left foraminal disc protrusion which
severely narrows the left neural foramen. There is no spinal canal or
lateral recess stenosis.

Conclusion:
L3-S1 degenerative disc disease
There is right lateral recess stenosis at L3-L4 and L4-L5 and left
neural foraminal stenosis at L5-S1. There is mild spinal canal
stenosis at L4-L5.

Two “loaded” questions I had:
1. I am a 36 year old passionate, competitive athlete at both pole vaulting and freestyle snowboarding. I really want to continue these sports. I realize I need to minimize my risk of “flat” landings off jumps or in the pipe which would cause heavy load on my back (which I think caused my whole current back issues over the years). Vaulting on the other hand, I presume would not be that bad for back issues correct? Two things come to mind for “back loading” in the vault. As you can see from my avatar pic, the take-off requires the back to arch into a “reverse C” position (yes if you take-off wrong you can force this position very harshly) and the other issue is the act of jumping off the ground itself at full speed and as quick as possible. This force is equal to multiple times your body weight. Forget exactly, but as extreme as 10x maybe. What is your opinion on me fully getting back to these sports at a high level? I have a very strong core and workout in a very “functional training” manner with focus on technique ( I had very bad technique in high school lifting with coaches that knew nothing so that may have also caused the start of this issue for me as well ). I do the Olympic lifts as well (Squat, Power Cleans and Deadlifts)

2. Goes along with #1, but I find it mind boggling that you don’t get a high percentage of re-occurring disc herniations after having the surgery since the disc has a hole that never “closes” since there’s no blood supply like cartilage. What actual “healing” really occurs and what keeps the disc in place?

Thanks for your time.

[Donald Corenman, MD, DC]

#4870

Sorry for the delay. You are considering a microdiscectomy for an L4-5 herniation for lower back pain, right leg pain and foot drop. Foot drop is related to an L4 or L5 nerve root compression. In general, any significant motor weakness should be addressed surgically soon. The best chance for useful strength return is with a timely decompression. The right L4-5 herniation is compressing the L5 nerve root and the microsurgery is indicated.

The second question has to do with return to high-level sports. Your spine has three levels of degenerative changes (L3-S1). This to me indicates a genetic predisposition for tears of the annulus. These degenerative discs by themselves do not rule you out for competitive sports but does indicate that you will have problems with your back as you do now.

The recurrence rate for herniations is 10%. A small thin layer of scar tissue does cover the annular hole where the disc extruded from. The volume of the nucleus is reduced from both the herniation and the surgery which most likely prevents further herniations.

Back pain from the degenerative discs can be controlled with core strengthening. I understand you need explosive push-off strength for pole vaulting but dead lifts and squats place high shear forces on the lower two discs. You might consider other methods to gain gluteus, quad and hamstring strength. Hyperextension for the takeoff in pole vaulting places greater stress on the facets and unloads the discs. Without a history of a spondylolisthesis, facet arthrosis or facet fracture- this position should not cause concern.

In regards to flat landings with snowboarding, this maneuver causes significant loading to the lower discs and the thoracolumbar junction. I can’t tell you how many fractures I see from this very mechanism. Great care needs to be taken to assess the landing and how much velocity is needed to reach it safely. If you land flat from a high jump, you do not escape Newton’s laws.

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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