[BlackSwan]

#7208

Hi Dr.

Thank you for reading in advance.

I had my 2nd lumbar discectomy on L4/L5 last February 2011. The first one was 10 years earlier. I needed a 2nd operation due to L4/5 herniation in 2 directions. Majorily towards the left and a bulge posteriorly.I had acute left foot drop and surgery within 2 days. The surgeon took care of the left sided extrusion causing foot drop but left the remaining disc alone. Therefore i still now have a remaining broad based posterior disc bulge. The surgeon did not think it necessary to adress the posterior bulge during my operation.

My followup MRI from 16/5/11 is below;.
L4/l5 there is a broad based postereocentral disc bulge 14 mm in width and 5 mm AP. No migration of sub-ligamentous extension. There is mild narrowing of lateral recesses. No definite neural impingement. Bilateral foraminal narrowing with contact without compression of L4 nerves. Severe facet arthrosis at this level and L5/S1. The cauda equine nerve roots are non blunt and non thickened. No features to suggest arachnoiditis.

A 2nd MRI done 2/11/2011 of last year says;

L4/l5 broad based disc protrusion mildly abutting thecal sac. Superimposed upon this there is focal signal abnormality within left lateral recess that diffuse lay enhances and is round like in appearance at 9mm. The left L5 nerve root is thickened at this point. Appearance is focal abnormal scar like tissue causing compression.

I have no weakness and bowel and bladder are normal. Although I never regained full power of my left foot. I do not need orthotics. I am very fit and exercise regularly including ore and back exercises. Normal height and weight, 40 year old female.

My problem is off and on deep sacral pain/ fullness with a feeling of tenderness. My lower Back easily stresses now and sometimes even a wrong movement or wearing the wrong shoes for 10 minutes may cause sacral pain and tenderness. Also I have migratory numb spots and tingling on thighs and buttocks ( not in perenium)which was the reason for my 2nd MRI only 4 months after the one in May of last year. Final symptom is when my lower back sacrum is acting up I get wind/gas and a feeling of a fullness back there. i am not sure if there is a connection?? What do you think my treatment course should be? What can I do?? How is the gas/ wind thing related to my back pain?

Thank you very much.

[Donald Corenman, MD, DC]

#7212

You have symptoms that match your MRI findings. Your history of surgery looks to be appropriate. When you developed foot drop, the rushed microdiscetomy was a good decision. Unfortunately, your motor weakness did not fully resolve but at least you can function without a support (AFO or ankle foot orthosis).

Your residual symptoms are of sacral pain and lower back instability; “My lower Back easily stresses now”. This is generally not a residual of the disc herniation but of discal stability. This is not atypical as the disc herniation by definition is caused by a large tear in the annulus of the disc and this tear can lead to instability and back pain.

Sacral pain is typical for degenerative disc disease as long as it is upper sacral pain. If the pain is low (at the coccyx) and not in the upper sacrum, this might indicate a different pathology.

Numb spots in the thigh can be residuals from the nerve compression. The surgery takes the pressure off the nerve root but mother nature has to heal the nerve. Residual symptoms are not uncommon. You also have some scar around the root which is also to be expected.

Sacral pain generated from degenerative disc disease can be treated with therapy, ergonomics, medications and injections. Finally, if the symptoms are intolerable, a work-up can be performed to determine if you are a candidate for fusion surgery.

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.

[BlackSwan]

#7220

Thank you very much for reply. I was wondering if you knew how wind/ gas was related to my lower back as that seems to be an issue for me when my back plays up.

Lastly, there is a new therapy here call IDD. Non surgical decompression. In your opinion am I a candidate for this? Or is my problem not the disc and rather overall DDD? You mention lower/ upper sacrum in your reply and pathology would be different. I think mine would be upper sacrum and not tailbone.

Thank you

[Donald Corenman, MD, DC]

#7226

“Passing gas” requires a Val Salva maneuver. You tighten the abdominal muscles and push the diaphragm down. This action can aggravate back pain by “backing up” the vena cava.

IDD typically means internal disc degeneration. I think you mean the traction device that promises to “heal” the disc through traction. The disc won’t heal but this maneuver may take some of the pain away. It can however aggravate the pain so be careful. Do not sign up for twenty treatments. See how you feel with three treatments. If no significant improvement, walk away.

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.

[BlackSwan]

#7524

Hi Dr. Corenman.

I did return back to my ortho and he did not wish to order a new MRi or do more evaluation. He said I will have episodic back pain and to live with it and get cortisone shots.

I have posted my MRi results in my earlier post. I need to ask you a question please. With my LB problem I have noticed that laying on flat surfaces like the hard bath tub or floor and any touch pressure applied to my sacrum will make it ache and ache with aches referring into back of buttocks and calf. It’s not a nervy pain but a deep ache/ throb. I always feel better walking. Sitting does not aggravate it only when I sit back into chair and pressure is put on LB either by a cushion, pillow, or the back of seat/chair. It can last 2 days even. With my MRI results is this from the disc, joints, ligaments??

Basically touch pressure on LB sets off the pain. Relieved with voltaren.

Thank you very much for your expert reply.

[Donald Corenman, MD, DC]

#7525

So that I can understand, there only is pain produced with pressure on the sacrum? You can stand or sit on a stool without a chair back and not have pain? You can exercise and not have pain? You have no more pain at the end of the day than the beginning?

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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