[foxbird]

#10662

Hello Dr. Corenman!

I was hoping to get an opinion from you on whether or not I should consider surgery for my particular case. I’ve provided the background information below for your review, as well as an MRI image and the pertinent details of the MRI report. Thanks for any help you can provide me!

I’m a 33 year old male, about 155lbs at 5’6″. I’m not overly active, but I do walk a few times a week to get exercise. Most of my daily work involves me sitting down in front of a desk, although I take breaks every few hours to stretch.

The issues started about 3 years ago while playing tennis. I leapt sideways to hit a ball, and I felt some pain in my right leg afterwards. The following morning when getting out of bed, the pain shot down from my right hip to my foot, locking up my whole body. After bracing for a few seconds, I could stand up and walk again, albeit slowly. The pain would usually stay away, until I sat down and got up again. I took a few days to relax and the pain gradually disappeared completely after about two weeks. The pain when it showed up was in the neighborhood of a 8 or 9, but it only lasted at most 10 seconds.

The issue reappeared a year later, but the same ‘treatment’ worked. Rest, relaxing, and two weeks later, it was 100% gone again.

This time, the issue reappeared in October of 2013. I took it easy again and the pain started to subside. Towards the end of the two week period, it returned to its previous issues. Deciding something was not right, I took the advice of a friend and went to see a Chiro. He did some adjustments over the course of the next several weeks, and more or less eliminated the sciatic pain in the right leg. It did leave me with odd occasional pain in the left leg (upper left thigh), occasional tingling, and small discomforts that bounced around between my back and either leg. The pain rating on this was never higher than a 1. He told me that it was degenerative pain and I’d need to adjust to it. I’m only 33 and figured that it was a little early to be having random pains.

I visited another doctor (a Physiatrist), who recommended I do some PT. I started that, but after about two days I had some serious nausea and a loss of appetite. The following day, I had a pain in my neck that was difficult to place specifically. It felt very sore to either side of my spine, but there was no loss of motion. The doctor gave me Mobic, but it didn’t seem to help with any of the issues (neck or back).

I continued PT, but it didn’t seem to help with the lower back or the neck. I established a relationship with a GP for the stomach issues, of which he could not find any. During this period of bouncing between doctors, I had two consecutive nights of a night sweats, where I woke up totally drenched. The GP referred me to an orthopedic spine specialist who ordered MRI’s of my neck and back.

The MRI for the neck returned a bunch of normal results with an indication of “Very mild disc degeneration. Visualized paraspinous soft tissues appear normal. C2/C3-C7/T1 without evidence of disc herniation, spinal stenosis, or foraminal encroachment”.

The MRI for the lower back holds a different story. “L3/L4: Mild disc bulge, no herniation or setenosis. L4/L5: Disc bulge, large central and right posteriolateral disc herniation, moderate spinal stenosis, right greater than left, severe right lateral recess stenosis, distortion of the right L5 nerve root. Narrowing at medial aspect of right neural foramen. Left foramen patent. L5/S1: Disc bulge, posterior radial tear; small, broad-based central and bilateral paracentral disc protrusion or herniation, overall canal dimension within normal limits. Mild lateral recess stenosis bilaterally. Foramina patent.”

As for the symptoms I currently experience:

• Both of my feet feel ‘cold’ and occasionally have a pins and needles effect on the bottom of the foot near the big toe. Additionally on the top of the foot from just inside the big toe to just inside the pinky-toe. The tingling extends up the leg on the front about an inch. The left foot generally feels this more than the right does.
• There is a tight pinching-like pain in the upper left buttock, near the center, running down about two inches. The pain is perhaps a 1 or 2. It’s usually only apparent when I sit, but also when laying down on the couch. Standing usually produces no issues.
• A slight pain on the outside of the right thigh extending down to the calf. The pain is usually a 1 or less when apparent. It typically feels like a burning sort of sensation.
• There is intermittent pain on the inside of the thigh as well, extending down toward the knee. Again, a 1 or less and manifests as burning sensation.
• Occasionally I experience pain in front of the leg, near the joint with the hip. This is a strong burning sensation and is about a 2. It’s rather intermittent and generally doesn’t persist for long.
• Less frequently now than before, I experience pain in the groin, focusing on my right testicle, but occasionally spanning to the left. This pain is a 2 and lasts for a few minutes, subsiding quickly.
• Pain in the lower back, centrally located. Feels like a warm burning sensation. Perhaps a 1 or 2 on the scale. The pain occasionally travels over to the top of the hip on the left or right sides.
• There is still mild pain in the neck, usually less than a 1, but occasionally getting up to a 2 on the worse days (once a week). Sometimes it seems to focus on a particular muscle in the neck, but usually it’s just general pain.

I’ve been told the neck pain is skeleto-muscular in nature and will resolve with stretching and exercise. However, it’s been a while since I’ve started treating it and it’s not resolved since.

Overall, the back issues that started in October were fairly painful, but that progressed into light discomfort and ‘ghostly’ feelings in the right leg after visiting the chiro. Since then, the neck pain started in early January, and the symptoms have gotten a small bit worse since doing the PT. Since a few weeks into PT though, they have been relatively constant and the scale and location hasn’t changed.

I would describe the pain and sensations as ‘tolerable’, but I don’t want to experience these for the next 40+ years of my life. I also don’t want to consider injections if they are simply a temporary relief from the symptoms. If the disc issues will eventually resolve over the course of a year, I can wait. However, I understand that the outcome of the surgery changes after about 6 months of issues. I don’t experience any of the ‘red flags’ that require surgery, and with the low level of pain they don’t ‘recommend’ it. However, I’m running out of options.

Would a microdiscectomy likely resolve all of the issues above without injuring me further? The 6-8 week (or 3 month) recovery time is rather daunting, but I would endure it for a good chance to be issue free. I am concerned that the surgery will have no effect, or make the issue worse. I’m also worried that in the long term, the surgery will exacerbate any further deterioriation I have going on and ensure more issues down the road.

Can you offer me any advice on the matter? I really do appreciate it.

SAG Images (Right to Left):
Axial Images (L4/5):
Axial Images (L5/S1):

(I tried putting links to the images here, but your posting engine thinks it looks like spam. I’ve sent the full message with links in the ‘contact us’ form on the website).

[Donald Corenman, MD, DC]

#10769

Your pain is no more than a 1 or 2 on a 0-10 VAS. There is no need for surgical intervention based upon your symptoms. Symptoms like these can cause consternation but should not involve any change in your activity level based upon the lack of severity.

Your MRI does have some moderate changes that can cause symptoms but can be left alone at this point.

An epidural can be temporary in relief of symptoms but there can be long lasting beneficial effects. In your case that you have symptoms that annoy you but are not severe enough to consider surgery. An epidural should be a treatment that you consider.

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.

[foxbird]

#10799

Thanks for getting back to me Dr. Corenman. I appreciate your opinion on the matter as it generally matches with most of what my other doctors are telling me.

Perhaps my expectations are a bit too high at this point in dealing with the issue. I don’t expect to pretend that nothing has ever happened, but I would like to experience days without the symptoms. I know a number of people tend to recover from this with ‘flare ups’ every so often, and that’s what I’m expecting. A few weeks or longer feeling normal (perhaps a little stiff but a warm shower would clear it up), and the odd flare up where I need to take a few aleve or advil. Does that seem to be too much to expect, or will there always been some daily issues I need to contend with?

I believe that’s why surgery was a consideration, in that a number of the good recoveries have people feeling ‘normal’ within a few months of the procedure. I’ve been dealing with this in one form or another since October and it’s starting to get frustrating not finding relief. I’m also concerned that some of these symptoms such as the tingling or burning will become permanent without some form of treatment. Physical Therapy didn’t seem to change the makeup much, but I can tell that I am a bit more fit than I used to be. Which is at least a plus.

I’ve asked about the epidurals for relief of symptoms, but since mine are so mild, I don’t mind ‘waiting it out’ if that will yield the same results over time. I’ll ask my doctor about it again when/if I see him again for a follow-up.

My biggest question now is: will the symptoms go away if I continue my exercises from PT, or should I expect to stay with the same issues I have for the rest of my life? If surgery has a better chance at making that happen, I might be more comfortable with the risks.

Thanks again for all your advice. It’s great that you’ve provided this resource and that you dedicate your time to helping those of us with questions and concerns.

[Donald Corenman, MD, DC]

#10802

5% of patients have moderate continued symptoms due to chronic radiculopathy (see website) but most symptoms do disappear over time. Yes, most paients do have great relief with only minimal what I call “echo” symptoms. These are slight hypersensitivity, occasional “weird sensations” like cold water on the leg or a bug crawling. Generally these fade away.

I am sure compared to your preoperative symptoms, these are much more tolerable. Be patient and I think that over time, these will fade. Try not to pay too much attention to them.

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.

[foxbird]

#10805

I’ve not actually had any of surgery at this point yet. I’m tending to shy away from it (as my doctors and you have recommended), but I don’t want to wait too long where surgery won’t help any longer either.

By continuing to treat with PT, exercise, and the occasional NSAID I’m hoping that the symptoms will go away. Is that likely to happen, even though it’s been about 4 months now with the same symptoms and no improvement? I’m keen on waiting if it’s likely to improve. Otherwise, wouldn’t surgery be a better option to getting me back to a more ‘normal’ state?

Thanks again for your input!

[Donald Corenman, MD, DC]

#10806

Since your pain is a 1-2 on a 0-10 scale, I would advise against surgery. However, if your pain is underestimated and causes you to focus on your pain while performing activities, then your pain scores are greater than you note. Pain is a difficult sensation to rate and only you know how impairing the pain is.

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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