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  • Nicolas
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    Post count: 1

    Hello Dr. Corenman.

    First of all, thank you for the opportunity for hosting this forum.

    My story: I am a 35y old male, BMI of 24, living in Europe. I used to have a normal active lifestyle and never had any back problems in the past worthy of mentioning. Also I have a background as a PT for +6 years, before switching careers to teaching.

    Before I eventually ended up having surgery, I was having mild sciatica symptoms in the hip and buttocks region for several months, which of that time were mistaken for muscle pains due to working out like running and cycling, which I frequently liked to do.
    At one moment the symptoms were growing worse, having sciatica all the way up to the big toe and experienced pain with lying on my back and sides in bed and during sitting.
    After a MRI was done, the cause of the symptoms was finally clear: a large para-central disc herniation, extruding to the left side at disc level L4-5 compressing the left L5 nerve root. No motor or sensory loss or back pain were present, just pain.

    After the diagnosis I tried the conservative approach for 4 months, having 1 epidural and practiced PT. Although the symptoms slightly reduced, improvement failed to occur. Since the symptoms were influencing my work and daily life that much, I opted for surgery.

    The surgery took place in June 2019 The surgery was done through a transforaminal approach, without any complications and I had a good recovery. At this moment I am still experiencing some nerve stretch pain ( I think I have to call it like this). When I change to certain positions that involve stretching my left leg I experience some nerve pain/feeling in that leg, which fades away immediately after I discontinue the stretch.
    For example when I sit on the ground with both my legs stretched, moving my feet towards me, bending my neck forward I can feel this annoying nerve stretch pain which increases when I continue bending my back more forward. I also feel this when I get out of a car that has a low situated drivers seat.

    My questions is: Is this a common phenomenon that nerves keep sensitive for stretching? Is this something that will dissolve? Should I stretch the nerve as an exercise? I do have the feeling it is getting slightly better over time but as I describe, at the moment I still happen to be restricted in my movements.

    A recent checkup MRI made clear there are no signs of re-herniation, epidural fibrosis or any factors to take into account.

    Kind regards,
    Nicolas

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    “I was having mild sciatica symptoms in the hip and buttocks region for several months…At one moment the symptoms were growing worse, having sciatica all the way up to the big toe and experienced pain with lying on my back and sides in bed and during sitting”. This is a classic set of symptoms for an initial annular tear and then a full tear through the annulus with a resultant disc herniation.

    You then noted “A large para-central disc herniation, extruding to the left side at disc level L4-5 compressing the left L5 nerve root”.

    You note “The surgery took place in June 2019 The surgery was done through a transforaminal approach, without any complications and I had a good recovery”. It is unusual that the posterolateral herniation was extirpated through a far lateral approach as that is not standard but since the new MRI report notes no residual herniation “A recent checkup MRI made clear there are no signs of re-herniation”, I can ignore that unusual approach.

    The root is still inflamed as a stretch of the root still stimulates pain and it has been some time from surgery. I would consider an epidural steroid injection.

    Dr. Corenman

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