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  • brina44r
    Participant
    Post count: 3

    Hello, I have been on workmans comp since April 18, 2016 I have had pain in my lower back down the back of my left leg (sometimes my right depending on how much I do in a day), and numbness in my left foot. I am fairly active as I have 2 toddlers, and livestock.I have been to a doctor in Steamboat Springs and in Grand junction for a second opinion, and both said there wasn’t anything wrong with me. My Pain management specialist requested a discogram last month and I finally got it. The results were that I had an grade 1 3-4 mm annular tear at my L5S1 impinging the left side nerve. I have been in physical therapy for 7 months, I have had 3 injections and none of it has helped. My primary comp doctor told me before my discogram that no matter the results there was no more they could do for me and I would be stuck at a desk job the rest of my life and treated as a cronic pain patient. I was wondering if you had any advice to give on as to what I should do. I see her tomorrow morning to follow up after my procesure, and I believe she is going to try and make me schedule for MMI. Thank you for reading.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    A small annular tear generally does not cause significant leg pain but there are always exceptions. There is a condition where the tear allows the disc nucleus to “leak” onto the nerve root. The nucleus is neurotoxic and can cause a “chemical radiculopathy”. One of the problems with this diagnosis is that surgical treatment is less effective for this diagnosis. In addition, the discogram would have needed to have at least one normal level tested in addition to the painful level, have to be blinded (you would not know which level was tested at what time) and the normal level would have to be relatively painless.

    If those provisions were used, the results found as noted above and there is at least a bulge at the painful level that is compressing or effacing the nerve, you could be a candidate for a microdisectomy. You note 3 injections that “did not help”. The question is did you keep a pain diary for the first three hours? See the section on this site to understand pain diary.

    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.
    brina44r
    Participant
    Post count: 3

    Thank you for getting back to me so quickly. I did keep a pain diary that the doctor gave me for 6 hours the day of and for a total of 10 days.I felt fantastic for the first day.I felt no pain at all the first day of my first procedure, and had about a 50% less pain for the next 5 days. The second injection I had no pain for a couple of hours and no improvement after. The third injection was an epidural injection and it was the same results as the second injection. I have protusions at the L2-3 L3-4 and L4-5 as well. Thank you for reading.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    So according to your history, you did have diagnostic relief with each of the 3 injections which does indicate that you have this left S1 nerve involved causing your leg pain. If there is a “bulge” which effaces the nerve (touches it without displacing it), you might be a candidate for a simple decompression. If the tear does not touch the nerve, surgery will probably be much less effective. Even with a bulge that effaces the nerve without compressing it, surgical effectiveness is in the 60% range (normally in the 95% range for a “normal HNP”).

    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.
    brina44r
    Participant
    Post count: 3

    Would you mind looking at my MRI and CT scan and results please?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Of course, any information on this forum I provide is free in the interest of education. If you want a personal consultation called a “long distance consultation”, I do charge a fee for this. I spend time reviewing your images and prior consultations, and discuss your history and condition with you personally over the phone. For the time I devoted for this service, it is necessary for a charge. You can call the office from the number at the top of the website if you have interest in this service.

    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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