Donald Corenman, MD, DC
Post count: 8427

“Dr. Corenman

I’ve seen the surgeon a month ago he said that in his opinion the compression I have does not require further surgical intervention (discectomy or fusion) . He is conservative and probably doubtful if a fusion will get my spine better then it is now. I’m gonna get a 2nd opinion.

1) The foot seems slowly getting better but I’m still suffering from my back in essence I feel already somewhat fused if I do 50-60% BLT postures I’ll get discogenic pain (and probably inflammation) reaction(s) what is the point of not getting that level fused if it is stiff and prone to pain?

2) There is a cycle I don’t understand: in the morning the foot paresthesia is at it’s worst – painful to walk and put some non cushioned shoes or sandals it gets better (more sensation) as the day progress and at night while lying in bed completely horizontal it feels like the nerve is growing/recovering sense of pleasent heat and tingling it can last couple of hours or so the foot is much less sensitive to pressure (and consequently less painful) but in the morning the story returns all over again. what are your thoughts about it? do you think inflammation has to do with it though it looks like it’s the same cycle even when my L5 -S1 disc is very guarded (unless a very degenerative disc is almost always inflammed not matter if it moves or not)

3) Lastley do you know any of these supplements : L-Citrulline, Acetyl-L-Carnitine, R-Alpha Lipoic Acid , Benfotiamine helpful for non-diabetic neuropathy and or nerve regeneration?”

Fusion can be helpful for discogenic or facetogenic pain that does not respond to therapy if the level or levels can be absolutely identified and proved to be the pain generators. A significant course of physical therapy needs to be undertaken before surgical back pain treatment is considered.

You note “in the morning the foot paresthesia is at it’s worst” which is typical as the root will swell when you are lying down due to your supine positioning. When you stand, gravity takes over and the swelling is reduced.

The supplements you note are not proven to be helpful as there are no studies but should not be harmful for most individuals. Membrane stabilizers (neurontin, Lyrica) might be helpful as they work to make you drowsy and can last up to 8-12 hours.

Dr. Corenman