Donald Corenman, MD, DC
Moderator
Post count: 8436

The S1 nerve is compressed from the front with a disc hernation. The S1 nerve travels behind the pelvis and attaches to the foot. The nerve acts like a cable on a pulley (the pelvis). When you bend forward or you raise your leg up, you lengthen the nerve. This pulls the nerve into the herniation which causes increased leg pain.

You probably feel better when you stand up or bend backwards. These two actions reduce the nerve stretch and therefore reduce the leg pain.

Surgery is indicated for three reasons; bowel and bladder involvement (rare and you do not have this-called cauda equina syndrome), motor weakness (which is also somewhat rare and you don’t note weakness), and finally pain that you cannot tolerate.

You fit into the third category. Then, timing of surgery is the question. In my practice, conservative measures are instituted for three months. These measures are therapy, medications, injections and activity modifications. If the patient has substantial improvement, then we continue on this path. If the patient has unacceptable improvement, then we tend to go to surgery.

By the sounds of your current complaints, you have continued unacceptable pain that you call “excruciating” when you bend your back or leg. This sounds like a surgical situation. There was one study that indicated surgery prior to six months from onset of event has a better success rate than after the six month period.

I have operated on many patients with pain from an HNP after this six month period with good results but there probably is some increased percentage of chronic radiculopathy (see website). Whether you want to undergo surgery is going to have to be your decision.

Dr. Corenman