Donald Corenman, MD, DC
Moderator
Post count: 8431

You do have a dilemma in decision making. I will assume that you do not have any motor weakness (especially of the tibialis anterior or the gluteus medius muscles-see website under “conditions’; “nerve injuries and recovery” then “symptoms of lumbar nerve injuries”).

This weakness will be discovered in a thorough physical examination which I assume you have already underwent. If you have motor weakness, in my opinion you need surgery much sooner than later. I will also assume that you do not have cauda equina syndrome (see website) as that disorder is also a surgical condition. If you do not have either condition, you have to consider the benefits and risks of waiting.

The benefits of waiting are that you avoid another surgery and the potential risks of that procedure. The risks of waiting are that this herniation is quite large and causing compression of the nerve root but not enough to cause motor weakness at this point. You have a chance of developing chronic radiculopathy (see website) which is a permanent condition of pain generation.

The problem is at this point, there is not a study that can answer two questions. How long do you have before surgery would be ineffective to prevent chronic radiculopathy? What percentage of patients in your situation will develop chronic radiculopathy? I am gathering data to write this paper but it will be some time before it is out.

Unfortunately, you do have the genetic traits that promote degenerative disc disease but that does not mean that you are going to be a fusion candidate in the future. Read the sections regarding back care on this website and find a good Pilates instructor who can educate you in core strengthening.

Dr. Corenman