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Hi Dr. Corenman,

Thanks for your time. I also really appreciate that you are both a surgeon and a chiropractor. A lot of surgeons seem too black and white about chiropractic. I am 6 months post microdiscectomy at L5-S1. MRI before surgery findings said, among other things:

“Straightening of the lumbar spine. No spondylolisthesis”

“L5-S1: Disc desiccation with loss of disc height. Large right subarticular disc extrusion measuring 11mm AP. Complete effacement of the right lateral recess with impingement on the traversing right S1 nerve root. Mild central spinal stenosis with AP thecal sac diameter of 8mm. No significant foraminal stenosis.”

Impression said:

“1. At L5-S1, large right subarticular disc extrusion with impingement on the traversing right S1 nerve root.
2. Facet arthropathy at L4-L5 with mild bilateral foraminal stenosis.”

I had tried conservative management for 4 months prior to the surgery. This involved traction and electroacupuncture. Unfortunately, I felt using the Teeter Dex II and also the Nubax back stretcher both aggravated the problem. In-office traction at chiropractor was okay though.

I was totally bedridden for 10 days pre-surgery with symptoms on right side and was admitted from the ER to go in for surgery. For the first three months after surgery I was recovering well. The weakness in the right leg improved and I thought at this rate it would make a full recovery. Nerves were sensitive to extension on both sides (even though I had no issue on left side before surgery), but it improved with time. Antalgia (body deflected to the side) resolved. I could stand, walk, sit, and lie down again, all without much pain. I worked up to walking 2 miles briskly on a dirt track every day. I would face my back to a corner of the kitchen counters and lift myself off the ground with my arms to put some traction on the low back. I never had an issue with this.

Then around 3 months post surgery, I did the same dangling from the kitchen counter, but this time facing towards the counter corner. This for some reason irritated the nerve and residual symptoms kicked up a notch, and some new ones appeared. I had more reduced sensation on the outside of the right foot, but now I also had emergence of reduced sensation on the middle three toes of the right foot. This confused me as I thought those toes were not associated with the level I was operated on. I also had emergence of reduced sensation on the heel of left foot, which I never had before at any time. Things seemed stable at this new level of symptoms. Then when COVID lockdown began, exercise reduced and I started pacing in my garden for half an hour, instead of briskly walking on the public track. Now the last 1 month all my residual symptoms have gradually intensified for no apparent reason, and weakness is increasing in both legs, especially the right calf, which was always the most afflicted. But I never had weakness of left side at all before now. Nor burning. Lying on my back with my knees up, reclining on a wedge pillow causes symptoms, when before 1 month ago it would not.

I have avoided sitting ever since surgery and am pretty much either using a standing desk, or reclining on my wedge pillow on my bed.

Questions:
1. What kind of doctor do I need to see? Do I need another MRI? Would this probably just be called failed back surgery and lead to symptom management? My neurosurgeon is still closed due to COVID and I can’t consult him.
2. What could be a reason for symptoms appearing on left side after the surgery? And why would progressive weakness occur recently? I don’t really even have that much pain, so it is surprising that weakness would start showing up.
3. I have read clinical trials and case studies of discs being regenerated through multimodal chiropractic things. I have also seen surgical literature showing regeneration of discs occurring spontaneously after surgically correcting flat back syndrome. Do you think it is worth pursuing chiropractic attempts to regenerate disc through things like traction and restoring lordosis though molding with tools like a denneroll? I feel like the mechanics of a flat back are just plain bad for sciatica and discs. Is there still enough material in the nucleus and the annulus left to be rehydrated after having lost some of it through discectomy?
4. Do you have any experience with PEA (palmitoylethanolamide) for sciatica or failed back surgery syndrome? There is very impressive literature on it that is almost too good to believe. Any experience with either methylene blue or ozone epidural injections for sciatica?
5. Though I consider ozone to be more conservative than steroids, is this the kind of situation that steroid epidural injections may help with? I am not looking for symptom management, but actually stopping the disease process.
6. I took 1 month of fibrinolytic enzymes (lumbrokinase, serrapeptase, and nattokinse) recently for unrelated reasons. They in theory could dissolve scar tissue. Is there any theoretical reason why doing so might have affected the disc or surrounding region?
7. I have a lot of tightness and some cramping on the right side since waking up from surgery. It has somewhat improved with stretching, walking, and graston therapy. Is this normal?
8. Can the symptoms in the middle three toes of the right foot be explained by the given history despite not being on the relevant dermatome?
9. My scar is about 1.5 inches. I probably still have the spinous process itself, right? Just part of the lamina would have been drilled out, right? That is technically a laminotomy, and not a laminectomy, right?
10. Is the ligamentum flavum really vestigial? It seems so substantial. I wonder if it becomes important if the spinous process is removed?
11. What happens to the attachments that are removed when a laminectomy removes the spinous process? Are there just “unanchored” living muscles and ligaments floating around in people’s back. I can find zero mention of what these particular muscles or ligaments are even called. My dad has had 4 laminectomies and I wonder how unstable things become.

Thanks so much for your time. I am very inquisitive (and worried). I hope it is not too much.
Thanks,
David