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Severe degenerative disc disease with severe right foraminal stenosis can cause two types of pain- lower back pain from the disc and buttocks/leg pain from the stenosis. Normally, if the other discs are intact/normal and the pain is generated from the L5-S1 level only (the history and physical examination is appropriate and diagnostic testing confirms), then the success rate for surgery should be about 90% for 2/3 relief of pain.
Testing might include a selective nerve root block for the L5 nerve and a discogram for disc pain generation.
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.in reply to: neck and lower back #5163You need a good spine surgeon to look over the results of your MRI and perform a thorough history and physical examination to determine what your diagnosis is and what needs to be treated.
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.Tests are very important but in context.
For example, if a patient has spinal stenosis and significant back pain only with standing that would be relieved with bending forward or sitting, I would order an epidural steroid injection to temporarily “numb” the spinal canal. Pain relief may lead me to consider a decompression.
If there was buttocks and leg pain as the symptom, a selective nerve root block would help to diagnose which nerve was causing the pain.
Back pain with standing and loading of the spine might require a discogram to determine if the disc is causing pain.
Finally, if there is pain with extension (bending backwards) as well as standing, consideration of facet blocks needs to be in the discussion.
A patient with isolated disc resorption at L5-S1 with Modec changes, endplate fractures and absolutely normal discs above with the appropriate history and physical examination might not need any diagnostic testing for a surgical discussion.
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.in reply to: Time for surgery? #5157Happy belated Thanksgiving!
Now to your questions.
Degenerative disc disease which appears to be causing the pain is related to both occupation, advocation and genetics. I believe that genetics plays a large role.
The pain in the central back most likely is related to the degenerative disc disease in the lowest portion of the lower back- most likely at L5-S1 but the symptoms could even originate from L4-5. Sacroiliac pain almost always is not from the sacroiliac joint but from the disc itself or from mild irritation to the adjacent nerve root.
These disc will not heal and the treatment is core strengthening and medications. Non-steroidal anti-inflammatories (Aleve) can be very effective in some patients to relieve pain. Epidural steroid injections can also be very effective. A consult to a spine surgeon or a physical medicine doctor may be very helpful.
The good new is that even though the symptoms are painful, they are not dangerous. That doesn’t help you when the pain can be incapacitating but at least you know that you are really not doing any more significant damage.
There is occasionally surgery for your symptoms, but you would need a good surgical work-up and you may not be a candidate for surgery depending upon the results.
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.in reply to: L5-S1 Microdiscectomy post op #5156Short term memory always suffers immediately after anesthesia. I have had patients mad at me for not seeing them immediately post-op even after I had spent ten minutes talking with them in the recovery room.
I cannot answer for your surgeon but I will tell you what I would answer to my patients.
Tightness and some mild burning in the leg is not uncommon after a surgical decompression for a disc herniation. Most patients have had significant pain prior to the surgery and after the pain is gone, these symptoms are uncovered. The symptoms were actually present before the microdiscectomy but were not noticed because the searing pain covered these symptoms up. It might take as long as three months for these symptoms to fade away.
Intermittent numbness can take as long as six months to disappear. The area of numbness will shrink down over time.
I cannot speak for your surgeon as far as going back to work but for my patients, they can go back to a sedentary job within one week to as much as six weeks. It depends upon how well the symptoms are relieved and if the job allows frequent position changes and part time work in the beginning.
I want my patients to walk after surgery a reasonable distance. Short walks are better and multiple “laps” instead of one long walk are preferred. Sitting time is to tolerance.
Ibuprofen is OK to use after about one week from surgery. Ibuprofen will not cause scar tissue to form.
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.in reply to: neck and lower back #5152You have to remember that the MRI does not always correlate with the symptoms. You could have a large disc herniation compressing a nerve root and have absolutely no arm pain. I will interpret what is on the MRI and what symptoms that could be caused by the results.
According to the radiologist, the only problem he or she noted on your MRI of the cervical spine is a broad based disc bulge with foraminal stenosis of the left exiting nerve root. This could cause central neck pain and shoulder pain with some arm pain and numbness on the left. The shoulder and arm pain would be worse with looking up and improved with putting chin on chest.
The lower back has more degenerative changes. You have very degenerative discs at L5-S1 and L1-L2. These can cause significant lower back pain at the belt line and at the highest area of the lower back. Your L5 nerves “light up” with gadolinium which outlines inflammation and you have had previous surgery here. Either the nerves were previously injured before the prior surgery or the current compression is actively injuring the roots. This would cause buttocks pain and posterior leg pain to the foot.
At L3-4, there is a left sided compression of the root. This could cause buttocks pain on that side with radiation into the anterior thigh.
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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