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in reply to: Down Under L5-S1 disc protrusion. #4635
Your wife by your account has a significant but typical disc herniation of L5-S1 right that is compressing the right S1 root. (See web site for lumbar herniated disc information). This can create excruciating pain as you and your wife are unfortunately well aware of.
If there is no weakness of the muscles, then this condition can be treated with medication, injections and therapy. If these treatments are ineffective or the patient is in extremis (severe pain and cannot obtain relief in any position) then surgery is required. Do not be apprehensive regarding surgery. 90- 95% of the time, the patient awakens without leg pain and breathes a sigh of relief.
The one important issue for immediate treatment in my book is whether she has weakness of the gastroc/soleus group of muscles (the calf muscles). The easy way to test these muscles is to have your wife tip toe for about 10-15 feet. It will be painful but have her try to do this action and ignore the pain for a very small instant. Watch her heels as she tip toes. The calf muscles hold the heels off the ground when tip toeing. If she cannot hold the affected heel off the ground on the painful side no matter how hard she tries, she may have weakness of this group of muscles.
Surgeons may differ on this but most of us feel that weakness of a major motor group is cause for surgery sooner than later as the motor nerve has the best chance for recovery with timely decompression surgery.
I understand the national health insurance issues in Australia make timely visits to a physician sometimes difficult, so try to contact a surgeon and have a conversation as soon as possible. If your wife has weakness, try and push up the timing of this visit.
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 herniated disc #4633Your physician recommended against physical therapy because of a bad response the first time you sought care so it makes sense that further care from the same therapist might still aggravate the radiculopathy. Therapists are not always similar and some are more talented than others. A different therapist may improve the outcome. Discuss this with your doctor.
Chiropractors are the same. In the face of nerve irritation from a disc herniation, some chiropractors can improve symptoms and some can aggravate them. It really depends upon the chiropractor. Some chiropractors incorporate massage in their treatment programs and massage typically will not aggravate nerve compression.
Back pain can occur from a disc herniation which presses onto the posterior annulus but this is not typical. (See the section on back pain in neckandback.com). Back pain normally occurs from discal instability. The typical treatment is a good therapy program. In addition, an epidural steroid injection can be helpful for the back pain and the radiculopathy.
Hope this helps.
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: pain after spinal stenosis op. #4631Were X-rays of your lower back performed? If so, did they reveal a degenerative spondylolysthesis or isthmic spondylolysthesis of the L5-S1 level? See website for more explanation. On the front to back view (the AP or anterior-posterior), was there a significant angulation of L5 on the sacrum? The presence of any of these can indicate the need for an additional fusion of this level to remove the foraminal stenosis.
Ask your doctor if there is instability of the level. Instability can also lead to a collapse of the foramen and the need for fusion.
If there is instability, a degenerative spondylolysthesis or isthmic spondylolysthesis of the level, then simple decompressive surgery like you originally had can occasionally cause foraminal stenosis as a side effect of surgery or at least not cure preexisting foraminal stenosis. This is no fault of your surgeon but simply one of the risks of decompressive surgery in the face of instability.
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 herniated disc #4629The disc herniation you describe initially (first two months) was improving without surgery like 70% of disc herniations will. There is a 10% rate of recurrent herniation however. This includes patients who have had and HAVE NOT HAD surgery. It is a possibility that you have extruded another fragment. None the less, you could have stretched the nerve somewhat over the existing herniation and re-aggravated the nerve.
As long as there is no motor weakness or bowel/bladder involvement, then you could continue conservative treatment. You do however mention bladder involvement. It is very unusual that the herniation is so large that it would compress the entire canal which is what it would take to cause cauda equina syndrome (see web site) and bladder involvement. I see this condition about once per year and see at least 400 patients with disc herniations.
If you do have cauda equina syndrome, you should have numbness around your rear and back of the thighs and significant pain around the “saddle region”. This condition is an emergency and you would need to see a specialist “yesterday”.
In my opinion, you should see a reasonable specialist for a surgical opinion. This would develop a relationship with that physician and the information would be helpful. You have to remember that a spine surgeon is there to help you understand what your options are to make a surgical decision and not to force you into surgery.
Let me know how you do.
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.An extruded disc at L5-S1 with motor weakness would normally need a microdiscectomy in my practice. In most cases without motor weakness, surgery can be avoided but with motor weakness, I feel that the best chance for motor strength recovery is with surgery.
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.Your father has had three prior spine surgeries. You do not mention which ones but apparently they were all discetomies and no fusions were involved. It sounds like he might have instability or stenosis associated with collapse. Please have him send his images to my office by Fedex (hopefully he has current X-rays and an MRI). My office number is 970 476-1100.
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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