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in reply to: L5 S1 Herniated Disk #4598
Weakness of the calf muscle (gastrocnemius/soleus muscle) caused by a herniated disc is a problem that in my opinion, needs to be addressed surgically. Pain, numbness and paresthesias (pins and needles) symptoms by themselves can be treated with injections, physical therapy and time. About 70% of the time in that case, conservative treatment can be beneficial. However, in the face of motor weakness, many surgeons including myself recommend a microdiscectomy. Recovery of motor weakness is less certain and a deficit of the S1 root creates problems with walking (the push-off), climbing stairs, hiking, running and in a pilot, more difficulty with rudder pedal control.
There still is a reasonable chance that motor strength can return without surgery but the odds of good useful motor strength return is less with “conservative care” (injections and physical therapy) than with surgery. There are no studies as of yet that indicate the timing of surgery may make a difference but logically, the faster the root is decompressed, the better the chance of good recovery.
I think it might be worth getting a consultation from a spine surgeon to get another opinion.
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: Question from Email – Back Pain #4596Answer-
I still will have to interpret your answers but I think I have a better understanding of what is going on. You had a laminectomy in 1979 and note your “left gastroc never really came back”. You note the muscle atrophied which means you had a large herniated disc at L5-S1 that injured the left S1 nerve and even with the microdisectomy surgery, the nerve never recovered. You had no back pain after surgery until 2009.
In July 2009, you developed back pain and you were treated by a chiropractor. You had a re-aggrevation of your back pain in Oct. of 2009.
In Jan. of 2010, you had an MRI and a CT scan because of the back pain. You had a “bulge” in the L3-4 disc (“bulge” could mean torn disc, herniated disc or spur formation) and a “crack” in the vertebra at L5-S1. The “crack” could mean a pars fracture or an endplate fracture- I cannot tell from your description. You finally had a nerve block at L5-S1 which diagnosed the pain generator as the L5-S1 level.
October 2010- you had a fusion of L5-S1 but you don’t mention which type of fusion (check neckandback.com for the type you might have had). You then started swimming 4 weeks after “things looked good”. Does that mean four weeks after surgery or four weeks after the surgeon thinks you have had a solid fusion?
You mention a sacroiliac injection after the fusion but don’t mention what the results were. Did you get relief for the first three hours?
You then mention a hip MRI. It sound like you have buttocks or hip pain now. Did you have the same symptoms prior to the surgery?
You then mention right sided pain with walking but you fell no pain on a bike. Is this the hip pain you mentioned? This could be consistent with foraminal stenosis. Again, check the web site (neckandback.com) for this diagnosis and let me know if that might fit with your symptoms.
I would be happy to look at your images. Please contact my office at (970) 476-1100 and ask for one of my nurses.
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: Question from Email – Back Pain #4594You don’t mention why surgery was performed, at what level, what your preoperative symptoms were or your current symptoms are now. You don’t mention if the new CT Myelogram demonstrated solid fusion or pseudoarthrosis (lack of fusion), any nerve compression or arachnoiditis. Please be more specific so I can determine what could be causing your pain.
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 spondylosis getting worse? #4591Based upon what you indicate, you might be a candidate for an eipdural injection/ pars block (see web site). This injection may be the quickest way to reduce your symptoms.
Alignment of the discs indicates a spondylolysis but does not indicate disc health.
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 spondylosis getting worse? #4589From the interpretation of your e-mail, you were initially diagnosed with the pars fractures when you were 15 years old and you are now 20 years of age. You don’t mention if you have a slip of L5 on S1 (isthmic spondylolysthesis) or fractures without slip (isthmic spondylolysis).
Treatment is now a somewhat controversial area for this disorder as we have developed very good ways to repair the fractured pars. However, repair surgery is not recommended if the disc has become degenerative or there is a substantial slip of the vertebra. In addition, repair does not absolutely guarantee full pain relief.
Let us assume that you have degenerative changes as many individuals do with long standing pars fractures. What normally happens to cause pain is that after the fracture is initially discovered (when you were 15), the fractures remain but the pain disappears. After an incident such as lifting or twisting, the pars pannus (see web site for this) tears or the disc itself tears.
The treatment, in my opinion is first to reduce the stress on the vertebral segments. Collagen fibers (that make up the torn pars pannus) take about 3 weeks to heal and 3 more weeks to develop tensile strength. Rest is good for a short while. Using a soft corset is also helpful. Isometric strengthening exercises for the core muscles is helpful initially. Eventually, the therapist will have to introduce loading and rotational exercises and hopefully, by 8-12 weeks, the repair has occurred and the pain has receded. I don’t mean that the fracture heals- that won’t happen, but the pars pannus can heal. Some individuals heal somewhat faster and some might continue with some discomfort.
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: what does this exactly mean? #4586I don’t know- everything I have discussed is speculation. You need a diagnosis and treatment.
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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