rypz79

Dr. Corenman

I’ve seen the surgeon a month ago he said that in his opinion the compression I have does not require further surgical intervention (discectomy or fusion) . He is conservative and probably doubtful if a fusion will get my spine better then it is now. I’m gonna get a 2nd opinion.

1) The foot seems slowly getting better but I’m still suffering from my back in essence I feel already somewhat fused if I do 50-60% BLT postures I’ll get discogenic pain (and probably inflammation) reaction(s) what is the point of not getting that level fused if it is stiff and prone to pain?

2) There is a cycle I don’t understand: in the morning the foot paresthesia is at it’s worst – painful to walk and put some non cushioned shoes or sandals it gets better (more sensation) as the day progress and at night while lying in bed completely horizontal it feels like the nerve is growing/recovering sense of pleasent heat and tingling it can last couple of hours or so the foot is much less sensitive to pressure (and consequently less painful) but in the morning the story returns all over again. what are your thoughts about it? do you think inflammation has to do with it though it looks like it’s the same cycle even when my L5 -S1 disc is very guarded (unless a very degenerative disc is almost always inflammed not matter if it moves or not)

3) Lastley do you know any of these supplements : L-Citrulline, Acetyl-L-Carnitine, R-Alpha Lipoic Acid , Benfotiamine helpful for non-diabetic neuropathy and or nerve regeneration?

Thank You Dr. Corenman

Dr. Corenman

2.5 Years post-op there is a good steady slow improvement on my right foot sensation. Now I know that all the top of my foot was also numb only half of it remains partially numb. I also know that it is the same kind of numbness as in the balls of foot area which I always complain about but you don’t feel it because you don’t walk/press on this area.
I still have problem with sitting on straight chair mechanical pressure sets in shortly after followed by discogenic pain after 1-2 hours. I still cannot put pressure on the balls of my foot, stand and walk freely on them, numbness (which doesn’t bother me) becomes pain that still remains THE major issue as it restricts me from doing physical sports and hiking as I used to do.

two weeks ago I did an MRI the results on L5-S1 were: No demonstration of abnormal contrast medium enhancement after gadolinium injection. a right disc herniation pressing on the sac, pushing the root of S1 in the canal space on the right as well as on the root of L5 out the right foramen. The roots on the left are free. facets are preserved.
Well if there is pressure when lying on the MRI bed it probably increases by several folds when you stand up (I don’t have back pain when standing) and obviously when you sit down.

If I opt to fusion (MIS TLIF) (after a successful surgery, recovery and PT):

1) will I’ll be able to sit more time freely without any mechanical pressure causing discogenic pain? i.e does “no motion no pain” principle applies mainly to vertical disc motion (instead of shock absorption in a normal healthy disc)?

2) From a nerve recovery perspective is there any medical logic of fully decompressing the nerves 3.5 years after the initial damage or to much time has passed and will have no effect on the L5 nerve root damage?

3) Other then stiffness what “new” pain fusion may bring after successfull recovery (6-12 months)?

Thank You

Dr. Corenman

25 months post surgery though I really started doing PT including inversion table 3-4 months or so after the surgery due to the covid19 outbreak.

There has been oveall improvement.
I think the nerve recovered from L5 root down to the foot. I now can sit with my right leg on the left one or lye (put pressure) on my right sciatic nerve without it aggravating my foot paresthesia.

The problem still remains in the foot I can feel somthing is going out there (burning, tingling, stabing pain) but still wearing a tight close shoe or putting pressure on my foot balls is painf and unpleasant. the process didn’t reach all the afferent nerve endings.

Based on the fact that we don’t know exactly what damage have been caused to my L5 NR during those 9-10 months of compression and assuming that we are talking about axonotmesis with these symptomatic findings over this period of recovery time my questions are:

1) From the known medical literature can sensorial (afferent) nerve get atrophied / become scar tissue? I mean can I feel numbness instead of pain or in other words the path to recovery is pain becoming numbness and maybe afterwards correct sensation signals?

2) Does lumbar radiculopathy (sciatica) that causes ONLY foot paresthesia classified as axonotmesis with recovery time greater than 24 months will ALWAYS end with some kind of neurological deficits?

Thank You