sidestick

Thanks for the reply Dr. Corenman,

I thought of some additional information that I could include that may be relevant. In the first 3 weeks of my post-surgical recovery, I had absolutely no issues standing for extended periods of time. I could have stood comfortably for hours at the time as I was trying to avoid too much sitting. My neurosurgeon had applied steroids to the nerve during the surgery as my nerve was quite compressed and ‘beat up’ in his opinion. Around the 3-4 week mark, I began to notice my intolerance to standing, and it gradually worsened to the point it is at now. I don’t believe it is getting any worse at this time. I find that it is less noticeable when walking, and I can walk with little discomfort for approximately 45 minutes. I still find standing for more than 15-20 minutes to be uncomfortable however.

I reviewed my 2 MRI reports from before the microdiscectomy. Both MRIs indicated normal spinal alignment, and that intervertebral disc spaces were preserved. My first MRI taken over a month before surgery noted a large paracentral disc extrusion contributing to moderate canal stenosis on my left side where it was impinging my s1 nerve root. Additionally, it was causing mild bilateral foraminal narrowing.

My second MRI taken a month later immediately before the surgery noted a mild disc bulge with the superimposed large disc protrusion. At this point it was assessed as causing mild right, and mild/moderate left neuroforaminal narrowing.

I guess my next question is regarding this foraminal narrowing. My MRI images noted that there was no significant narrowing at any other levels in my lumbar spine with the exception of the L5-S1 level where the bulge and herniation were present. Would my microdiscectomy have cleaned out and improved this foraminal narrowing, or is it something that could still be present at that level? Is foraminal narrowing or stenosis common to see in an otherwise healthy 35 year old male? I’m wondering if perhaps my left nerve root is inflamed or swollen and is giving me symptoms due to the fact that there is no longer as much space on that side between my vertebrae and am wondering whether it could become asymptomatic if I can get the inflammation down.

Another point of interest is that prior to my surgery, the only position that would provide me any relief from my leg pain and numbness was to put my back into extension. I would guess that this would mechanically make things worse with regard to foraminal stenosis, but in my case it seemed to help for some reason. Since the surgery, I have been slightly less tolerant to extension of my back, however it seems to be improving with PT. When I put my back into extension now, I don’t have any pain radiating down the leg, but do get a bit of lower back pain.

I will get in contact with my neurosurgeon and inquire regarding an oral steroid. I mentioned it at my last followup appointment, but he didn’t think it was necessary as I hadn’t been on my feet for long and appeared to be moving around quite well. Unfortunately here in Canada it can be tricky to get another MRI, but I’ll see what I can do if things don’t settle down in the coming weeks.

If I do have some height loss and foraminal stenosis at my L5-S1 level, is this something that typically requires additional surgery down the road, or can it be controlled for the rest of your life with activity, PT, etc?

Thanks again for your time.