L4/L5 decompression plus microdiscectomy

Slump test

Slump test

I had the above operation in June, but unfortunately my latest MRI shows that the disc L4-L5 shows small right sided paracentral recurrent disc protrusion surrounded by scar tissue, obliterating right anterior epidural space and lower half of right neural foramina compressing the descending right L5.

I saw the surgeon who then recommended a nerve root block injection which I had 2 weeks ago. Unfortunately, I have not seen any decrease in the pain.

I seem to be somewhere between your Grade 3 and 5 detail. I have virtually no pain in the lower back, but cannot stand for long periods of time. My right leg is a constant problem, mostly at night, when it feels hypersensitive and I can't get comfortable, even with pillows. I have an itch on the top of my right big toe, the top of my foot feels tender, my knee feels larger than it is and solid.

I find I can't walk too far anymore, but still enjoy swimming although a lot of the above sensations are felt whilst swimming too. About every six weeks I have a relapse where I am in agony and have to resort to painkillers for a few days, then start all over again.

I was doing Pilates but am reluctant to push myself anymore. What might be the answer? Many thanks.

There's no simple solution.

1. If you are able, do nothing and there's a fair chance the disc material will be gradually reabsorbed. It means six months of staying at home, hard discipline about exercising, not sitting too much and trying not to take too many painkillers. Not really what I would recommend, but worth a consideration.

2. Go for repeat surgery, this time recognising that rehab is vital after both surgery or chiropractic care; the pain goes away much faster than the disc heals. Get back in the deep end too quickly, back to sitting and bending before the hole in the disc has healed and more disc material ruptures through.

3. Have complete decompression and stabilisation with a cage or plates and screws.

4. Find a good chiropractor, with experience in this sort of thing, and give yourself a solid two months to recover.

I've treated many such cases, in fact been there myself which you can read at femoral nerve damage, producing very similar symptoms to what you are having. Each case is tough and to be judged on its own merits; I was lucky myself, went to a very good colleague (my daughter) and recovered completely.

In all the above scenarios you are faced with a couple months at home, and much gnashing of teeth. Good luck. Meantime take a look at our slipped disc rules.

How much pain in the leg does Slump test provoke?

Let me know how you get on.

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

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