Doctor responses to patient questions: Pinched Nerve, Discectomy or fusion, soft tissue and continued pain

On this page:

• Questions: Spinal Stenosis Surgery, Numbness from Spondylolisthesis
• Questions: Pinched Nerve, Discectomy or fusion, soft tissue and continued pain
• Questions: Sciatica related numbness, progressive loss of leg strength

Peter Ullrich, MD

The following explanations, insights and advice about numbness and leg pain are provided by Peter F. Ullrich, Jr., MD, an orthopedic spine surgeon and Medical Director for Spine-health.com.

Patients frequently e-mail us questions about leg pain and numbness caused by back problems. While we don’t provide individual responses, periodically, Dr. Ullrich will take time to respond to the more frequently asked questions and we publish the responses in this section of the site.

Please understand that the following responses to questions about feeling with numbness and leg pain represent the opinion of one physician, and are intended for informational purposes only and not as a substitute for professional medical help or advice.

Time to see a surgeon for hand numbness from pinched nerve?

The Question:
I have reoccurring numbness in my left hand and have taken Flexeril and have had two pain blocks with PT. Numbness and neck pain keep coming back. Also, I have started to have burning sensation in left shin and I don't know if it is related to back/neck problems or if it is related to my bad left knee (3 surgeries). I am 44 years old and extremely active (golf, aerobics and weight training). I go to a chiropractor occasionally, but the relief is only temporary. Any advice?

Doctor's Response:
The shin pain would not be related to the neck pain and you are probably right in assuming that it is due to something in the knee. The hand numbness might be due to a pinched nerve in the neck. A MRI scan would be the best test to see if there is a pinched nerve. If there is one and it has been going on for a while (over three to six months) surgery may be an option. Typically this is an anterior cervical discectomy instrumentation and fusion procedure that is typically a very reliable procedure for relieving hand numbness and pain. It sounds like you have already pretty much maximized your conservative treatment so it may be reasonable to see a spine surgeon at this time.

Discectomy or fusion to treat numbness and leg pain?

The Question:
I have seen an orthopedic surgeon. He wants to do a discectomy for numbness and pain in my left leg, but said that would not help my lower back and buttocks pain because of disc problems at L4-5. I think I'm saying this correctly. I have scheduled a discogram at his suggestion. I see a possible recommendation for a spinal fusion coming, which I don't want.

No one has suggested IDET or LED. Advice?

Doctor's Response:
It really all depends on your predominant problem. If chronic low back pain is more your problem, then it is reasonable to at least consider a fusion procedure. If you have had acute low back pain that is associated with the disc herniation and the leg pain, then it would be more reasonable to just treat the disc herniation with a microdiscectomy and then proceed with rehabilitation (physical therapy) for the low back pain. In most cases of acute low back pain, even if there are some degenerative changes on the MRI scan in the disc spaces, microdiscectomy leads to a good to excellent result and a spine fusion is not necessary. Also, a spine fusion surgery can always be done at a later date if rehabilitation fails after the disc surgery.

If you have two degenerated discs they are probably looking at a two level fusion. A two level spine fusion changes the mechanics in the back quite a bit because the L4-L5 level is a major motion segment in the lumbar spine, and fusing it transfers stress to the L3-L4 level.

A microdiscectomy does not change the mechanics in the back, and is designed to alleviate compression on the nerve root and allow it to heal.

The two principal factors you need to consider are whether or not your leg pain is worse than your back pain and if the pain is fairly acute (3-6 months). If both of these are the case, then microdiscectomy is probably more reasonable. If you have more back pain and have had it for years, then spine fusion surgery is possibly a better way to go. IDET will not address the leg pain and would probably be contraindicated if you have any degree of nerve pinching

Scar tissue and continued pain – should I consider surgery?

The Question:
I'm 20 years old and I had a discectomy on L4. At the time, the MRI showed I had two herniated discs, L4 and L5-S1, but they only operated on one of them because the surgeon believed this was causing the problem. I was doing fine and running until I started carrying a heavy backpack and sitting for long periods of time, and my back started to gradually get worse. I had a really bad episode of back pain and pain on both legs. My symptoms go all the way down my inner thighs and big toes, and then I get numbness and pain in the area below the waist, a sensation of having a ball on my left knee, along with this warm sore feeling all over my lower back.

My last MRI was taken a month before this bad episode started, and it showed that I still had the L5-S1 herniation, along with scar tissue from my previous surgery, so my neuro surgeon told me that if the pain got too bad that I should consider surgery. It's been 6 months and all this time I've been lying in bed and only being able to walk for 5-10 minutes (otherwise my symptoms increase and some of them don't go away). Lying in bed has started to give me upper back pain now.

Would surgery be something to consider? Scar tissue alone can't give me this many problems, can it? So far I've tried deep massage, acupuncture, traction, physical therapy, the swimming pool (which is the only activity I can tolerate) and medication. What should I look for in a surgeon if I consider surgery? The surgeon that I'm seeing now is not the surgeon that operated on me before. I've heard an endoscopic discectomy has helped many because it's less invasive - have you had patients that had this procedure?

Doctor's Response:
I would agree with you that scar tissue would not give you these types of symptoms and it is unlikely that it is a cause of symptoms at all. With widespread pain such as you are experiencing, it is unlikely that a disc herniation alone would be giving you all your symptoms. Taking out a disc is only about 50/50 in terms of success, and is usually much more reliable for radiating pain down one leg (radiculopathy-pinched nerve).

The endoscopic microdiscectomy is really no less invasive than a well done microdiscectomy using traditional tried and true methods. As a matter of fact, the visualization through the scope is so limited most patients are not even a candidate to have it done. In my opinion, it is mainly a marketing tool.

You first need to know if the disc is your only problem. If it is, it may be time to try a discectomy, but with the knowledge that it may or may not work. It would only be reasonable to try this if there is a large fragment, and not just a disc bulge.

There is a chance that more of your pain is coming from pain within the disc space itself. If the pain is from a degenerating disc then either fusion surgery or an artificial disc is probably a more reasonable option than a microdiscectomy alone.