When observing endoscopic surgeries with Dr. Yeung, he showed me a sciatic nerve root that was covered with a substantial layer of fat. He said something like, "This patient might have substantial nerve root compression with no symptoms because the nerve is insulated from the neurotoxic chemicals that are excreted via the disc herniation. Later that day, he showed me another nerve root and said something like, "Do you see the way this nerve root is all pink and exposed. There is little or no fat layer insulating the nerve root. This patient might have a minor bulge or protrusion that does not substantially compress the nerve root, yet may still have severe radicular symptoms associated with the chemical irritation of the nerve." This was 5 years ago... I'm paraphrasing... but this is a lesson that I'll never forget.
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