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Dear Dr. Corenman,
I’m a 44 year old female. Lost 100 lbs since 2011 and very active in the gym 4-5 days a week.
On 11/13/19 I hurt myself with a single incident of stupidily lifting something heavy incorrectly. Loudest pop ever . Sent me on my bed with my knees pulled in. I could not stand with out excruciating pains overcoming my left leg. On a scale of 1-10 it was a 20. I visited ER that night after 4 hours of screaming and crying in pain. They started me on prednisone, lots of pain meds. Next day I saw a pain management Dr. who suspected foramin herniation since I could sit slouching forward comfortably. He started me on 600mg Gralise extended daily. After 5 days pain didn’t give up I had MRI. MRI showed mass herniation at L4-L5 “large left side extruded disc which obliterated the left epidural recess extending into the left L4-L5 foramen with mass effect of the nerve root in and outside of foreman ”. The rest of my back has some bulges and another small herniation at T12-L1. I couldn’t lay flat so the mri was sitting, which still sent me out of the chair 3 times.I had a steroidal Injection one week later, then another one 1 week later again. The latter one exacerbated symptoms and I was back to square one with beyond excruciating pain , and screaming about 1 hour after procedure. Dr thinks he pushed fragment or something. Another round of prednisone, Percocet etc. After a couple days I could bend, sit on a firm chair and lay fetal position and didn’t need cane but still could not stand very long. I consulted with a spinal surgeon who suggested a microdiscetomy. I scheduled it for two weeks out. I Had it on 12/17/19 which was 5 weeks from my accident. Dr said he had to remove disc from outside and inside. Was a “really, really huge ” fragment. Upon waking I felt great. I could stand without the pain. I was on Percocet and advil for first two weeks. At my 2 week post op appointment Dr. took me off all meds. I stopped Percocet and tapered off Gralise. I continued to take advil. At around 3 weeks i was having bladder problems. Had to go to my regular dr to rule out uti etc. It was a busy day of going to cvs twice and getting on Dr exam table. Later that day I developed a twinge in my lower back when I walked and still felt just off though only 3 weeks out. I felt I was walking slower and with more pain. My Dr. started me on 12 day strong steroid. I didn’t feel like it did anything but give me anxiety. I feel the sensations in my leg still. Shooting, sharp, numb, pains. I have always been able to stand on my toes and heels and still can. I have no left knee reflex and shin is numb. Fast forward I’m now 5 weeks post op and literally cry every day. I hate the way I feel. I can just about cross my legs to finally dress myself. I have a weird pain, sensation below my scar like above my butt crack. I don’t necessarily feel it shoots down my leg. I constantly find myself holding it with my hand. I can’t sit long, I’m uncomfortable almost always. Its different than how I felt pre surgery. Not as excruciating. I can lay flat, and walk albeit uncomfortably. I push myself to walk 1-2 times a day about 25 minutes each time. Plus I pace my house all the time. I try so hard to abide by the No bending, twisting or lifting. I fear I sat too long in beginning weeks.
I texted my pain management dr and he had me start Gralise again, this was 5 days ago. He wanted to do another steroidal Injection but i was so scared after how bad the second one went. Plus being just 4.5 weeks post op I couldn’t imagine more needles in thst area. So i passed knowing I had an appointment with my surgeon in a few days. Hi
I just had another MRI 2 days ago with contrast. The impression was:
At L4-L5 status post left sided microdiscetomy enhancing post operative inflammatory changes with a small recurrent left sided supiorly extruded disc fragment mildly deforming the sac and indents the left L4 root”
T12-L1 there is again a small right sided disc herniation deforming the sac.I spoke to my surgeon the afternoon after the mri and he pulled up the mri on the phone with me. I had coincidentally had an appointment with him today and saw him to discuss further. Both times He is adamant that he sees no red flags or concerns and that the disc fragment is so small/tiny it would not cause pain. He even alluded to if that’s what it even was???
I asked if I did something to cause a piece to break off and he said no.
Could he have missed it?He told me to relax as I haven’t been handeling any of this well. Which isn’t good for recovery. I don’t sleep well, am depressed,and Im so bored and just want my life back. He told me that my nerves were very compressed and I just need more time. He told me no PT yet and to see him again in 4 weeks.
I can not raise my left leg without shooting pain to my back. And just feel so raw and vulnerable. I can just barely cross my left leg to put pants or socks on and feel a twinge.
I told him my mri upset me as I have literally bulges at almost every level. I feel Like my spine is just going to give way and is too weak and Again he didn’t seem alarmed at all.
Can you please shed any light on this for me. And I thank you in advance. I have been reading this forum literally for the last 5 weeks and finally had the courage to post.
I’m just so depressed, bored and feel like I will never feel better.
If there is a way to send you my mri report id be happy to.
Thank you in advance
Regards,
StephanieI’m sure I’ve overwhelmed you but think I should describe my symptoms better.
First initial symptoms upon accident was an excruciating pain that cane from outside of left buttock to outside of hip and wrapped top of thigh and hurt so bad Upon standing I needed cane or only releif was to go on floor on my hands and knees. Or sit on firm chair with posture cushion. Could only stand 20-30 seconds.
Steroidal Injection one week later
And felt more mobile in bending after couple days, still couldn’t stand long maybe 1-2 minutes with pain returning.One week later another steroidal Injection. This is the one that exacerbated symptoms but different location. It over cane top of left thigh to top of knee and burned and squeezed with pain I literally wanted to die. Texted with dr and started prednisone again, Percocet every 4 hours and ketorolac. About 9 hours later the excruciating pain subsided enough for me to sleep. Days following was stiff again in totso area, needed cane, but then after maybe 4 days back to no cane, bending, could get up and down off floor. Was doing cat and cow stretches. Laying on back or stomach made that awful pain over come my outter thigh area.
Leading up to surgery I remember timing myself and stood in early morning for 10 plus minutes. Pain but not as excruciating. But by day end it would feel worse and i needs to sit often.
Microdiscetomy on 12/17/19. Woke up with just pain in incision area. Stood straight felt amazing. Everyone said how relieved my face looked. I still had nervy sensations into left leg but I didn’t feel that pain overcome my left hip over to thigh that made me stand bent over and crooked. What I forgot to mention above was first night after microdiscetomy i used restroom and my pants feel to ankles. Embarrasse to ask for help I put my right hand on sink and gently lifted my left leg ( im left handed so think that was natural but stupid to do) while trying to bring it up to me ever so slowly as i bend not over but down. Well i felt an electric shock from my knee down to shin into arch of foot. I told my surgeon the next morning my concern. He didn’t seem alarmed. I already had shin numbness and no knee reflex pre op. The sensation stayed with me but now comes and goes even to this day.
Because i was so concentrated on the pain upon standing it hard to remember what my leg felt like aside from the excruciating pain.It wasn’t until 3 weeks post op I began to feel a different twinge/pain in my lower back below scar. Doesn’t feel muscular feels nervy. It also doesn’t really feel like it radiates down the leg.
Prednisone for 12 days didn’t do anything.
So here i am 5 weeks post op with feeling very vulnerable in back area still with a heavy uncomfortable nervy feeling. I can walk stairs and lead with bad leg and it doesn’t necessarily exacerbate the feeling.
After my post i layed in bed and lifted my left leg a bit straight and did not get the zap but I didn’t go to high. I do however feel very uncomfortable getting dressed still as i sit and have to help cross my left leg onto right knee to get socks on and its dicey because i feel the teinge in that area.All i can do is walk albeit slower and a bit uncomfortable, lay in my zero Gravity chair, lay fetal position either side. I literally have been doing this for 5 weeks. Plus even more limited 5 weeks pre op. Everything aches from no use like laying on my sides.
To date My left leg is very nervy on top of thigh, down into shin which is still numb but different sensations too. And feel it into arch of foot a bit. Week or so post op my husband couldn’t touch my shin it would make me jump it was so painful now it doesn’t feel that way.
The sensations range from shooting to sharp zaps, cold etc. The leg feels weaker but I can walk stairs gently leading with left leg and I can stand on my toes and heels.Thank you again and hopefully I didn’t overwhelm you too much.
Regards,
StephanieWow, we have a lot to go over. I’ve copied many of your notes as you describe things well.
We’ll start with your initial pathology. “L4-L5 “large left side extruded disc which obliterated the left epidural recess extending into the left L4-L5 foramen with mass effect of the nerve root in and outside of foreman”. This was a large herniation that compressed the L4 nerve root. This explains why you note “I have no left knee reflex and shin is numb”. This fits with injury to the L4 nerve.
Your surgery I will assume was an L4-5 microdiscectomy. This surgery could have been tricky as it sounds like there were fragments both in and out of the canal. Typical approach is either inside or outside depending upon where the incision is. I will assume other than that small fragment, most of the herniation was removed. Your symptoms did get much better after surgery.
You now have symptoms “Its different than how I felt pre surgery. Not as excruciating. I can lay flat, and walk albeit uncomfortably. I push myself to walk 1-2 times a day about 25 minutes each time”. You are improved and you did have a significant crush of your nerve root. These take time to heal. The internal damage to the root may not vanish quickly. It can take 6 months for symptoms to abate and if you had quadriceps weakness (weakness of the muscles in the front of your thigh- can’t do a one legged squat on that side), these can take up to a year to recover.
You then note “I just had another MRI 2 days ago with contrast. The impression was:
At L4-L5 status post left sided microdiscetomy enhancing post operative inflammatory changes with a small recurrent left sided supiorly extruded disc fragment mildly deforming the sac and indents the left L4 root”. I can’t tell you how that fragment could be affecting the root. It depends on where it is, its size and how the root is distorted. For the most part, the radiologist thinks that the bulk of the herniation is gone.Your current symptoms “I can not raise my left leg without shooting pain to my back. And just feel so raw and vulnerable. I can just barely cross my left leg to put pants or socks on and feel a twinge”. The nerve root is still pissed off and oral steroids (of which you’ve had enough) have not helped. You could consider a TFESI (an injection of steroid right on the nerve root).
“So here i am 5 weeks post op with feeling very vulnerable in back area still with a heavy uncomfortable nervy feeling. I can walk stairs and lead with bad leg and it doesn’t necessarily exacerbate the feeling”. I don’t think you are too bad right now considering. Maybe your expectations are greater than they should be at this point. Ask your surgeon if an oral membrane stabilizer could help (Neurontin or Lyrica).
Give it 4 weeks and keep in touch.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Thank you Dr. Corenman. You have given me peace of mind. I sincerely appreciate you taking the time to reply and for this forum. Colorado is very lucky to have you!
Dear Dr. Corenman,
I just wanted to update you and seek your opinion.
Today I saw a neurologist for a second opinion.
He popped my mri’s in front of me which my surgeon never did.He stated the first mri was such bad quality. It was sitting and i was slouched with a pillow because of pain. Was surprised surgeon even operated with it.
MRI with contrast from last week very clear. He said bluntly I Re herniated. I said but its just a small piece of fragment. He stated its still a reherniation and sees it pressing on L4 nerve.
Also what was never told to me or said on either MRI report was at L3 there is stenosis that he said I’d be back in 5-10 years for another surgery. He showed me my other disc spaces then that one how narrow it was.
He said these are my options.
1) Conservative with steroidal Injection and PT. He stated the body should Re absorb.
He said risk is waiting with compressed nerve and not feeling better in say 6 months surgery anyway.
2) Redo discectomy. But may reherniate again.
3) Redo Discectomy AND then Fusion of L4-L5. He would go in, do another disctomey to clean everything up then fuse.
Option A above only or
Option B Fuse AND fix the stenosis above at L3 to give it a bit more room. He said the risk is it could weaken the fusion.He said some people just want peace of mind they wont reherniate and opt for fusion.
He said some people never want surgery again. And try conservative.
He said he can’t use same scar because for some reason he went far to the left. He didn’t know why he went out so far.
I’m just beside myself. 6 weeks post microdiscetomy and I still feel so raw to even begin PT. I did have weakness in my left leg when he pushed down. I could stand on my heels and toes.
Last few days i feel worse. More pain in back and nervy pains sensations into left leg as has been happening. I’ve even been feeling things in my other leg which is freaking me out but he said he doesn’t see anything contributing to that so now I have in my head i made myself worse since MRI
Could you please give me your opinion?
Is there a way I can pay for you to review my MRI’s?
Thank you in advance.
Best,
StephanieThe rate of reherniation if you have had 1 prior surgery is only about 10-15%. Based upon this relatively low percentage, fusion of all patients with 1 prior surgery would mean 85% of patients would have a fusion that don’t need it. Not a great statistic.
If there was enough debulking of the herniation during the surgery and you don’t have motor weakness, you could try a steroid injection. You don’t need to give it 6 months but give it 6 weeks.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books. -
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