Viewing 6 posts - 1 through 6 (of 11 total)
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  • LA_Frankie
    Participant
    Post count: 21

    Hello.

    17 days ago I had a microdiscectomy and decompression at L5/S1. Prior to surgery I exhausted conservative treatments starting with PT, NSAIDs, and my first epidural injection. The sciatic pain lasted for 3 months, each month getting worse, until after the injection I could no longer walk and was bedridden for 10 days before surgery.

    Initial MRI was in March, the followup MRI in May reported the following, “At L5-S1 there has been slight increase in right subarticular disc protrusion resulting in severe right subarticular zone stenosis. The protruded disc contacts and posteriorly displaces the descending nerve roots, slightly worsened in comparison to prior examination.”

    The first 10 days or so following surgery I felt great. 85% of the right leg pain was gone, no pain in the back (although my symptoms were never in the back per se.) I have slight calf weakness (cannot stand on my tippy toes for more than 5 seconds.) I had this symptom during the 2nd month but I regained the strength in my calf prior to surgery. Heel feels numb, or as if I am walking on rocks. But nothing major, or nothing unexpected I should say.

    Suddenly, day 14 or so I began getting shooting pains in my ‘good side’, the left side which was unaffected prior to surgery. Shooting pains reminiscent of the nerve pain in the right (glute, hamstring area.) It is not persistent. It usually happens when transitioning my position, or when reaching for something.

    At this time, the pain in the right leg also started to increase in intensity. Still NOWHERE near where it was before surgery. I can stand for 20 minutes now without pain, walk for almost 1.5 miles. Prior to surgery, like I said, I couldn’t walk 10 feet! My pain level was a 10/10 which landed me in ER one day after the epidural injection.

    45 y.o. male, good health, normal BMI. Currently taking 220mg naproxen twice daily, 500mg Tylenol twice daily. Ice and heat as needed. Incision is pretty much healed. Experienced no complications following surgery.

    My question and concern is this: why am I now getting pain on my ‘good side’? I asked the N.P. that works with my surgeon and she told me that it should resolve in ‘a few weeks’ and is typical. It sure doesn’t feel typical and I am looking for more of a medical explanation as to why my left side is now symptomatic.

    Thank you for reading my story.

    LA_Frankie
    Participant
    Post count: 21

    I guess I won’t get a reply with a Post count of 1. :(

    Well, now it’s 2.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    Must of missed your first post-sorry.

    Contralateral pain is not typical after a microdiscectomy but can occur due to inflammation of the opposite nerve root, a seroma (collection of post-operative fluid that somehow traverses to the opposite side) or discal settling that can trap the opposite nerve root in the lateral recess or foramen. A rare, unusual condition is a recurrent disc herniation that develops from the opposite side (seen that twice in 30 years).

    There is an unusual crossover phenomenon that normally occurs with severe pain on one side that “transfers” to the opposite side due to the opposite nerve tracts that cross in the cord.

    Since the symptoms have improved substantially post surgery, give this some time to resolve. If the symptoms are annoying, you can ask for an oral steroid. If they are progressive or impairing, a new MRI might be warranted.

    Dr. Corenman

    LA_Frankie
    Participant
    Post count: 21

    Thank you, Dr. Corenman for your reply.

    As it turns out the pain in the ‘good leg’ has disappeared since I started being more cognizant of my posture and balance. I had been favoring the affected right side for so long that I was using my left leg exclusively to stand, turn, push off, etc. I think the shooting pain might have been from overuse of those muscles — specifically the glute/hip area where the shooting pains were located.

    This bring another question to mind, without posting a second thread hopefully you can provide your feedback.

    I have developed atrophy in my right glute. There is noticeable shrinkage of the muscle. The entire leg is weaker as well. The calf still presents weakness but feels like it is slowly improving. (I can stand on my toes now for 5 seconds before it weakens. Last week was only 3 seconds.)

    I have been injured a total of 4 months, and my question is will muscle atrophy related to nerve injury recover through exercise? Is muscle atrophy and nerve health directly related?

    Sincerely,
    F

    Donald Corenman, MD, DC
    Moderator
    Post count: 8468

    The right gluteal muscle consists of 3 different groups; the minimus, medius and maximus. The medius is connected to the L5 nerve and causes a limp called a trendelenberg gait. The maximus pulls the hip backwards when you walk, propelling you forward and is typically an S1 nerve innervation. If either nerve is affected, the corresponding muscle will atrophy (lose volume). The good news is that since they are so close to the nerve source, they have a much better chance of regaining nerve supply and recovering when the nerve is decompressed.

    Dr. Corenman

    LA_Frankie
    Participant
    Post count: 21

    Thank you, Dr. Corenman.

    My major concern is the lower part of the buttock which has flattened completely and will not activate when I try isometric exercises. Granted, it has only been 3 weeks since decompression.

    Are there any exercises specifically that you would advise your patients with gluteal atrophy to bring up with their therapists?

    Also could the atrophy be related to the piriformis? I did not have tightness before surgery but now I cannot stretch my piriformis without considerable tenderness/tightness.

    Thanks again. You are a great asset to those of us dealing with these issues!

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