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  • Jbeans9999
    Member
    Post count: 13

    Dr. Corenman,

    I had a PLIF on my l5s1 3 months ago (Previously had 2 microdisectomies at same level) but since my original herniation the 2 discs above have been bulging; especially the l4l5 but I have never had any problems with my lower leg at any point in last few years.

    In the past few weeks I have been getting pain in my lower outside leg (same side; left) and also increased numbness in my foot moving further towards big toe (but no pain/numbness in big toe). Right now I “know” I herniated it and have appointment with surgeon next Monday.

    In your experience you likely have had many patients with repeated herniations who “know” when they herniate without a doubt.

    Based on your experience, my having that feeling of “knowing” I herniated my l4l5, and basic symptoms (pain lower outside of left leg), do you think I should be concerned?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    What was the purpose of the PLIF surgery at L5-S1? Was it for a recurrent herniation? Did you have nerve pain (radiculopathy) that was the indication for fusion surgery? You note you haven’t had “any problems with my lower leg at any point in last few years”. Did you have the fusion for lower back pain?

    You most likely did not reherniate your disc at L5-S1 as the PLIF surgery should have ablated this disc. Now, the cage (PEEK spacer) at L5-S1 could have displaced which would compress the nerve root or you could have herniated the disc above at L4-5.

    A good physical examination will help to indicate why you have developed new onset leg pain. You might need a new MRI.

    Dr. Corenman

    Jbeans9999
    Member
    Post count: 13

    The PLIF at L5-S1 was from a 3rd herniation of that disc (I previously had 2 microdisectomies at the same level; first in 2008 and the second in 2012).

    I had the fusion due to pain in the back of my upper left thigh, but really never had back pain.

    Now i have pain in my lower left leg (outside) and increased numbness in my foot across more of my foot (with other herniations numbness in foot limited to left 2 toes, now numbness all way to big toe). Also, I now have more pain in my back, but it is hard to know if the pain is from healing of the fusion or this new problem.

    I know I can not reherniate after the fusion which is why I suspect herniaton of the l4-l5, especially since it is the same type of pain and very localized.

    I saw my surgeon the other day and he ordered an MRI which I got this morning. I guess we will see.

    Thanks,

    Jbeans9999
    Member
    Post count: 13

    I was able to get the surgeon to look at the MRI and these are the findings they gave to me based on his looking (without the final report from the radiologist):

    1. The L5-S1 operative level looks OK, no obvious nerve impingement.

    2. The next two levels up, L3-4 and L4-5, look the same as before surgery.
    Some disc bulging, but no disc herniation, and certainly no NEW nerve compression.

    3. So I think this is some nerve inflammation, nothing that would require any further surgery.

    Most people would not say this, but I was hoping for herniation because now I am worried about permanent nerve damage. I have probably spent a combined total of a year (if take all time periods from herniation through surgery) dealing with this type of pain/sensation on a continual basis over the past 4 years. Even my physical therapist and I were discussing and based on what hurts vs. does not hurt for different movements it sounds like nerve pain.

    Could the continued (and worsening) pain be a sign of permanent nerve damage?

    If so, is it even possible that if I had problems at l5-s1 I would be exhibiting pain in areas more commonly associated with l4-l5?

    Is there anything you would recommend in terms of tests or literature?

    I am at a loss for words and in fear of becoming one of those people with chronic pain issues. Any advice would be greatly appreciated.

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