Cksd5ParticipantAugust 15, 2020 at 4:12 pmPost count: 2
Hi Dr Corenmen, I have been reading the forum on this website for some time now and mustered up the courage to ask for some insight out of desperation.
My current situation is as follows; I am a 31 year old male. I was in pain for 8 months prior to my L4/L5 Microdiscectomy. I was told I had a herniation that was compressing my sciatic nerve which caused me pain down my left buttock, hip and calf.
I had my Microdiscectomy 6 weeks ago and felt great after my opp. Around the 4 week mark I started experiencing similar pains I had prior to the procedure. This gradually got worse and I now find myself in a position where I’m questioning whether the operation was a success?
There are differences to the pain I was experiencing prior to the operation. When I do the “straight leg test” I don’t get pain. However in the mornings soon after I wake up the pain is bad and tails off after a couple of hours. In the evenings I feel it coming on again but it’s not as intense as it was prior to the procedure. I do notice when I cough or sneeze I get a shooting pain but again, it’s not as intense as it used to be. If I stand or walk for longer than 15 minutes and then sit down I can feel pain in the hip and buttock. I feel walking aggravates it. (To clarify, this is the sciatic type of pain that radiates down my hip)
I didn’t feel any sudden pain that would suggest it had reherniated, it just got worse as the days went by?
My question is could this be nerve inflammation? If so, based on your experience, how long does it take for this to settle? My surgeon has suggested i take anti inflammatory drugs but they don’t seem to help much.
Some side notes, I have no problems raising my legs or don’t feel any weakness in my legs. I don’t have trouble sleeping but get stiffness in the back at night (which I’m sure most people get)
Really appreciate your time. Kind regardsDonald Corenman, MD, DCModeratorAugust 16, 2020 at 10:42 amPost count: 8459
“I didn’t feel any sudden pain that would suggest it had reherniated, it just got worse as the days went by?”
The possible causes of increased leg pain after a period of relief after microdisc surgery are inflammation of the nerve, seroma, recurrent herniation and infection with some much more rare conditions like facet fracture.
Inflammation is common after decompression of the root. A compressed structure that was injured will “swell” and become congested. Oral steroids and time are the best treatment.
Seroma is a common condition. Fluid exudes from surgical sites and can build up and congests and compresses the nerve root. Seromas typically resorb after some time but occasionally need to be aspirated by needle.
Recurrent herniation occurs in 10% of patients and normally increase pain significantly. Recurrent weakness and a “tighter” leg (SLR) are very common. If the recurrence is not too large, sometimes an epidural can be helpful. A redo microdiscectomy is not uncommon.
Infection should be rare at less than 1-2% of all surgeries. Interestingly, many patients do not have fevers or chills but have increased back pain that translates to leg pain eventually. Lab tests are the beginning for diagnosis.
For you, since the symptoms are moderate and impeding your recovery, I would think a new MRI would be warranted.
Dr. CorenmanCksd5ParticipantAugust 16, 2020 at 12:55 pmPost count: 2
Thank you Dr. Really appreciate your response. I have an MRI planned in the next 2 days. I will report back once I have the results.
I am hoping that this isn’t a reherniation, I have read that the outcomes for second Microdiscectomy aren’t great and eventually patients require fusion surgery. After reading about fusion, I am completely petrified due to the experiences patients have reported. There seem to be more horror stories about fusion surgery than positive.
As always, highly appreciate your time.
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