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  • professorW
    Participant
    Post count: 14

    Hi, Dr. Corenman. I had previously posted but starting a new thread for a new issue. I’m 5 weeks s/p 360 L5/S1 fusion. Had a post op MRI at 4 weeks due to continued back pain, and it shows no compression. However, I have begun, over the weekend, to have burning pain in my feet, especially my right, on the outside of my foot. At times, it is unbearable. My MRI notes “At L5-S1, there is fairly prominent right anterior epidural enhancing scar tissue which extends around the right S1 nerve sleeve and into the new right hemilaminectomy defect. Again, however, there is no epidural fluid collection. The right S1 nerve sleeve is not significantly displaced or effaced.”

    -Could this be what is causing the burning/squeezing pain in the lateral aspect of my right foot?
    -Is this “scar tissue” indicative of permanent scar tissue or just inflammation?
    -I had had some of this burning earlier in my post op course, but it got much worse. Is it normal to come on this late?

    My doctor has ordered 300 mg Neurontin to be taken at night, when pain is most disruptive.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    You note “I’m 5 weeks s/p 360 L5/S1 fusion. Had a post op MRI at 4 weeks due to continued back pain, and it shows no compression” You then note “At L5-S1, there is fairly prominent right anterior epidural enhancing scar tissue which extends around the right S1 nerve sleeve and into the new right hemilaminectomy defect. Again, however, there is no epidural fluid collection. The right S1 nerve sleeve is not significantly displaced or effaced.”

    I am somewhat confused. Did you have an anterior then posterior approach (belly incision and then back incision which is a “360” or did you have a TLIF (the incision is only in your back)? The MRI implies that you had a decompression of your S1 nerve which can only be performed from the back and would be unusual with a “360” surgery.

    You then note; “I have begun, over the weekend, to have burning pain in my feet, especially my right, on the outside of my foot. At times, it is unbearable”. This is the distribution of the S1 nerve root which has granulation tissue around it as noted above in the MRI report. It is too early for scar tissue so this must be inflammatory tissue. If the S1 nerve is yelping at you so close to your surgery, I would consider an epidural steroid injection sooner than later.

    Dr. Corenman

    professorW
    Participant
    Post count: 14

    Hi. I had a belly incision and also a back incision. They removed the disc through my abdomen and I believe put in the cage that way, then did decompression and fusion from my back. I have the burning pain in both feet, just worse on the right. My surgeon told me they “cleaned both sides out,” but the MRI did not note a hemilaminectomy defect on the left, only the right. Does that mean only the right side (where I had the herniation) was decompressed? If so, I’m not sure why I have the burning pain in both feet, in the same distribution, unless the left-sided nerve could be irritated from the fusion?

    professorW
    Participant
    Post count: 14

    [quote quote=33070]Hi. I had a belly incision and also a back incision. They removed the disc through my abdomen and I believe put in the cage that way, then did decompression and fusion from my back. I have the burning pain in both feet, just worse on the right. My surgeon told me they “cleaned both sides out,” but the MRI did not note a hemilaminectomy defect on the left, only the right. Does that mean only the right side (where I had the herniation) was decompressed? If so, I’m not sure why I have the burning pain in both feet, in the same distribution, unless the left-sided nerve could be irritated from the fusion?[/quote]

    …I would further ask–does this type of fusion (in through the front and then cleaning out and fusing the back) involve removal of facet joints on both sides?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    You had an anterior fusion-ALIF (“They removed the disc through my abdomen”) and a posterior decompression and fusion. You then note; “My surgeon told me they “cleaned both sides out,” but the MRI did not note a hemilaminectomy defect on the left, only the right. Does that mean only the right side (where I had the herniation) was decompressed”?

    It appears the you had a left decompression only based upon your MRI reporting. However, the anterior cage typically distracts the canal which can indirectly open a narrowed passage without decompressing from the back. It really depends upon the pre-op findings and how much distraction was performed from the ALIF.

    Symmetrical burning bilaterally in the feet sounds more like a peripheral neuropathy that a nerve injury but a stretch of the roots is still possible.

    Dr. Corenman

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