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  • wave7
    Participant
    Post count: 5

    Dr. Corenman,

    I was an active runner, swimmer and duathlete. On March 17th I had left L4-L5 discectomy, prior to the surgery I had extreme left buttock pain and left lower leg and left big toe. Right before the surgery I started getting twitches right lower leg and right heel and big toe. The first 2 days after surgery the pain level was probably a 2, however the fifth day the pain was so bad I had to go to the emergency room. They ran a post-surgery MRI and said everything look good. My nerve was pinched for six months, the emergency room said it would take some time for the nerve to rejuvenate. During my post-op visit with my doctor I told him about my ER visits he prescribed a steroid packet but did not give me anything for pain. I continue to have pain in my left big toe, side of my left leg and left buttock and right heel. My question is if the surgery was successful why am I still in pain and when will I be able to run again? When will the nerve pain go away? April 17th will be one month.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    Symptoms that increase after a microdiscectomy could be from recurrent herniation, seroma (a compressive collection of post-surgery fluid), root swelling (inflammation) or from chronic radiculopathy (internal injury to the nerve root from the herniation mass effect). There is no way to know if symptoms are from root swelling or from chronic radiculopathy. Mass effect (recurrent herniation or seroma) is easy to diagnose from a post-operative MRI so we can rule those two out (unless the MRI was read incorrectly).

    The other possibility is a mechanical collapse of the foramen that compresses the root which is unusual but can occur after a herniation. This would be buttock/leg pain with standing that improves with sitting or lying down.

    In any case, I would consider starting with a transforaminal epidural steroid injection to calm the root down if the oral steroid was ineffective. Occasionally, more than one is required. Also a membrane stabilizer such as Gabapentin or Lyrica could be helpful.

    Dr. Corenman

    wave7
    Participant
    Post count: 5

    Thank you Dr. Corenman,

    My doctor scheduled physical therapy appointments, however I was only able to attend one, because I have extreme pain after and no med to help me get through the exercises. I usually feel the pain from the physical therapy exercises about an hour after. I am concerned that by me not being able to do these exercises, I may be causing future problems down the line.

    Could my but pain be from piriformis syndrome and is it safe for me to do exercises for piriformis after a month out of back surgery? What is the next step to cure my nerve pain?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    It is almost certain you don’t have piriformis syndrome. A new MRI would be helpful as you are not progressing and PT seems to be detrimental.

    Dr. Corenman

    wave7
    Participant
    Post count: 5

    Thank you Dr. Corenman,

    My surgeon has scheduled 4 more PT sessions, he has scheduled another MRI on May 27th and will release me if he doesn’t find anything on the MRI. I will have to find a long term pain management doctor. I have muscle atrophy in my thighs, but the physical therapist only works on my back. I am nervous that I will never run again and that my surgery is a failure. This nerve pain kicks my butt everyday.Can this injury be cured?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    The new MRI will be important (as well as new X-rays). Let’s hold off on supposition until the new imaging is available. Get the radiological report, copy and paste it here. There will always be a report dictated by the radiologist.

    Dr. Corenman

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