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  • bole888
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    Post count: 1

    Dear dr. Corenmann
    I had disc herniation with extrusion on L5-S1 segment on October 2021. The symptoms were radiculopathy S1. Calf weakness, could not lift my heel of the floor. MRI showed disc extrusion with compression on left S1 nerve root. EMNG 6 weeks later showed denervation on calf muscle, neurography was within normal values, so neurologist said there was no significant nerve injury, and said it was moderate nerve injury (there was temporal dispersion, but no big action potentials indicating severe axonal loss and strong compensatory axonal sprouting). I was refered to physical theraphy. I did another MRI, in March that showed reapsorption of extruded disc material, with still a compression on a nerve, but not that significant. EMG still showed denervation in calf muscle to a lesser extent, Neurography was normal. I underwent surgery 7 months later (on May). Unfirtunately got reextrusion second day after surgery and was reoperated in 01 July. After surgery there was significant improvement in muscle stregth three fold. Control MRI is normal, without compression, but I still have calf weakness (can do 5-7 calf raises on affected leg). Control EMG shows very scarce fibrillation potentials and positive sharpe wawes (neurologist found them only on one place out of 5 tested on left calf), and the amplitude during max contraction is lower that on the right side indicating atrophy of the muscle.
    The problem I see is that I cant seem to streghten calf further (like I have plateued). Lateral head of left gastrocnemius is significantly smaller than right, but no longer shows signs of denervation.
    I am confused because neurologist suggests it is primarly atrophy, but I cant seem to streghten the muscle more.
    From your experience is this more likely to be permanent or ir more strenghtening of the muscle needed.
    If needed I am open to consultation call
    Kind regards
    *I am also in medical field, if needed I am open to consultation call

    Donald Corenman, MD, DC
    Moderator
    Post count: 8378

    If there is axonotemesis (nerve is injured but myelin sheath is intact), the nerve will regrow down the intact sheath at about one inch per month. Since the muscle’s nerve point is at the top and middle of the muscle, measure from your incision to the midpoint of your calf. That (in inches) is how long the muscle will take to regrow with one-inch-per-month formula. If the distance is greater than 18 inches, your muscle may not fully recover as 18 months is the time it takes for the muscle cell to scar over.

    It is also possible that you have neurotemesis where the entire nerve cell and myelin sheath are both injured in which case, there will be no healing. There is no way to tell with our current measurement tools. Give it time and allow nerve budding and hypertrophy to work. There is no easy answer but surgery in the face of weakness sooner than later is recommended.

    See: https://neckandback.com/lower-back/#:~:text=How%20Muscles%20Recover%20from%20Nerve%20Injuries
    https://neckandback.com/lower-back/#:~:text=Nerve%20Damage%20%26%20Healing

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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