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  • Jeff W.
    Participant
    Post count: 7

    Hello Dr. Corenman,

    On your website you say “The only way to know if the nerve will heal is to provide it the best environment to heal and then wait. Many times this means surgical decompression if a disc herniation or a large bone spur compresses the nerve. After decompression, only time will tell what injury the nerve had suffered and what recovery is possible.”…

    I had a compressed nerve root and 2 disc herniations that resulted in significant right leg radiculopathy. Over 9 months more conservative measures did not help, and including the status of my L4/L5 and L5/S1 discs, a highly-regarded surgeon advised fusing those 2 levels with rods/screws and a TLIF on L5/S1, as well as scraping down the calcicifications that had grown up around the herniations. I had that performed 11/29/2016 (~7 wks ago). The fusion seems to be healing nicely, however I still have the significant right leg radiculopathy! A Medrol Pack did not help. I’m now told to wait and see over the coming months, and hopefully the pain will decrease. (I’m currently on 1500mg Gapapentin, but still have several debilitating pain episodes per day.)

    My question is… besides following my fusion instructions (wear brace, take my vitamins, walk as possible, no BLT, etc), is there anything else I can do to “provide the best environment possible” for my decompressed nerve to heal?

    Thank you. I found your website very informative!

    Jeff W.
    Participant
    Post count: 7

    Oh, just another couple contextual points that may help:
    * My radiculopathy both before and after fusion follows the S1 perfectly from my right buttock down to the outside of the ankle/foot. Any my pain typically felt like a painful cramp. Also, it seemed to make my leg/skin hyper-sensitive… when in pain, moving my leg, or touching my leg in those areas, would make it hurt even more. These pain episodes (level 6-9) would occur several times per day/night, usually for 30-60 minutes. The rest of the day I would have various less intense pains.
    * My amount/intensity of radiculopathy pain episodes after surgery is maybe somewhat better (10-20%?)
    * I had no “weakness” or numbness before nor after surgery. Just radiculopathy pain.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Your continued leg pain has many possible causes. One potential cause is if you have a post-op seroma (blood or liquid causing compression) that is causing continued root compression. This condition is diagnosed by an MRI and treated by needle aspiration and steroid injection. Hypersensitivity (light touch causing pain) can be an indication of chronic nerve injury or CRPS (complex regional pain syndrome). These are treated differently. There also is a slight possibility that there was incomplete decompression even in the hands of a great surgeon.

    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.
    Jeff W.
    Participant
    Post count: 7

    Thank you Dr. for your response. I will look into those possible causes for continued pain.

    However, it doesn’t seem like you answered my primary question…
    assuming my nerve root is, in fact, now decompressed:
    Is there anything else I can do to “provide the best environment possible” for my decompressed nerve to heal?

    Thank you for taking the time and effort to help me. :-)

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    The best environment is a full decompression, minimal scar formation and good nourishment (blood supply) without inflammation. Surgery creates the decompression, scar formation has to do with surgical technique, some ancillary techniques and “luck” (you would hope your body does not create substantial scar). Good nourishment has to do more with the initial amount and type of compression as well as scar formation. Lack of blood supply and scar formation is what causes chronic radiculopathy. Inflammation is the one factor that can be controlled by epidural steroids.

    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.
    Jeff W.
    Participant
    Post count: 7

    Dr. Corenman, thank you for your prompt response!

    At this point, it seems addressing any inflammation is the most I can do…
    As a point of context, prior to surgery over several months I had 4 epidurals… the ones directly into the L5/S1 joint were relatively painless, however the 3 that went into the “area where the S1 nerve exits” were VERY painful for several minutes. The effect of the epidurals was minimal… the best response I had was from the 2nd epidural where day 4 and 5 were GREAT, but alas on day 6 the pain returned.

    A couple weeks ago I tried a Medrol Pack to see if that might help…. it did nothing for me. (Similarly, prior to surgery over the 9 months or so I tried the Medrol Pack twice… similarly it did little or nothing to reduce my pain episodes.

    Do you feel this suggests an epidural now (post surgery) would be unlikely to help (ie. perhaps inflammation is not my problem), or do you feel an epidural now (post surgery) still warrants consideration?

    Thank you so much.

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