[sunny4lady]

#31205

Hi Dr. Corenman.

I would like to ask you a question, but first of all, I wanted to say that I loved your article reg. L5 injury. I found it very helpful. But I still have some questions.

The case is as such: Last year april 2018 I fell 2 stories and landed on both my heals and buttocks. This crushed both my calcaneus and 2 lumbar vertebrae – L4 + L5 (I had other injuries such as 6 broken ribs and there was also prevertabrae bleeding retroperitoneal). I was lucky I did not become paralysed. They had to do 3 surgeries on my back – 2 on the backside and 1 from in front to stabilise the cage implant that was inserted due to my L4 + L5 being completely crushed – during these operations I also bled a lot.

I was recently diagnosed with L5 nerve damage, and they did some tests that show that the nerve damage does not stem from the periphery nerves but from the L5 nerve. BUT when I asked if the L5 nerve could be compressed, they said that that was not passible, since they made sure that there is enough space between the L5 nerve and the CAGE implant.But I am in doubt since there is no MRI scan to prove this. I asked if they could do an MRI scan, but they refused due to the fact that they say that they made enough space for the nerves during surgery of my back.

My symptoms since the accident are as follows:

I can not dorsal flex right foot very much (I can to some extent), can not extend big toe of right foot, can not supinate right foot, can not invert right foot very much, I can pronate a bit my right foot, I can plantar flex my right foot and there is some eversion of my right foot (much more in comparison to how little I can invert my right foot). Also, I have decreased sensation of the lower leg on the anterior-lateral side and the top part of my foot close to my toes. BUT, since the injury there has been SOME improvement to the sensation of my lower leg and foot, and there is also some improvement in the dorsal flexion of my foot. I do however still get nerve pain OCASIONALLY on my right foot in the form of ”electric shock” sensations.
Also, the pain that I have in my lumbar region has improved a lot since the accident, it was only a few months ago that I couldn’t even sneeze while laying down as it would cause jabbing pains in my lumbar region. I still have pain if I sit for too long or carry heavy things.

So, my questions are as follows:

1. Is it possible that during surgery the CAGE implant was somehow placed so that my L5 nerve is compressed?

2. I understand from my nursing career that if the nerve is cut of peripherally, there is a chance that the nerve can grow out again 1 mm a day if the Schwansk cells did not get damaged, which would mean that my nerve could self repair. But where does one draw the line on peripheral nerves? Does it mean that the nerves that continue RIGHT after the root of the spinal cord are also considered peripheral nerves and that there is a possibility that these nerves can then regenerate?

Hope you can answer my questions.

Thank you.

[Donald Corenman, MD, DC]

#31206

It does sound like you have an L5 root disorder. You are now 1 1/2 years out from your injury so it is unlikely that nerve Wallerian regeneration is going to allow the root to heal.

Even if they made plenty of room for the L5 root, bone spur formation can occur that compresses the root. I would find someone who would consider both a new MRI and a new CT scan of the lumbar spine. You have very little to lose and much possibly to gain from this imaging series.

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.

[sunny4lady]

#31211

Thank you for your answer! I have an appointment with another foot surgeon in 2 weeks for a second opinion. I will def. mention the bone formation and ask again for an MRI and CT scan.

Here is some additional information:
I have a slappage gait on my right foot, and I also have weakness on my right leg (the posterior thigh muscles are weak) and have to hold on to the stair railing when walking up the stairs to get extra support.

I don’t know how to add photos here, so I created a facebook page with an album of three photos. There is a photo of the CAGE implant in my back. Then there is a photo of my right foot after surgery of my back, and this photo was taken right after they removed the plaster cast on my feet (they were put because I had a lot of edema on the feet) and if you look carefully, you can see that the big toe is straight and not under the other toes. Then there is a photo I took today, and in this photo, you can see that my big toe is under the other toes as there is no mobility in that big toe. But I noticed today that I have some edema on the top part of my foot, where I am pressing my finger in the photo. There hasn’t been any edema for over a year so this is something new that just happened out of nowhere. Do you have an idea of why this is?

[Donald Corenman, MD, DC]

#31636

You might have a Trendelenberg gait, a disorder of weakness of the gluteus medius muscle due to an L5 nerve injury. (“I also have weakness on my right leg (the posterior thigh muscles are weak) and have to hold on to the stair railing when walking up the stairs to get extra support”).

The foot doctor can order the CT and MRI of your lumbar spine but don’t expect an expert opinion of the cause of your nerve root disorder.

Sorry but I had to remove your hyperlink as this is an anonymous site and I can’t have identifying information here.

Edema of the foot can be caused by may different disorders like DVT, CRPS or local injury so I cannot differentiate as to why you have local edema.

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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