[LizzieJo]

#27025

Dear Dr Coleman
I had servere sciatica from June this year. Chiropractor arranged MRI as things were worsening. This showed prolapsed disc at l4l5 along with some stenosis.
Nerve root block seemed diagnostic but not therapeutic.
Had to wait till 24th November for discectomy surgery, in which surgeon also said he made more space with a foramenectomy. He said the prolapse was significant and the nerve was very inflamed.
Post op all the leg pain had gone, with some remaining pins and needles in my foot.
However at about 10days post op the leg pain returned, not as severe as pre op but definitely the same pattern. I also had hip pain (I had a THR2 years ago).Last night I then had servere calf pain and this morning the whole leg is painful, again not as bad as the worst pre op pain.

Is this likely to be the nerve healing? The surgeon said it could take quite a while for pins and needles to stop but he didn’t mention about leg pain returning.
Or is it more likely that the disc has reherniated?
I have been quite careful since surgery but am concerned I may have sat for too long a few days ago.
I don’t see surgeon again for month or so so any advice much appreciated.

[Donald Corenman, MD, DC]

#27026

Recurrent leg pain can be from a recurrent herniation but other post-operative causes can affect the nerve. You could have a post-operative seroma/hemotoma. This is a collection of blood/fluid that can compress the nerve. Post-operative swelling of the root can occur, especially if the root was severely compressed. What I do is to start with an examination. If the root is not really significantly “angry” (milder straight leg raise test which stretches the root-the angle of leg raise test is the same or better) and there is no motor weakness of the muscles associated with the nerve root, I start with an oral steroid. If no significant improvement, then a new MRI is ordered. If seroma-a needle aspiration and steroid injection is considered. If a recurrent herniation and it is small, an epidural steroid injection is considered. If the recurrent fragment is large, a redo surgery is considered.

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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