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  • jbfd
    Member
    Post count: 2

    I had back surgery done in March 2006 for problems of spondylolithesis causing sciatica and hamstrings spasms to both legs. Surgery consisted of laminectomy, decompression and discetomy with instrumentation fusion of pedicle screws.It was done by an orthopedic surgeon and neurosurgeon.

    I had immediate relief of the sciatica and no longer had spasms of the hamstrings. I had very little post-operative pain and used Dilaudid only at night to get a good night’s sleep.

    Immediately after the surgery,I felt a new problem. There was an unusual amount of tightness and spasm to the dorsolateral left thigh. It would worsen during the day but went away during the night. I was able to walk for longer & longer distances without pain, but the left thigh would go into tightness, spasm and pain when I stopped walking. Sitting for long periods of time made it worse.

    My doctor thought I was having problems with scar tissue in the foraminal area of the fusion. In 2008, a fluroscopic guided steroid injection was done to L4-L5. It didn’t have any effect at all.

    Since then, my left leg problem has worsened and I now have persistent burning pain to both feet. A physiotherapist determined I have very weak hip abductor strength, left side worse than right. I have tried various exercises to strengthen the hip muscles, but they continue to feel fatigued and weak. I have consequently developed a lot of lateral knee pain.

    I had an MRI done in April 2013. The report indicates :

    Pedicle screws transfix L4 and L5.

    L2-3: No disc bulge or herniation exiting nerve roots appear normal.

    L3-4: There is Mild disc bulge but no focal herniation. Moderate narrowing of the exiting neural foramina bilaterally.

    L4-5: There is disc space narrowing with anterolisthesis of L4 on L5. Secondary to this there is mild narrowing of the right neural foramina and moderate narrowing of the left neural foramina.

    L5-S1: There is mild disc bulge but no focal herniation. There is mild narrowing the exiting neural foramina bilaterally.

    Impression: No recurrent disc herniation is present. No enhancing scar tissue is noted.

    Would you be interested in looking at my MRI and seeing why I am getting the unusual left leg pain?

    I am happy to say that I don’t have any pain in the low back. I can lift and carry heavy weights with no problems or immediate increased pain to the left thigh.

    My doctor says I have foraminal encroachment and wants me to have another fluroscopic injection. I wonder if the first injection wasn’t into the foramina?

    Can a foraminotomy be done in L4-L5 if there is already hardware from the fusion?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    By interpretation of your films and history, you had a degenerative spondylolisthesis of L4-5 with spinal stenosis. You underwent a typical posterolateral fusion with a central decompression of that level with what sounds to be very reasonable results.

    “Tightness and spasm” of the dorsolateral thigh can have many potential origins. Of course one could be nerve root irritation and the fact that this new symptom occurred immediately after your surgery leads to the suspicion that it could be from nerve compression after surgery.

    You underwent an epidural steroid or foraminal steroid injection in 2008 without any relief. The most important time to record relief after the injection would be the first three hours (when the anesthetic is working). If you remember back to the first three hours and no relief was afforded you in this time period (assuming the injection was placed in the correct location), then your pain is not from the nerve root injected.

    Burning pain that is bilaterally equal is more concerning for peripheral neuropathy. See website for description of that disorder.

    “Tightness and spasm” of the dorsolateral thigh could also originate from hip disorders. I assume you have had a pelvis X-ray. If not, that would be the next step. Trochanteric bursitis could also cause these symptoms. Deep palpation of this region could reveal the presence of this disorder and a simple in-office injection could resolve it.

    Yes-a foraminotomy could still be performed after a fusion of this level. I would be happy to review your films. Please call the 888 888-5310 number.

    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.
    jbfd
    Member
    Post count: 2

    Thank-you Dr. Corenman. I’ll try and make arrangements for you to view my films. Yes I have had hip xrays with no apparent findings of anything wrong.

    Ironically, the hospital called me yesterday and they have fitted me in for a foraminal injection today. It had been ordered by my family doctor last month.

    I’ll take note of whether I get any immediate relief from the injection. The radiologist doing the injection will be be able to see from the 2008 film, where the previous injection was done. Maybe a slightly different location will be tried this time.

    It might be too late for you to respond, but what steroid and/or anesthetic do you recommend and what is the appropriate dosage?

    I live in a small community and I met the orthopedic surgeon at the schoolyard last night while waiting to pick up our children. When I told him that I would be having an injection today, he was surprised that it has so long ago ( 5 yrs ) from the last injection. He is adamant that my problem is due to scar tissue and that a foraminotomy would likely only cause further scarring and damage.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    Your surgeon could be correct that this is scar tissue causing root compression but that is not very common. Again, with your symptoms being bilaterally symmetrical with burning to both feet, peripheral neuropathy can also be a diagnosis. See the new section on peripheral neuropathy on this website.

    The foraminal stenosis could be causing your symptoms. Again, keep a pain diary to determine if that nerve root is the cause of your pain. See the section on pain diary to understand how to record the results. A successful injection (three hours of temporary pain relief) will identify the root involved.

    This temporary relief does not mean however that the nerve compression is absolutely causing the root dysfunction. If the root has previous injury from the original herniation (see section on nerve root recovery and chronic radiculopathy), surgical manipulation or even scar tissue (rare), this injection will yield relief.

    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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