jpgsprParticipantJuly 24, 2020 at 3:22 pmPost count: 11
L4/L5 microdecompression (laminotomy/foraminotomy) and discectomy for 4mm bulge and severe congenital stenosis (complete effacement of csf).
First 9 day 1 post op was improving and mostly pain free. Was walking in 2-5 min intervals every hour or so. On day 9 decided to go for a first walk outside, approx. 0.90 miles. Got up from a couch quickly and also felt a “pinch” but nothing major.
Day 10: Sciatica/pain referred to leg and back at night time (after night above). Mild pain in the day time and continued 5 min walks hourly while lying on a couch working from home. Level 8 pain radiating from “surgical site” at night.
Day 11: Moderate sciatica pain/radinating from surgical site at day. Level 10 serve pain at night (could not sleep).
Day 12: Serve pain during day and continued at night. No walking.
Consulted with Dr. who thinks the surgery was fine but nerve could have gotten inflamed and was given oral steroid with MRI if pain persists over the next week.
Does this theory sound reasonable that walking intermittently inflamed the nerve? Is it possible that I herniated the disc or something else? The level of pain is quite serve prolonging more than the pre-surgical flare-ups. What are your over all thoughts?
Thank you!Donald Corenman, MD, DCModeratorJuly 24, 2020 at 8:10 pmPost count: 8455
The possible causes of increased leg pain after a period of relief after microdisc surgery are inflammation of the nerve, seroma, recurrent herniation and infection with some much more rare conditions like facet fracture.
Inflammation is common after decompression of the root. A compressed structure that was injured will “swell” and become congested. Oral steroids and time are the best treatment.
Seroma is a common condition. Fluid exudes from surgical sites and can build up and congests and compresses the nerve root. Seromas typically resorb after some time but occasionally need to be aspirated by needle.
Recurrent herniation occurs in 10% of patients and normally increase pain significantly. Recurrent weakness and a “tighter” leg (SLR) are very common. If the recurrence is not too large, sometimes an epidural can be helpful. A redo microdiscectomy is not uncommon.
Infection should be rare at less than 1-2% of all surgeries. Interestingly, many patients do not have fevers or chills but have increased back pain that translates to leg pain eventually. Lab tests are the beginning for diagnosis.
Dr. CorenmanjpgsprParticipantJuly 24, 2020 at 8:22 pmPost count: 11
Dr. Coreman, thank you, I appreciate you taking the time to read and respond.Donald Corenman, MD, DCModeratorJuly 24, 2020 at 10:24 pmPost count: 8455
Please keep us informed of your progress.
Dr. CorenmanjpgsprParticipantAugust 1, 2020 at 10:28 amPost count: 11
After a week and the steroid pack pain and inflammation has dropped to the tolerable 3-6 range (no pain medicine needed). PT has started. I still have dull achy pain near the surgical site (L4/L5 location) when I lie down and difficulty walking even short distances without similar pain from the same location. Buttocks and foot pain has all but diminished. Is this something to be concerned about or normal? Before the flare up I had no issues walking (Days 3-9 post op)
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