[Psc55]

#9686

Dr. Corenman,
Thank you for the opportunity to ask questions. I had spinal fusion 16 days ago on L4-S1 and it’s been a semi- rough road to recovery. I have a new symptom and called my doctor for direction but he didn’t seem too concerned about it. And told me if I felt strongly about it to go to the emergency room.

The pain that drove me to the spine doctor initially was the sciatic nerve compression 24/7 down my left leg. I am not having pain in that leg, rather, I am having severe leg cramps in the right calf and upper right thigh. I haven’t slept the last 3 nights due to the pain. I’ve walked my neighborhood and the inside of my house for hours on end yet the cramping will not subside. I eventually take 2 Oxycodone with aceptametamine and Robaxin but I know I’m taking too much of them. During the day the cramps aren’t felt too badly but at night they are excruciating . I rubbed my upper thigh last night with K(c-II) BCFGL 10%_2%_10%_6%-2%. There was no relief. I finally feel asleep on the couch out of sheer exhaustion. Are leg cramps in the unaffected area normal after double spinal fusion? If I need to push through the pain, I certainly will. But I’ve read nothing about opposite side of leg cramps after spinal fusion.

I thank you from the bottom of my heart for your advice,

Sincerely,
PSC55

[Donald Corenman, MD, DC]

#9688

Leg cramps can originate from nerve irritation, vascular changes or even a blood clot (DVT or deep vein thrombosis). The first thing to do is to ask the doc if he would consider a venous duplex ultrasound to make sure there is no DVT.

A simple examination of the foot of the left leg would indicate if a vascular condition would exist.

If the exam notes nerve irritation (sensory deficit, tension signs or motor deficit) then a new MRI might be in order to determine if there is any irritation to the right nerve roots.

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.

[Psc55]

#9699

Dear Dr. Corenman,

Thank you for responding to my plea for help. Seventeen days post op, I did go to the emergency room for further testing. I was tested for blood clots in both legs, which came back negative, and all blood work came back normal.

When asked why the leg that never hurt before has cramps from the calf to the thigh, I was told it was muscular and there was no clear answer for the reason. The doctor did, however give me more Oxycodone and the muscle relaxer, Flexerall.

On the 14th day post op, I returned for my 2week checkup with my surgeon and I told him my concerns, he said, “what do you want me to do? Of course you’re going to have pain, I just operated on you!” He laughed and left the room. The PA was still in there as was my 36 year old son. She said to come back in a month and if I had any questions, give them a call. I left there in shock and asked my son for his opinion. Not wanting to upset me further, he just said the surgeon had a horrible bedside manner.

My surgery was performed with the Renassaince robot at the Celebration Hospital in Florida, one of only 2 in the state. I can honestly say that had I known the aftermath of spinal fusion performed by my surgeon, I would have taken the 24/7 sciatic pain down my left leg hands down before these new pain symptons.

I wanted to let you know that I so appreciate the information you have provided previously and had I lived in Colorado, my choice of surgeon would have been you.

Thank you for your time,
PSC55

[Donald Corenman, MD, DC]

#9700

I am not a fan of robots in the operating room as surgery is such a specific, meticulous and careful art form . Robots cannot comprehend what structures are visualized and surgery is really as much about “feel” as about visualization. The tactile feedback as to what structures my surgical tools are touching guides me to know what needs to be done. Visualization along with this tactile feedback is what allows a surgeon to perform a careful and successful operation.

Did your surgeon examine you during this followup visit? Did he look for signs of nerve root irritation? This would be motor strength testing, sensation, tension signs (the straight leg raise test) and reflexes. The presence of these signs (especially if they were not present before the surgery) might indicate new onset compression of a nerve root. This would trigger an MRI in my office to look for new causes of nerve root compression.

Were new X-rays taken at this visit? These new X-rays might reveal the aberrant position of instrumentation which could lead to further imaging.

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.

[Psc55]

#9766

Dr. Corenman,

I just saw your message – it had gone into my spam folder.

To answer your question, x-rays were taken while on my back and on my left side. The only examination was of the incision which is doing fine. My surgeon did not perform any other exam, e.g., motor strength testing, sensation, tension signs or reflexes.

He ordered a back brace and told me to continue walking and return in one month. I am 4 weeks post op today and I can do minimal things before needing to lie down from pain. I would be grateful to you if I knew what questions to ask when I see him again on Nov 18. Like I’ve mentioned before, he breezes in and out of the room giving me at most 2-3 minutes and then the nurse comes in.

I’m frustrated yet I don’t know what else to do. His cavalier attitude makes me feel like I’m over reacting and he alone knows what’s right or wrong with me.

I thank you for your valuable time and information.

Sincerely,
PSC55

[Donald Corenman, MD, DC]

#9769

You need to pin him down when you see him next visit. Tell him that these symptoms are new and disabling. Tell him that you have educated yourself by viewing the internet and want him to perform an examination of your legs to look for possible new onset of nerve involvement. Make sure he looks for reflex, sensory and motor defects as well as tension signs (straight leg raise and the “flip test”).

You can test your motor strength yourself. The three main muscle groups are the quadriceps (knee extenders-straightens out the knee), the tibialis anterior (the muscle that pulls up your foot) and the calf muscles (the muscles that push your foot down).

Hold onto a counter while standing up. Do not use your arm strength to push your body up but just to stabilize your torso (unless of course, the tested muscle does not hold you up in which case your arms can engage and prevent you from falling). Lift one leg up.

Test each muscle with 10-15 repetitive motions while standing on one leg (to isolate and put more weight on that muscle). In the case of the tibialis anterior, you would stand on the right leg with the left off the ground and lift your toes 10 times. Do the same on the opposite side and compare.

A weakened muscle will not lift you up with as much strength, will not be able to contract with as many repetitions or will cramp with this activity. Pain in that leg that prevents you from contracting the muscle does not indicate weakness but that the nerve is inflamed.

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.

[Author]

Posts