utahguy058ParticipantJuly 15, 2017 at 1:00 pmPost count: 2
I had a microdiscectomy on my L4/L5 to take care of a herniation. I am not certain when the herniation began, but I know that about a year and a half ago was when intense across back into my buttocks and a numb foot started. I went through conservative measures for a year and a half hoping for recovery. I made great progress, with just back pain after standing awhile that radiated into my hip and an intermittent numb foot. A surgeon had been telling me that I had nerve damage and that I would need surgery if I didn’t want it to progress to where I was dragging my foot. I am a teacher and did not like the idea of it progressing to a point of dragging my foot. It seems like it was compressed for 18 months then.
On June 8th I had a microdiscectomy and woke up from surgery with leg pain. I had not experienced leg pain prior and was concerned from the onset. I always hear about those with leg pain waking up to it gone. The surgeon said it went well. When I saw him at 10 days post op he said my nerve was compressed a long time and will take time to heal and not to worry. Most days I have leg pain, I have had a couple days where it isn’t as bad, but then it comes back just as bad. The doctor gave me a Medrol pack which didn’t help, and just four days ago I had a nerve block on my L-5. I had a day where I felt some relief, but the next day it was back. The two things that make it the worse are sitting, which is just torture for anything longer than 5 minutes, and if I lay on my left side. Prior to surgery I could work with my pain full time, now I fill that isn’t an option and devastated.
Here are my important questions I can’t seem to find an answer to.
1. If it is a nerve healing or inflammation, then why would certain things like sitting and laying on my left side make the pain worse? It seems that it would be constant instead of situational based on position. This question has me baffled and I don’t meet with the surgeon for awhile yet.
2. What is a fair amount of time after surgery for a nerve to heal with leg pain, assuming leg pain is normal for a nerve healing? I am 5 weeks and 2 days post surgery.
I truly appreciate any insight that you may offer me. I am really struggling with the pain, and the fear that I will not be able to work again.
KCDr. CorenmanModeratorJuly 16, 2017 at 8:18 amPost count: 5211
If you had this herniation for 18 months without any motor weakness, the comment from your surgeon was wrong. The only way you could have developed progressive motor weakness after 18 months is with a recurrent disc herniation (another fragment coming out of the same hole in the disc). The chance of that recurrence was only 10%.
Nonetheless, if you had symptoms that were not tolerable, surgery generally should be performed earlier than 6 months of symptom onset to have the best results. It does sound however that symptoms were tolerable before surgery.
Leg pain after surgery has multiple reasons. The nerve has to be manipulated (gently moved) during surgery and this manipulation can irritate the nerve. This could take as little as 2 weeks to calm down or as much as 4 months. Since you note that sitting is the biggest symptom producer, you could have has a recurrent disc herniation immediately after being moved off the surgical table or possibly, a hidden fragment was inadvertently un-removed and you have continued nerve compression. You could have a seroma (a fluid collection) that could be compressive but this disorder normally fades away after some time.
I am surprised that you had an epidural steroid injection without a new MRI. Normally, a new MRI is warranted if you have had increased pain after surgery and if the pain doesn’t resolve with oral steroids. A new MRI should be considered.
Dr. CorenmanPLEASE 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.If this forum has helped you, please let Dr. Corenman know!utahguy058ParticipantJuly 16, 2017 at 11:51 amPost count: 2
Dr. Corenman- I appreciate your well thought out response. It was very helpful and informative. I will call my doctor to see if they are willing to do an M.R.I. They have been opposed so far, even though I got leg pain which I never had since waking up from surgery. I have two quick follow up questions
1. What is a reasonable amount of time to try conservative treatment for a reherniation of a disc? I suppose it has been 5.5 weeks already. If I did have a second surgery what are the odds that it would be a success?
2. I also am worried about work as I have worked full time prior, but fear that this pain will keep me from work, if there was a second surgery, or conservative treatment are outcomes favorable to someone being able to go back to work full time?
Thanks so much again,
KCDr. CorenmanModeratorJuly 16, 2017 at 7:25 pmPost count: 5211
There will be a reason for the leg pain- most likely a recurrent disc or a missed fragment. Without motor deficit changes, 6 weeks is a reasonable time to wait before a new MRI. Ask for one now.
Dr. CorenmanPLEASE 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.If this forum has helped you, please let Dr. Corenman know!GhostgirlParticipantJuly 17, 2017 at 1:06 pmPost count: 4
I went conservative too, for as long as I could. I had a quote “massive” rupture at L4/5 and bone chips around my spinal cord. Had a hemidiscectomy in September of 2004 wherein they also removed bone ‘schrapnel’. It was a long operation. 10 days later, I had another one. A week after that, my doc finally fused it. By then, I had permanent nerve damage in my right hip, leg, and foot. I asked my surgeon if this would go away. He said, ‘sometimes it does, sometimes it doesn’t.’ 13 years later, I still have the pain. IMHO, it should have been fused in the first surgery. After the fusion and subsequent hardware removal (the titanium was literally poking through my skin), they had to go in and remove excess bone that had grown between and around my vertebra. And because fusing vertebrae causes problems with the discs above and below the disc in question, I ended up having microdiscectomies at L3/4 and L5/S1. I understand the desire to be ‘conservative,’ but sometimes appropriate action needs to be taken in appropriate situations. I am a leg-dragger.Dr. CorenmanModeratorJuly 17, 2017 at 4:14 pmPost count: 5211
Ghostgirl-I know you had an unacceptable result but fusion for a disc herniation is only necessary in 10% total of the cases. An initial herniation normally has a 90-95% rate of satisfaction for surgery. Even a recurrent herniation surgery has a high acceptable satisfaction rate. Most individuals with foot drop (a “leg-dragger”) if they get surgery quickly enough will have resolution of their weakness. It sounds like things did not go well for you and you now have chronic radiculopathy (see https://neckandback.com/conditions/chronic-radiculopathy/).
I agree that surgery needs to be performed on a timely basis and if the surgical wait is prolonged, the results can be less than ideal.
Dr. CorenmanPLEASE 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.If this forum has helped you, please let Dr. Corenman know!
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