LizzieJoParticipantDecember 22, 2020 at 2:12 pmPost count: 5
I had a revision left l4/l5 decompression/discectomy (due to severe radiculopathy confirmed by MRI showing disc protrusion) 4 weeks ago. The previous revision was three years previously.
The nerve was stuck to the disc and bone etc with more scar tissue than the surgeon had ever seen and so the operation took a long time and the nerve was stretched quite a lot. Post op I had some weakness in left leg but that was improving over the first week. Pain was significantly reduced.
However, one week post op the leg weakness deteriorated significantly and I developed a Trendelenberg gait and needed to use crutches. A MRI at this point showed no issues that would explain this.
Two weeks post surgery I then developed increasing pain in virtually the same pattern as the previous L5 radiculopathy. The pain is now very severe. The surgeon think it is still post op nerve irritation causing the pain and neurapraxia causing the leg weakness. With both hopefully improving over time. It is possible that a previous left hip replacement, plus hypermobility EDS plus the neurological issues of pernicious anaemia may be contributing to this situation.
I am currently on gabapentin, cocodamol, naproxen, amitryptLine and diazepam for pain relief.
I wondered if you had any thoughts about the delayed onset weakness and pain, and also the contributions of the hypermobility and pernicious anaemia to the situation.
Many thanksDonald Corenman, MD, DCModeratorDecember 24, 2020 at 7:47 amPost count: 8459
I am a little worried about your statement “the nerve was stretched quite a lot” during surgery as nerves don’t tolerate significant retraction very well. The next statement “Post op I had some weakness in left leg but that was improving over the first week. Pain was significantly reduced” is also concerning if you did not have weakness in that leg prior to surgery. However, pain reduction is encouraging at least in the first week.
Your next statement is more discouraging “However, one week post op the leg weakness deteriorated significantly and I developed a Trendelenberg gait and needed to use crutches. A MRI at this point showed no issues that would explain this”. It would be helpful to have the MRI report copied here. Weakness which causes a Trendelenberg gait is loss of the L5 nerve supply to the gluteus medius muscle which is the nerve you had operated on.
I’m not sure what pernicious anemia has on the injured nerve root and I don’t notice anywhere in your report of hypermobility. Why did you bring up that term?
Dr. CorenmanLizzieJoParticipantDecember 28, 2020 at 4:33 amPost count: 5
I can’t copy the radiology report sadly. But it did say there was some soft tissue odema and scarring as expected and a mid line Sedona but no cause identified to explain new onset of weakness one week post op.
Pernicious anaemia causes damage to the myself not sheath of the nerve so I was wondering if this made the nerve damage more serious/healing slower?
Also I have Ehlers Danlos hypermobility so I was wondering if this makes the healing slower. I know it also makes pain experienced differently.
I know the left hip replacement would have cut through the gluteus medius so this muscle is already weak.
As you say it is concerning that both the pain and the weakness deteriorated some time post surgery.
I am now Four weeks post op and the weakness seems to be improving. The pain does too in that I don’t have the horrible leg pain. However I do have quite significant lower back pain and definite painful stiffness particularly on waking.
Do you think this is the nerve damage? Or muscle weakness in the area?
Your insight is much appreciated.LizzieJoParticipantDecember 28, 2020 at 11:26 amPost count: 5
I should probably explain that the nerve was stretched more than normal and more than the surgeon would have liked as as he had to remove a considerable amount of scar and other tissue from the area to separate the nerve from the disc and the bone it was stuck to. There was so much scar tissue he said he had never seen so much and sent it to pathology, still waiting for results. Again I have been told that this amount of tissue around the nerve could be due to my EDS as it is a connective tissue disorder.
Sorry typo in MRI report…serona not Sedona..over the scar area.LizzieJoParticipantJanuary 11, 2021 at 4:32 pmPost count: 5
Week 7 I am still finding it difficult to walk and the pain is awful.
I would appreciate your thoughts to the extra information provided.
Many thanksDonald Corenman, MD, DCModeratorJanuary 13, 2021 at 8:41 amPost count: 8459
With revision surgery with epidural scar revision, it is matter of time to determine how the root recovers. Even though seven weeks feels like a lifetime, in “nerve years” that is a very short period of time.
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