[dth1115]

#30441

Dr. Corenman,

I have learned very much from your site over the past month. Thank you for helping to educate us.

I had a severe rupture of L5/S1, flattening and moving the nerve about 0.5 inch. Searing pain in left foot, couldn’t stand or sit. Pain medicines didn’t control pain. Surgery was 4 days later. I am now 4 weeks post op. Since then, the pain has subsided. Have some left leg sciatic type pain but fairly tolerable laying down or standing. But I cannot do a toe raise at all. I can move foot but any load over a small amount of weight, causes my foot to collapse. Cannot have straight left leg raised over 45 degrees without bad calf pain. Also, I cannot sit longer than 20 minutes without causing sciatic symptoms to worsen.
This is 2nd surgery on this disc. About 4 years ago it ruptured and has loss of feeling in right leg and had a successful surgery. Was a fairly easy recovery.
In your experience, with this onset of muscle weakness, does it sound as if the disc is ruptured again or is the nerve damaged? If nerve is damaged, what can be done? My surgeon is saying if in the next 3-6 months it shows no improvement, then its likely permanent. I am doing PT daily either on my own or with a therapist. Is this your experience with muscle weakness post surgery? What’s likelihood of even a partial recovery? What are options in your opinion?

Thank you,

DT

[Donald Corenman, MD, DC]

#30447

When you say you cannot do a “toe raise”, I interpret this that you cannot walk on your tip-toes which is another way of saying you can’t heel walk. Is this correct? This would make sense as the gastrocnemius/soleus muscles (the large calf muscles that push the toes down) would be affected with a large HNP at L5-S1. I’m glad that you had surgery relatively soon after the onset of symptoms (4 days) as this gives the nerve the best chance of recovery.

Having a positive straight leg raise after surgery (“Cannot have straight left leg raised over 45 degrees without bad calf pain”) worries me. I think that a course of oral steroids might be helpful about now. If no significant improvement, a new MRI would be helpful. See this to understand how nerves heal; https://neckandback.com/conditions/peripheral-nerve-anatomy/

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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