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Hello doctor Corenman, I’m 48, healthy and athletic but I’ve been spiralling down for the last 18 months with abad case of sciatica. Beginning in January 2018, had MRI (confirmed herniated disc L5S1), took meds, did physio and seemed to get over it by June. Dug a hole for my dog on all fours and on the 10th of June I was broken. Rushed to emergency but eas cleared to go home with medication. Had probably the hardest 40 days of my life with sleep ess nights and excruciating pain. Finally got epidural on the 25th of July and things sort of calmed down. Pain was there always though. Spent most part of the winter with pilates, walking, exercising and was almost good to go on February. Then I played some golf (which I painfully regret) an from the beginning of March my right leg is a neurological mess. Muscle spasms, calf cramps, electric shocks, numbness, atrophy eyc. It was so bad that I just laid on my back or stood up straight. Anything else gave me symptoms. Finally I had a microdiscectomy on the 25th of June where the neurosurgeon who operated did so fo three and a half hours because the disc had calcified around the nerve and was damaging it as he said. Woke up from the surgery and nothing changed, to be honest the symptoms were a bit worse and in the 50 days that followed until today remain so. I have good days where I think I’m recovering followed by bad days where I ask my self if I actually had surgery. My body is as stiff as it gets, I cannot move my legs in bed without getting all sorts of dysesthesias and when I walk I get an audible crack each time my bad leg goes forward. And I still cramp at any given moment. Is all this nerve regeneration to you (I was told it could take months) or continuous nerve compression? I’m asking because the symptoms preop and postop are the same. If it were something different I wouldn’t worry so much. Thank you so much.
LOCATION AND QUALITY OF PAIN
Starts from the lower back (surgical site), migrates to the back of the thigh, back of the calf and ends up at the foot (outer two fingers and under them).
It’s not constant but mostly a feeling that everything’s about to cramp up and when it actually happens it’s a stabbing pain mostly concentrated in the back of the calf. When lying on my back the feeling softens but when I lie sideways it gets more intense as well as when I sit. When I walk it’s mostly concentrated under the foot and I get a constant crack low in my back everytime I extend my right foot. When I swim I don’t hurt but I’m dragging a half numb leg in the water (I can’t flap my right leg when I backstroke because of the numbness). I don’t have any other activities during the past five months and I don’t BLT as per instructions by my surgeon.
The skin is not hypersensitive to touch.
There are no associated skin changes.
PERCENTAGE OF PAIN BY LOCATION
The lower back after surgery has me in a lot of discomfort when sitting 60%, less when standing 30% and even less when walking 20%. When resting on my back it doesn’t hurt or put me in discomfort.
Where it concerns the leg it is definitely posterior traveling down the back side ending at the outer two fingers of the right leg.
INTENSITY OF PAIN
The pain is not as intense it was last year. Lower back pain 2-3 constant when not lying down, leg pain (from thigh to foot) 2 (but ready to cramp at all times), 7-8 when cramp occurs. When it does and eventually subsides the pain left for several hours is close to a 4. Last year when I had severe sciatica for about 40 days the pain was close to a 9.
WEAKNESS
This is in my opinion the main issue that I’m stuck with after all these months. Because of my right sciatic nerve impingement for so long (and even now, I’m not sure about that) my right leg is weak. I feel that it’s at 60% of what it should be. I don’t have a limp (I’m walking funny though as I’ve been told) but everytime I step on it it’s dull. It’s not what it was like when I was normal.
Climbing stairs is a little problematic due to weakness (I have to hold on to something) and I definitely cannot stand on the toes of my right foot (it drops instantly). No foot drop whilst walking, only slight discomfort. (Although I get the feeling I need to learn how to walk properly again).
ONSET AND LENGTH OF TIME SYMPTOMS HAVE BEEN PRESENT
Never had back problems in my life. I suspect it all gradually occurred since 2006 when I began playing golf at age 35. I didn’t stretch pregame or post game and I played very athletic golf everyday at least for the first four years. I had a bout of sciatica in 2010 which lasted several months, I didn’t pay much attention and it went away. Todays woes began in January 2018 and progressed as I describe in the above post.
ACTIVITIES
Sitting increases the pain and symptoms whereas standing reduces them.
I can sit for about 20’ before I have to get up both because of lower back pain but most importantly leg symptoms.
I can walk for about a mile without much discomfort whereas in the winter I could walk for as long as I wished.
Bike riding on a stationary bike can be done but slowly since bending and straightening of legs brings a little discomfort (leg neurological symptoms), standing for a while is ok, walking up to a mile is ok, sitting is not good yet (neurological leg symptoms), no lifting, no jumping, computer work not easy (neurological leg symptoms), driving for about an hour ok, I haven’t flown yet.
Lower back hurts a little when sitting and more when bending, leg produces muscle spasms in the calf when sitting not when standing or walking.
I have neck pain because of the lower back pain not primarily. Last year when the back pain was somewhat resolved the neck pain vanished.
There is no excruciating pain since I don’t BLT, so I’m being extremely careful.
Daily function has dramatically changed for me since March when the leg neurological symptoms began. In a nutshell I would say that since then I move around like a seventy year old with arthritis instead of my forty eight years and unfortunately I can feel it through my extreme body stiffness.
PAIN INTERVALS
I have muscle spasms that lead to cramps when sitting. If I swim, or walk, or stand, or lie down (I’m not lifting or jumping, or doing anything so active yet) I do it all on a weak, dull, numb right leg.
I get good days, followed by bad days and then good days again and bad days and so on. Fifty days out of surgery and my situation is the same as preop. I had some good days and then some bad days. When my leg cramps I’ll usually have a couple of bad days in a row where I won’t walk or do my PT etc
ACTIVITY AND OCCUPATIONAL RESTRICTIONS
It has 100% changed my life. Up until January 2018 I worked out, I golfed, I played pool, I hiked. I was a very active person.
I don’t golf anymore, I don’t go to the gym, I can’t bend over to play pool. Basically, my previous live is on hold. I genuinely feel like an old man since March.
What I do now is light PT, some walking, some swimming (summer in Greece) and nothing more I’m afraid.
I work doing sports commentating from inside a studio which has me sitting for hours (that’s a problem). At least I work at an average of fifteen days a month.
LIABILITY
No liability
PREVIOUS CONSULTATION OR TREATMENT
I’ve been to physiotherapy during my first period of light sciatica (Jan-May 2018) which worked until I dug a hole for my dog.
I had an epidural steroid injection in July 2018 which dropped the high levels of pain I had in June-July 2018.
I did pilates and light exercises during the winter of 2018-2019 plus walking which helped a lot. Physiotherapy in March,April and May 2019 which helped a lot with the back but none with the leg symptoms which worsened.
Consulted two neurosurgeons for the leg and was advised to have a microdiscectomy which I had on June 24th.
Sadly, as I mentioned above nothing has been resolved and that is why I’m looking for answers wherever I can.
Thank you in advance if you take the time to read and evaluate everything I sent.My first question is have you had another MRI with gadolinium after surgery to assess the nerve root status? Also, what do your X-rays implicate as you might have foraminal stenosis or collapse? There are many possibilities here including continued compression, instability or chronic neuropathy. You need a new work-up.
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.Thank you for the response! I had X rays right before the one month appointment post op with my surgeon which were good as he pointed out. I will have an MRI in the following days to see if all is well with the nerve root but I suspect some form of pressure albeit not constant as I have days with minimal pain which unfortunately are followed by days with tightness in the calf and cramps. As if something moves involuntarily and changes the intensity of the symptoms either for the better, either for the worse. Walking a lot seems to make things better but I can’t walk all day. Would you think (if the nerve root is still somewhat compressed) an ESI would be helpful. I had one last year (a year preop) and it helped a lot for several months. Thank you!
Epidurals are helpful for reduction of pain symptoms. These injections will not cause any decompression of the root in general but do reduce inflammation, one of the causes of pain nerve sensitivity. Please copy and paste the results of the MRI here.
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.I have sent the MRI results at the mail of your secretary as you pointed out. I have already checked on it and three neurosurgeons (not the one who operated, I have lost confidence in him) have told me that it shows a disc fragment impinging the nerve root which is constantly inflamed. Two of them said reherniation but the third one (a good friend of mine who is a renowned hand and fingers surgeon who works at the same hospital with the surgeon who operated) told me that he found out that the surgeon purposedly left the disc fragment inside and then proceeded to close me after three and a half hours of surgery beacause he was afraid that he would damage the nerve. My question therefore is, what kind of surgeon leaves a job half done and then proceeds to inform his patient that everything went ok, that the nerve takes time to heal, be patient etc etc. I only found out myself when I had the MRI with contrast not per his instructions. Basically he sent me on my merry way with a disc fragment still in there causing problems each and every day telling me to be patient. Needless to say, I’ve been having psychological issues since the day of the surgery due to the fact that nothing was resolved. The leg symptoms I had pre surgery are still there and my back aches all the time. To top it off because of the constant lower back pain I’ve developed pain all the way up to my neck. I’m a train wreck both bodily and psychologically and I have no idea how to proceed from here. I do a lot of walking and physiotherapy, taking 150mg of Lyrica each day and I’m really fighting this but is there light at the end of the tunnel or am I fighting a losing battle? Of course I know that I should go to him with the MRI and demand explanations but I’m afraid he’ll sugarcoat it and offer a reoperation (which of course he’ll get paid for again by my insurance company).
Sorry for the long message but I’m really frustrated. I thought that I’d be over and done with this by now since a microdiscectomy is considered one of the easiest surgeries for a neurosurgeon who is supposed to be one of the best at what he does.
Thank you in advance Dr Corenman -
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