BlackSwanParticipantMay 28, 2013 at 5:12 amPost count: 10
Hi Doctor Corenman,
2 years ago I had emergency Micro D, due to left foot drop . I had a L4/L5 left fragment pinching nerve. Surgery corrected that and fragment was removed. But I still have a residua broad based 5mm disc bulge posteriorly slightly abutting thecal sac. An MRI reveals that there is extreme facet arthritis from l4-S1. Also I have scar tissue attach to left L5 nerve root which has thickened. I have full range of motion, and I have done straight leg raises (on myself) and can do them fine.
My main issue is I have a chronic low level sciatica(mostly left leg) in calf. Not much back pain. When I wake up I am fine for many hours and as day progresses it may get a bit stronger. Sometimes I only have a calf itch. Other times my legs may both ache a bit, or even my opposite right leg aching. like a deep muscular ache in legs. i rarely take meds for these issues. I try to stay active and do treadmill 5 times a week.Lying in bed will cause calf pain and if I walk on an incline it aggravates leg worse. A pillow under knees for some reason will also cause left leg pain. I was in physio for 4 months but did not get stronger or better so I stopped. It comes and goes during the week and some days I am perfectly fine. I am wondering if I should be worried or just adapt to it. Is it permanent now? Will it get worse? What do you think may be causing it? Is the ache in legs a different etiology than the calf pain and neurogenic itch in calf? Do I need more physio? Any advice please. I am fit and normal weight, age 40.
Thank you very much!!!Donald Corenman, MD, DCModeratorMay 28, 2013 at 9:41 amPost count: 8460
Residual disc bulge after a microdisc surgery is not too uncommon. Either the annulus which originally tore is bulging (see anatomy to understand this concept) or a bone spur has developed (again-not uncommon) after a disc herniation.
This residual bulge can still irritate the nerve root. There is another finding which can be possibly linked to continued leg pain. “Extreme facet arthrosis” can be associated with a condition called degenerative spondylolisthesis (wee website for details). This disorder is best diagnosed with standing X-rays including flexion/extension views.
Scar tissue can also be associated with continued leg pain if this scar tethers the nerve root. Finally, there is the possibility of chronic radiculopathy (see website for description) as the cause of your pain.
In my practice, an epidural injection would be the next step. You might also try membrane stabilizers like Lyrica or Neurontin. Make sure that you keep a pain diary if you have an epidural (see website for details). If you get great but short-lived relief, you might be a candidate for another decompression.
Dr. CorenmanBlackSwanParticipantMay 29, 2013 at 5:35 amPost count: 10
I am grateful for reply. This was actually my 2nd Micro D on L4/5. First was in 2000. This disc extrusion had a left sided Free fragment, and also a 14 mm x 5 mm bulge posteriorly .My surgeon calls it a bulge but both radioligists refer to it as a protrusion.The surgeon removed fragment due to foot drop, but left the residual bulge alone. I asked him and he said that I needed my disc and it wasn’t necessary to address posterior bulge and cause extra trauma. Not sure if bulge has moved over last 2 years since operation due to physical activity. I spent 4 days in hospital and when I went home I resumed light activities and went back to work within 4 weeks. Though it took me a while to feel well again.
The MRI done a few months after operation state that there is mild bilateral foramen narrowing with contact but without compression of L4 nerve roots and narrowing of lateral recess. Although now I have not had an MRI in close to 2. 5 years, I had one twice after my surgery because I thought I was In bad shape and both times my orthopaedic sent me home as he did not feel that I needed anything more than voltaren.My biggest problem is the bilateral leg aches and mild sciatica in both legs. This worries me. As I mentioned I am 40 but quite fit and exercise regularly. Physio did not make me any better after 4 months.
My GP will not allow me to have epidural injections for fear of arachnoiditis I live in Oz and we do not have spine clinics here. We have public health system and the gatekeeper is the GP.
I am wondering if it is wise just to leave things alone for time being since my sciatica is mild with little back pain. and I have full range of motion, or am I doing more harm than good?
Lastly, I am arthritic in my sacrum area. I feel things niggling around in there so I just try to be careful. I was wondering if my 5mm posterior disc protrusion was something from your perspective that I should concern myself with in terms of continuous monitoring?
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