[Bltzfgrw]

#21616

Hello and thank you for this informative website!
I had lumbar fusion on L-2 through L-5 on January 9, 2016.
The fusion is healing well but since the surgery I had excrutiating pain starting in my left buttocks and traveling
all the way down to my toes. The pain is much better but
the nerve that controls the calf and all of my foot
needs to regenerate. I know regeneration is about an
inch per month. My question is how do you know where
this nerve starts to regenerate? Is it at the vertebrae (L-5) or somewhere further down the leg? I seem to have good control
of my muscles all the way to my knee. Of course the
reason for my question is that the length from the
vertebrae to the toe is much longer than if it were
from the knee to the toe and would thus entail more
than 40 months of rehab versus about 12-18. Is there
a test to determine this? Thanks so much!

[Donald Corenman, MD, DC]

#21620

First we have to determine if this leg pain was there prior to the surgery or is it new since the surgery (“The fusion is healing well but since the surgery I had excrutiating pain starting in my left buttocks and traveling
all the way down to my toes”).

If it is new pain, there has to be a reason. Excruciating pain that develops after surgery needs to be looked into with an MRI or a CT (or both). If it is preexisting pain present prior to surgery-why did it not improve with a decompression which is typically included with the fusion? These are the first questions that have to be answered.

For the “nerve healing” question, the answer will be found here; https://neckandback.com/conditions/peripheral-nerve-anatomy/. There are four types of injury to the nerves. Only one of the four types of injury heal with the “one inch per month” result. If the nerve is longer than 18 inches from the cell body (cord) to the insertion into the muscle, the muscle will fibrous (become dysfunctional) before the nerve has a chance to reconnect.

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.

[Bltzfgrw]

#21627

Thanks much for the fast reply!
My mistake in describing the pain (both before/after).
I had the pain from the buttocks on down to the toes both
before and after the fusion. Since the surgery and start
of PT the numbness has gone away until you reach the outside
of the left leg calf. Then there is numbness on that entire
Left side of the calf but little pain. Then starting
at the ankle through the foot and toes there is dull
pain and it feels like it’s sprained. More importantly,
I can push DOWN my toes but cannot lift them UP. I CAN
slightly lift up the front of the foot (about 2″). And
When I walk I definitely have a “drop foot type” limp. There
is also slight swelling around the ankle. A
The calf muscle seems to have returned to normal. (The
entire left leg after the surgery appeared to be atrophying)
So, given the further clarifications above is this
The type of condition that will heal itself over time
by continuing daily PT? And, if so is there an average
or median length of time for that to heal?
Finally, if it does require the nerve to regenerate
at the one-inch per month, is there a way to determine
where the beginning point of regeneration would be
given that the leg from the calf up appears to be functioning
normal?
Thank you so much for taking your time to answer this!
Regards

[Donald Corenman, MD, DC]

#21629

it appears from your description that the S1 nerve (which goes to the calf muscle) is intact and the L5 nerve is not functioning well. The L5 nerve goes to the tibialis anterior, the muscle that lifts the foot when you take a step. Since the symptoms improved since surgery, I will assume that the nerve is improving. The distance from the origin of this nerve to the muscular insertion is about 20 inches in a normal adult. This distance is too long for a nerve to regenerate if it could in the first place.

There is a testing technique in a superficial nerve (of which this nerve is not) where you can percuss the path of the nerve and a “zinging” sensation (a positive tinel’s sign) will be felt at the front of the healing nerve traveling down the channel.

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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