Neural Tension after L5-S1 TLIF

///Neural Tension after L5-S1 TLIF
Neural Tension after L5-S1 TLIF
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  • YubYub
    Participant
    Post count: 4

    Hello Dr. Corenman,

    I actually saw you last August for a consultation regarding chronic low back pain 2/2 to bilateral pars defects at L5-S1. You had recommended a TLIF at the time. I want to thank you for the time spent explaining the condition and proposed surgical intervention.

    I recently had surgery at my local hospital due to proximity and financial reasons, TLIF L5-S1. I am 12 days post-op and back pain is good, however, I have noted neural tension in my left leg now as indicated with positive straight leg raise on the left and intermittent throbbing pain at times in my calf, hamstring, and buttock.

    I did not have radicular pain prior to surgery and know that the surgery was a left-sided approach. I do not have any Sx in my right leg.

    What are your thoughts?

    I have a follow up this coming week but thought I would ask.

    PS: I have tried piriformis stretching on the left and note when I perform the stretch increased paresthesias in my L5 dermatome in foot.

    Donald Corenman, MD, DC
    Moderator
    Post count: 6401

    When a TLIF is performed, the transversing nerve root (the one that crosses the disc space) is retracted. Depending upon the amount of retraction time and the intensity of retraction, this nerve (S1) can be irritated and complain (soreness, pins/needles, pain with stretch). It might be helpful to ask for an oral steroid to calm the root down. Seromas (fluid collection) can also cause this so an MRI might be helpful if the steroid does not help and the symptoms don’t calm down over time.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    YubYub
    Participant
    Post count: 4

    Thank you Dr. Corenman.

    YubYub
    Participant
    Post count: 4

    Hello Dr. Corenman,

    I had my 6 week follow up with the surgeon and they performed a lumbar CT. Apparently the CT looks good, no screws touching nerves.

    I was given a 6 day course of methylprednisolone that seemed to help a little, however, my left side leg pain continues.

    I noted the other day my L5 myotome, left side great extension is reduced left compared to right, additionally noted some very mild L4 myotome weakness on the left with ankle dorsiflexion.

    I guess my question is, how much of this can be expected from normal neural root irritation from the surgery versus something more serious? i.e. is it possible to have mild motor weakness from neural root irritation? And, in your experience with your patients who have experienced neural root irritation following surgery do corticosteroids normally help and if they don’t does that indicate something else going on?

    Donald Corenman, MD, DC
    Moderator
    Post count: 6401

    Don’t know why a CT was ordered and not an MRI. CT looks at bone and screw position so maybe there was a concern of the hardware location.

    This sounds like a retraction injury which can happen uncommonly during surgery. Your ankle dorsiflexion (tibialis anterior muscle) is probably also an L5 nerve problem which would fit with the other findings.

    Most likely, this problem is going to be a matter of time for recovery. See https://neckandback.com/conditions/peripheral-nerve-anatomy/ to understand how nerves heal.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    YubYub
    Participant
    Post count: 4

    Hello Dr. Corenman,

    In your experience what is the prognosis for a nerve retraction injury?

    There is scant literature on the topic – I cannot find any information online regarding prognosis.

    It certainly seems to be this type of injury as I am 4 months out of surgery and continue to have Sx.

    There are many days where I have no sx or pain, however, I cannot do any form of hamstring stretching, long arc quads or straight leg raise to any degree w/out an immediate aggravation of sx. Nerve flossing/gliding of the sciatic nerve also immediately aggravates sx. I continue to have Left great toe extensor weakness and predominantly L5-S1 dermatome sx.

    I’ve simply been waiting it out, and note my severe leg pain I experienced the first 2 months has gone away but I can’t seem to get over the sx.

    I haven’t had an MRI yet or gone to for a follow up with another surgeon as I moved out-of state from where I had my original surgery, but am considering it now.

    Thanks,

    • This reply was modified 6 days ago by  YubYub.
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