[anelsen15]

#8743

I also have alot of pain when transitioning from sitting to standing, but it is not in hamstring area it is in low back and feels like something shifts. I often feel it when standing up straighter, physically feel something shift. At times when it shifts my legs get weak and spastic feeling. I do not have any sciatica and MRI shows only 2-3 mm buldges.

[Donald Corenman, MD, DC]

#8744

I am confused. You are responding to another’s thread as your own? Are you on the correct thread? Your name is different than the initial responders.

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.

[anelsen15]

#8746

yes sir, I am sorry trying to figure out when I try to reply I always start a new thread. I will get it in right place, sorry

[sheray]

#9668

Dear Dr Corenman,

An update – I had my surgery one month ago. However, the endoscopic microdiscectomy through the side had complications due to anatomy and could not be completed. Conventional microdiscectomy was then performed. Basically, therefore, a procedure which should have taken an hour had the endoscopic surgery been successful took 4 hours. The reason I was given for failure of the endoscopic procedure was the narrow L5/S1 foranima and every time the surgeon placed his needle through the foranima, I felt pain.

As a result, I understand that my nerve was extremely irritated and after surgery, my right leg was very numb, in particular my right foot (sole and toes). For a few days after surgery, I had no leg pain, only the discomfort of the numbness. The staples at the incision site were removed a week after surgery. However, the leg pain returned a few days after surgery.

Since then, the numbness is getting better and at present is less, although I still have some numbness at the sole of my foot and around the toes, as well as at the top of the foot, at the ankle.

The concern I have, however, is the leg pain. It is the familiar sciatic pain I had prior to surgery, only more uncomfortable. I cannot bend forwards without feeling pain and, in fact, cannot keep my right leg straight when bending forward. The pain is sometimes in the buttocks area as well as the back of my upper leg. At other times I feel pain to the side of my knee and down the right side of my right leg, up to the ankle.

I am doing some simple stretches as well as walking daily.

I am presently taking paracetamol 2/3 times a day for the pain.

I have been told by the surgeon that the numbness and the leg pain are usual and expected due to the extreme nerve irritation. My concern is whether there may have been nerve damage and if so, what would alert me to this.

In your experience, is it normal that the leg / sciatic pain should still persist even though the herniation may have been removed? I was told it can take months to heal. In fact, prior to surgery, sleeping was my most comfortable and pain free position but now I have discomfort when lying down.

Is there anything I should or should not do to help move things along?

Also, should I go for another MRI and if so, when would be best given that surgery was a month ago?

Thank you very much indeed for your valued advice and time.

[Donald Corenman, MD, DC]

#9669

Numbness after surgery that is greater than the numbness prior to surgery (or present where it was not present before) is most likely due to nerve manipulation during surgery. Every microdisc surgery has to involve gentile nerve manipulation to retract the nerve to get to the herniation underneath. The more aggressive the nerve manipulation, the more post-operative numbness will be noted.

The increased pain noted two days after surgery could be from the original nerve compression or from the nerve manipulation during surgery. The fact that the pain is more intense and covers more area could be an indication of a greater need for this nerve manipulation during surgery.

If I noted these symptoms in a patient after surgery, I would put the patient on an oral steroid to reduce the inflammation and possibly reduce the potential injury to the root. If the symptoms were very pronounced, I would order another MRI to make sure the root had been decompressed and to make sure there was no seroma that had developed (a fluid pocket that can form after any surgery). These seromas can be compressive on rare occasions.

This should be a cautionary tale regarding the “endoscopic” procedure to remove a herniated disc. These endoscopes are not what they are always advertised to be and have taken a one hour procedure to a four hour procedure.

In general, a simple microdiscectomy is a tried and proven procedure with very minimal risk of complications and the technique has been perfected over the last fifty years. In my opinion, patients should think twice with new technology as there is the danger of falling for “the triumphs of technology over reason”.

I hope that the nerve pain recedes quickly. Please keep us informed regarding your progress.

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.

[sheray]

#9674

Thank you very much indeed for your valued response, Dr Corenman. I will see how things progress over the next few weeks in order to determine if another MRI is necessary. Your advice on new technology is agreed with. Prior to surgery though, the possibility of a quicker less invase surgery and quicker recovery had been a major factor in my decision. But there are no short cuts it seems. Regarding oral steroids, would you be at liberty to let me know what particular type / brand you would recommend to a patient?

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