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Dr. Corenman,
Thank you for running this Q&A forum. It is truly a one of a kind resource for patients. My question pertains to some unexpected symptoms following my second back surgery.
Background: I’m in my 4th week post-op from a second microdiscectomy at L4/L5. The prior herniation was in 2017 and was managed successfully with a microdiscectomy. After that surgery, I woke up with no pain and a small patch of mild numbness in my foot that I no longer notice today. Recovery was a breeze. Residual symptoms such as transient sciatic pain in the affected leg lasted around two weeks and were minor.
My second herniation occurred at the same level and side in April of this year and was operated on in June. The MRI described it as a “right subarticular protrusion.” All my pain was on the right side and excruciating. My surgeon performed a revision microdiscectomy and, like last time, I woke up in almost no pain (aside from the surgical incision).
Question: The recovery this time has taken an unexpected path. In addition to the expected post-surgical right-side residual pains, I noticed a few days after the surgery that my LEFT heel was completely numb. This alarmed me because I’ve never had symptoms on the left side, and the surgery was targeted toward the right side. At my two week follow-up, my surgeon told me this was not anything to worry about and just part of the healing process. Since then, my residual symptoms seem to be occurring in both legs, but more in the LEFT. These symptoms mostly consist of transient sciatic pains ranging in severity from 1-3, occasionally 4, in different locations of the legs. Additionally, the numbness in my left heel not only persists, but now my left foot develops an uncomfortable and sometimes severe hot sensation when I drive or walk a lot, and the heel sometimes hurts. This sensation can persist for long periods of a time and is very vexing. I’ve also noticed that the left leg sometimes feels tired.
I spoke with my surgeon’s PA this week and he said to continue doing what I’m doing and that this is probably nothing to worry about. I’m scheduled to start physical therapy at week 6 of my recovery.
Are opposite side symptoms something you’ve ever seen? Any idea what kinds of things cause this? Is this the type of thing that will get better without any intervention? I am concerned about this being permanent because, although it is infinitely better than being in debilitating pain like I was, it’s still quite distracting and uncomfortable. My surgeon said this surgery was mostly uneventful. He noted that this herniation wasn’t particularly large, but that scar tissue from the prior surgery had made it hard for the nerve to “escape” from the protrusion, which is why it felt so severe. He also noted the scar tissue was a bit harder than he expected (he said normally it softens more).
Thank you so much for donating your time to this forum.
It is uncommon but not impossible that opposite site symptoms occur. Positioning during surgery could have put pressure on opposite side ankle nerves which could leave a numb heel temporarily. It is possible that a small fragment of disc migrated to the opposite side or even a seroma (collection of fluid) is causing some compression. You could ask for some oral steroid which can take down symptoms faster that just “Father Time”. If symptoms don’t resolve in 5-7 days, you could also ask for a new MRI.
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.It is uncommon but not impossible that opposite site symptoms occur. Positioning during surgery could have put pressure on opposite side ankle nerves which could leave a numb heel temporarily. It is possible that a small fragment of disc migrated to the opposite side or even a seroma (collection of fluid) is causing some compression. You could ask for some oral steroid which can take down symptoms faster that just “Father Time”. If symptoms don’t resolve in 5-7 days, you could also ask for a new MRI.
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.It is uncommon but not impossible that opposite site symptoms occur. Positioning during surgery could have put pressure on opposite side ankle nerves which could leave a numb heel temporarily. It is possible that a small fragment of disc migrated to the opposite side or even a seroma (collection of fluid) is causing some compression. You could ask for some oral steroid which can take down symptoms faster that just “Father Time”. If symptoms don’t resolve in 5-7 days, you could also ask for a new MRI.
Dr. Corenman
Dr. Corenman,
Thank you so much for your prompt reply. I will reach out to my doctor this week to inquire about the steroid.
I saw that you didn’t mention reherniation as a possible cause of my odd symptoms. Do you think that’s less probable than other causes? For obvious reasons, that is my biggest fear. My surgeon told me, however, that in his experience a third herniation is “extremely rare.” Also, the pain sensations I’m feeling are nowhere near as constant or severe as presurgery (they feel like residual pains).
One data point that I forgot to mention (although I don’t know if it’s important), my surgeon said following this second surgery I only have about 30% of my disc left. Could loss of height be triggering bilateral symptoms?
Lastly, I’ve read some accounts from others that they’ve had poor outcomes following revision surgery due to scar tissue (epidural fibrosis). My surgeon said this was why my herniation, though small, was likely so painful–because my nerve was adhered and got pinned by the extrusion. Is this a real concern and is there anything I can do to mitigate the chance of it? I inquired on my follow up and my surgeon said epidural fibrosis is a normal occurrence and does not cause pain.
Thank you again for your insight!
The fact that the symptoms are much reduced indicates you don’t have a significant recurrent HNP. When I said ‘It is possible that a small fragment of disc migrated to the opposite side”, this means either a residual fragment or a small recurrent fragment. None-the-less, your symptoms are better so give it some time to recover. Your surgeon’s statement; “my herniation, though small, was likely so painful–because my nerve was adhered and got pinned by the extrusion” is a true statement. Nerves can “get out of the way” from an HNP is there is no scar. Scar makes the root less mobile.
It’s unlikely that disc height loss has caused foraminal or lateral recess stenosis to cause opposite sided compression.
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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