[jhthomas]

#33001

Hi Dr. Corenman, new member and VERY grateful you have this forum. THANK YOU!

I’ve included my detailed surgery report below, but some quick background: I’m a 60 year old, formerly very fit, elite level road racing cyclist. 5’10”, 146 lbs.

In September 2019, I had the onset of extreme sciatic/nerve pain in my left leg, from the groin all the way down to the foot.

Since then I’ve had PT + 3 epidurals and one facet joint injection, and pain/symptoms have improved, but still remained. I couldn’t ride and sitting was painful. Walking was tough and neuropathic leg pain was constant, sometimes gripping. MRI, reviewed by neurosurgeon, identified the issue as stenosis at L 4/5 and to some degree, 5/S1.

I had a lumbar decompression on 7/21/20 (8 weeks ago), and since then the recovery has been very lumpy and hard. Nerve pain still remains in the ankle and foot, occasionally in the thigh, and additionally, there’s achy pain in my hip, lower back and groin. I can’t ride my bike.

MY QUESTION IS, how long can the recovery take given the procedure performed? I’m getting very depressed as I read on Google about people feeling back to normal after 3-4 weeks and I’m worried about a “failed surgery”, but I’m wondering if given my age, and the amount done, it might take a lot longer? Any thoughts and guidance based on your experienced very much appreciated. Thank you!

HERE IS THE NEUROSURGEON’S SURGERY REPORT:

Date of Operation: 7/21/20

Preoperative Diagnosis: Lumbar spinal stenosis on the left at the L4-5 level causing neuropathic pain down the left leg.

Postoperative Diagnosis: Lumbar spinal stenosis on the left at the L4-5 level causing neuropathic pain down the left leg.

Operations Performed: Left-sided L4-5 interlaminar decompressions with hemilaminotomies L4 and L5, partial medial facetectomy and foraminotomy, microscope, diagnostic radiograph.

Assistant: None

History: This patient with pain radiating down the left leg has evidence of significant spinal stenosis on the left side at the L4 foramen just over the L4-5 level and operative intervention is indicated.

Description of Procedure: The patient was placed under spinal block anesthesia, turned prone onto the Wilson frame with all pressure points padded. The side and site were verified. The lumbar area was carefully marked and prepped and draped in the usual sterile fashion. Local anesthesia was applied, and a small incision was carried out to the left of midline with reflection of the paraspinous muscles and placement of a speculum retractor. A marker was placed and lateral radiograph, which I personally interpreted identified us to be at the L4 pedicle just above the L4-5. The operating microscope was prepped and brought into use. A left hemilaminectomy L4 was carried out with laminotomy L5 and partial medial facetectomy and foraminotomies. Meticulous attention was paid to remove the ligamentum flavum above the L4 hemilamina allowing me to follow the L4 nerve into the foramen from its origin and foraminotomy was achieved with foraminal rongeurs. I then moved down into the L5 foraminotomy as well following the pedicle of L5. The lateral recess was fully decompressed and the foramina were fully decompressed and the dura was intact. The wound was washed with copious antibiotic solution, packed with vancomycin powder and I then closed the fascia with 2-0 Vicryl and closed the subcutaneous tissues 3-0 Vicrl and I closed the skin with Steri-Strips. Sterile dressings were applied. The patient was then turned supine and taken to Recovery.

[Donald Corenman, MD, DC]

#33006

You noted; “extreme sciatic/nerve pain in my left leg, from the groin all the way down to the foot….Walking was tough and neuropathic leg pain was constant, sometimes gripping”. Then you note:
“MRI…identified the issue as stenosis at L 4/5 and to some degree, 5/S1”. I will assume that you did not have diagnostic blocks to determine the root level (https://neckandback.com/treatments/diagnostic-vs-therapeutic-injections/).

The neurosurgeon’s diagnosis was “Lumbar spinal stenosis on the left at the L4-5 level causing neuropathic pain down the left leg” and the procedure was “Left-sided L4-5 interlaminar decompressions with hemilaminotomies L4 and L5, partial medial facetectomy and foraminotomy”. This means he took out bone that was compressing the nerve root(s).

You then note; “the recovery has been very lumpy and hard. Nerve pain still remains in the ankle and foot, occasionally in the thigh, and additionally, there’s achy pain in my hip, lower back and groin. I can’t ride my bike’.

Since the original pain was aggravated by standing/walking and I will assume relieved by sitting or flexing forward, it sound like you had either lateral recess stenosis or foraminal stenosis (or both).
See if either of these fit with your symptoms; https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/ and https://neckandback.com/conditions/lateral-recess-stenosis/.

If you had foraminal collapse (similar to foraminal stenosis but with an angular collapse of one vertebra on the other), then a foraminotomy would generally be ineffective to relieve the root of compression. The best was to see this is with a standing AP (front to back) X-ray. You would look at the angulation of one vertebra to the adjacent one. If you do have foraminal collapse, the best way to treat it is with a fusion surgery using an intradiscal spacer (TLIF or OLIF). If there is no collapse, then possibly the decompression might have been incomplete. A new MRI might be helpful.

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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