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Hello Doctor: I would really appreciate a response and your help. Before I was in a car accident, I was a very healthy and extremely active guy. Due to the accident, I had a severe disc herniation in my lumbar spine L4-5. As soon as I woke up from the six hour surgery on February 8, I experienced immediate relief. However, it is now May 3 and I have been experiencing significant radiating pain in my right leg. I have had an MRI twice in the last two weeks and my Neurosurgeon who is very knowledgeable, skilled and respected says there is no re-herniation of the disc or infection or any other apparent bulges or herniations, but he says there is significant internal scar tissue. I am experiencing severe and constant radiating pain from my lower back, into my right side of my butt, hip, down the right side of my right leg to my ankle before it spreads out over the top of my right foot. I also have radiating pain in my inner groin on the right side and other radiating pain in other parts of my right leg, but it is not constant. My right shin has been numb since the accident and still numb. I am currently taking an oral steroid for one week and a drug called Lycra. My pain is not getting worse, but it is not getting better. No pain medicine does anything to decrease the radiating sensation or pain. My Neurosurgeon says if the oral steroid does not work, that I may need to get spinal injections, but everything that I have read say that spinal injections provide initial temporary relief, but not long term. My top priority, is there any way to permanently get rid of the internal scar tissue that is supposedly causing my pain and radiating sensation? My neurosurgeon is extremely busy. How can I find someone to explain step by step what the report of my MRI really means in normal, easy to understand terms?
I am confused as to the operation that you underwent for a disc herniation. If all you had done was a microdisectomy, that is a one hour operation. Did you have a fusion, a front and back operation or ????
Scar is inevitable from surgery but normally causes no significant symptoms. A large disc herniation however does crush the nerve root and can cause temporary or permanent damage. The nerve has to heal after the decompression and there are specific types of injury that heal at different rates. See the section regarding “Nerve injuries and recovery” to understand the physiology of nerve injury.
Decompressing the nerve allows recovery but mother nature is responsible for the healing. As long as the nerve is decompressed and there is no hematoma that continues to compress the nerve, healing will take place. In my opinion, an epidural steroid injection is a valuable tool for treatment. Inflammation in the spinal canal is the enemy of the nerve root and steroid injections are the best single treatment for this inflammation.
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.I hate to say it, but I don’t know exactly what kind of operation that I had. It lasted six hours in the operating room; and I was upside down; the incision was in my lower back. My neurosurgeon who is really great and highly respected in our area said I had a massive disc herniation at the L4-5. The surgery took place on February 8. It immediately, but now seems temporarily, resolved the pain and numbness in my lower lower back and right leg except for my shin. Last Friday, I began having significant lower back pain and radiating pain in my right butt, right hip, right side of my right leg down to my right ankle where it spreads out over the top of my foot. I went to the Emergency Room because the pain was becoming unbearable, my neurosurgeon did another MRI and he said there was no re-herniation, but he saw significant scar tissue. He put me on an oral steroid — Presdezone? — for one week with pain medication, but it has made no difference. He said if that did not help, which so far it has not, the next step would be to do a steroid injection. He said if that did not work, he would have to do another operation, but he said he did not want to do that and it would be a very complicated surgery. Can I get more than one steroid injection to cover the entire area from the L4 to the S1? And will the steroid injection remove the scar tissue that is causing the pain? I am being as positive and optimistic that I can because I absolutely do not want to have another operation, but everything that I have read has said that steroid injections provide temporary relief? How can I find someone to look at my MRI results and give me a step by step explanation of what it means?
One possible cause of increased pain after surgery is infection. This can be ruled out with laboratory tests (CBC, ESR, CRP). I assume you don’t feel “crappy” (fatigue, fevers, sweats, chills, nausea, etc.) If you don’t feel “right” (other than pain in your back and leg), then a work-up for infection should be undertaken.
I do not understand why he would consider another operation if there is only “scar tissue” without instability or further compression of this level. I do endorse an epidural injection (as long as there is no infection present).
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.I cannot tell you how much I appreciate your response. My neurosurgeon ran blood work and MRI right away looking for infection and there was no sign or symptoms of infection. I am more than willing to try anything including epidural injections. I just want the pain to be gone and to not come back in a couple months when the injection wears off. In terms of instability, do you mean weakness in my right leg and right foot? Or instability in the area of the original surgery and the scar tissue? I have significant weakness in my right leg to the point it is difficult to maintain my balance and walk. I also have what my neurosurgeon calls “episodic” radiating pain in other parts of my right leg and my inner groin on the right side.
Is your leg pain worse than prior to surgery? Is your leg weakness new or worse than it was prior to surgery?
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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