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  • ftkm92
    Participant
    Post count: 28

    Hi,

    I had a discectomy and laminectomy in August 2014. After 2 months from the surgery I was in great pain and I had another MRI Done with cotrast. The report says lordosis abnormal lumbar may due to spasm. L4-L5 minor paracentral disc herniation indenting the theca.L5Si left paracentral disc herniaion with annular tear, narrowing the left neura foramen causing impingement of the left S1 nerve root. This a further compromised by scarring and granulation tissue inflammatory changes at the site of surgery but no obvious abscess.

    I The month of octorber 16 2014 I had revision discectomy done and remove the scar tissues and rhizolysis done too.

    In January My Dr called for a MRI with contrast and EMG and NCV. The nerve test shows normal.

    The Latest MRI Report
    Recent surgery has been performed at the L5S1 level. A discectomy was done.The surgical tract is visible as a tract of T2 prologation. There is enhancement along the tract.
    The left posterolateral aspect of the disc also enhances. There is enhancement around the left S1 root. However there is no residual or any compressive lesion.

    At the L4L5 level there is a central buldge of the disc whichmidly indents the ventral theca.

    comment.
    Recent discectomy at the L5S1 level via left hemilaminotomy.
    Signal abnormality and enhancement along the surgical tract , and enhancement adjacent to the S1 root
    Granulation tissue?
    No residual disc herniation at this level
    central buldge of the L4L5 disc.

    Currently i have difficulty sitting and laying on the bed. When I sit or laying on the bed I feel a pulling sensation at the back of buttock all the way to my toes. The side of the ankle feels tight. I been able to push all my 5 toes downwards and I find it difficult to fush all my five toes towards me. Most of time i drag my left leg and sometimes I walk like climbing staircase. occasionally my left leg twitches.

    From your experience what is causing the problem? Is it the question mark granulation tissue giving in the problem.

    In fact those leg discomfort only started in the month of december. In the month of January it became worse. Now February still the same and the leg gets very tight and pulling all the time when I don’t walk.

    Hopefully You can help me what is giving me the problem. My surgeon says I should not have pain and he wants to see me walk normally by the next visit.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    By your report of symptoms, it seems you have a chronic radiculopathy (see website) and motor weakness of the tibialis anterior (foot drop). This is reenforced by your report of toe dorsiflexor weakness (“I find it difficult to push all my five toes towards me”). You also report a steppage gait associated with weakness of the tibialis anterior muscle called foot drop (“Most of time i drag my left leg and sometimes I walk like climbing staircase”).

    What is somewhat perplexing is that the surgery was performed at L5-S1 to decompress the S1 nerve root (“Recent surgery has been performed at the L5S1 level”) and the S1 nerve root supplies the calf muscles causing weakness of push-off, not of foot drop (normally mediated by the L5 nerve).

    The EMG findings you do not report and these could be valuable to help differentiate the nerves involved (with the understanding that not all investigators who do these studies are as accurate as they can be).

    Your surgeon should have performed motor strength testing in the office as part of his physical examination and reported to you the results. See “symptoms of lumbar nerve injuries” to fully understand these disorders. If you have weakness generated from injury to the nerve root, the motor tests should be obvious and you will not be capable of “walking normally” as your surgeon requests.

    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.
    ftkm92
    Participant
    Post count: 28

    Hi.

    Is it possible to have a footdrop? From the previous MRI it shows a paracentral. Herniated at L4L5 but it did not compress the L5 nerve root. Another issue is Paracenteral at L5S1 level with compression in the S1 nerve root.

    I not sure what’s going on? According to the physiotherapist I have problem with the L5 and S1 nerve root.

    Previously had an enormous about of scarring of the S1 nerve root from the first surgery.

    current mri show granulation tissue and a bulging disc at L4L5 level.

    According to my surgeon he says my ankle is weak. He ask me to push up his hand using my toes and I fail most off the time. The big toe does not go up.

    Latest MRI shows granulation tissue.
    .
    Dr says I should not have pain and should be walking normally. I have been limping for 8 months already. Had two surgery done.

    Is it those problem cause by the granulation tissue surround the nerve root? Is it possible the herniated disc at the L4L5 level without compression causing the problem?

    My surgeon says he not sure because Nerve test shows normal.

    ftkm92
    Participant
    Post count: 28

    I could not bear the pain and i am taking targin, arcoxia 120, neurontin 900mg and ultracet to manage the pain.

    I also went for treatment under pain management doctor. She says I am having foot drop.

    Is it normal that I feel the discomfort when i sit, laying on the bed. Walking no pain just weak and slow. Standing slight pulling feeling.?

    The granulation tissue surround the S1 nerve root only.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    There are two places the L5 nerve could be compressed. One is the foramen at L5-S1 which would be the most likley area of compression and the other is L4-5 in the lateral recess.

    There has been no comment regarding foraminal stenosis or a big enough compression at the L4-5 area. There is a very small possibility that you have a lumbarization of L5 (the L5 vertebra congenitally is part of the sacrum) and the root with scar is really the L5 nerve and not S1.

    What were the results of the EMG/NCV testing?

    If the nerve has scar (granulation tissue) without compression, then there is a probability of this nerve having a chronic injury (chronic radiculopathy-see website).

    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.
    ftkm92
    Participant
    Post count: 28

    On 26/6/14

    1st MRI report.
    L4/L5 There is a disc prolapse with mild central canal and bilateral lateral canal stenosis.

    L5S1 There is disc prolapse and left parasagittal disc extrusion causing moderate central canal, left lateral canal stenosis and mild right lateral canal stenosis, it results compression onto the traversing nerve root of left S1 in later canal.

    Did surgery in 10/8/14

    2nd mri report on 8/10/14
    L4/L5 The prolapse disc result in mild central canal and left lateral canal stenosis.

    L5S1 The prolapse disc results in left sided moderate central canal and left lateral canal stenosis. ITcompressing onto the traversing nerve root of left S1 in lateral canal.

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