AbbeygirlMemberJuly 1, 2011 at 10:19 pmPost count: 40
Hi Doctor I had back surgery 14 years ago it was a lectomey l5/s1 and have been pretty good up until 3months ago when I reinjured my back again had bad pain in left buttock and the back of left leg and numbness in left foot as well had ct scan and went back to the neurosurgeon who did my first operation I had MRI scans and he operatored on the s1 nerve after the operation I still had the same pain after a week I still had pain the nerosurgeon had me get a nerve block injection and then I went home still no improvement but I started getting pain in the right buttock as well and leg seemed to be getting pain in all different areas if not worse then before surgery went back to the surgeon he put me on nerentin and said I should feel better in about 10 days and still sore went back again last week and he got me to go for another MRI just received a phone call from his secretary today and she said there was no underlieing problem and that it was just inflammation and that he was going to organize another nerve block injectiDonald Corenman, MD, DCModeratorJuly 2, 2011 at 12:41 amPost count: 8436
According to your history, you had a laminotomy/ microdiscectomy at left L5-S1 14 years previously most likely for a herniated disc. You then re-herniated the same disc presumably on the same side 3 months ago. This is not uncommon as the recurrent herniation rate is about 10% in an active population.
You underwent a redo microdiscetomy at L5-S1 left and had no improvement after surgery and even developed symptoms in the opposite leg. A new MRI reportedly demonstrated no further nerve compression but inflammation only.
Some questions. Did you have any relief in the intensity of the left leg pain after surgery or did the pain change in quality or location? Does the pain increase when you sit and bend to tie your shoes or does it improve with those positions? Does the pain become worse with standing and walking or does it improve? Is the pain constant and does not change with any position and does it have a burning quality?
The reasons for those questions is that there are three potential sources of pain. One is that the pain source might have been not fully diagnosed. If you have foraminal stenosis (see website), you will have pain with standing that improves with sitting (the opposite of herniated disc nerve pain). The MRI will reveal foraminal stenosis if closely observed. This can be diagnosed with a selective nerve root block.
If there is a residual fragment of disc material that is still compressing the nerve, the MRI may also reveal it. Ask to review the MRI report from the radiologist. This report may be complicated, but it still can be interpreted.
Finally, you may have chronic radiculopathy. If the nerve has been injured by these recurrent herniations, after surgical decompression, the nerve needs time to heal. This occurs 90% of the time and heals by Mother Nature. Full healing is not always guaranteed and residual pain can continue. It may take 6 months to know if the nerve will heal. Epidural steroid injections are a good treatment as nerve inflammation is significantly reduced with these. Membrane stabilizers like Neurontin are also beneficial medications if there are minimal side effects.
Dr. CorenmanAbbeygirlMemberJuly 2, 2011 at 2:30 pmPost count: 40
Hi doctor thanks for your quick reply when I am standing it does hurt a lot more and when I try to bend back just a little it really hurts I just can not do it brings tears to the eyes also get pain in the left leg and also the bottom of my left foot goes numb got a appointment with orthapedic doctor on Monday hope I can get some help I need to get back to work thanks again for your reply I am starting to understand what might be wrong do you think that I should had a fusion at the l5/s1leval when I was doing pt the man said when he look at the ct scan that there was narrowing at that level and the disc that was there was black and very small which he said meant there was no fluid there he said that he could not help with pt and that I needed to see Nero and that he would put a cage in then when o went to see the Nero he said that he would do a nerve decompression of the s1 nerve I said that’s sounds better the what the pt said the said that because I had got 14 years out of the last op that he was going to go the same way so that I did not loose any movement just don’t know if I have did the right thing sorry for the long storyDonald Corenman, MD, DCModeratorJuly 2, 2011 at 9:52 pmPost count: 8436
By your symptoms of pain with standing that becomes worse with bending back, you may have foraminal stenosis. Again- this problem is discussed at length in the website. The way to accurately diagnose this is with a highly selective nerve root block (see SNRB on website).
If the disc has collapsed and the foramen is narrowed, you could try to have a foramenotomy procedure as one of your surgeons suggests but the success rate for that procedure with a discal collapse is not as high as some others.
The TLIF procedure involving a fusion of this level uses the “cage” that some other physician has recommended. This procedure increase the height of the collapsed disc space to make more room for the nerve and is the best procedure for opening the foramen and increasing the space for the nerve.
If you did have a foramenotomy and the procedure was unsuccessful, you could always then have a TLIF procedure but that does possibly increase the chances of chronic radiculopathy (see website for this) from multiple surgeries and continuing compression of the nerve root.
Dr. CorenmanAbbeygirlMemberJuly 3, 2011 at 1:19 amPost count: 40
Thanks again doctor you explain things a lot clearer than anybody else has I just want to get better but I must admit I am getting a bit scared because I am still very sore and the symptoms are all over the place I have done everything that I have been told to do I have been taking nerotin and still have pain also I have been taking a fair amount of endone as well anyway thanks again for your informationAbbeygirlMemberJuly 3, 2011 at 12:48 pmPost count: 40
Hi doctor I sorry for keep on writing stuff but really I do not know what is going on I just brought the newspaper as I do not seem to be able to get comfortable I decided to lye on the floor on my stomach to read the paper which was a struggle on it own straight away had pain in my lower back but I persisted with it then my big toe on my right foot went numb so I got my daughter to take off my slipper then she rub it and after a few minutes got feeling back then my left big toe went numb but not as numb as the right more like a pins and needle numbness I then got up which was a struggle I don’t think I will be doing that in a hurry again I just do not know what is going on with me if you could you explain things so well is this normal to have these sort of problems thanks doctor for your help I just wish I was able to get to your practice thanks again for your information just one more thing I know it is hard without seeing films of my back but what are some of the reasons that I am getting numbness in my big toes for thanks again for your information
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