Donald CorenmanKeymasterMay 7, 2011 at 11:04 pmPost count: 52
I had this surgery on L5 S1 after months of chronic left leg pain. Pain was gone and strength back in the leg after surgery but 2 weeks later some pain came back in left leg and then in my right leg. Another MRI shows no further herniation but some scar tissue. I am now nearly 4 months post op and still have pins and needles, muscle twitches and some pain in both legs. Doc says it’s nerve damage and may take up to a year to come right! Back feels fine though.Donald Corenman, MD, DCModeratorMay 7, 2011 at 11:05 pmPost count: 8614
You mention three symptoms- paresthesias (pins and needles), muscle twitches and pain in both legs. Let’s discuss what can happen to a nerve root with a disc herniation and go over each symptom separately.
When a nerve is compressed, as from a herniated disc, damage can occur to the nerve that is permanent. Remember that the nerve is really just a very long cell with the membrane of the cell conducting the signal. Pressure on these membranes from a disc herniation can stop the signal in terms of numbness or stimulate the signal in terms of pain sensation. If the nerve membrane was damaged by the herniation/compression- permanent pain and numbness can occur by blocking the signal or allowing the pain signal to be generated by a leaky membrane.
Most herniations do not cause permanent symptoms but some do. Symptoms of “pins and needles” can take up to six months to disappear after the discectomy and occasionally can be permanent. Most individuals can ignore these paresthesias as they subside. Nerves can continue to be “persnickety” and sensitive for up to two years.
Pain can continue if damage to the nerve occurred. Most times, the pain recedes over 6 months but again, some individuals can have chronic pain from nerve injury. If the pain does not improve and a new MRI reveals no compression (must look for other causes such as foraminal stenosis), the the patient has a chronic radiculopathy and needs pain management services.
Muscle twitching could be from an injury to the motor nerve. This would manifest as weakness (the foot is undependable or “flops when walking” or more difficulty with climbing or descending stairs. If you notice weakness or the physical examination reveals weakness, an EMG test can reveal if recovery is possible.
Hope this helps.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.AnonymousGuestMay 8, 2011 at 5:56 amPost count: 8
Thankyou for your reply. Given that I had no Symptoms in my right leg pre op ( all symptoms were left side), I wondered if the nerve was damaged in surgery. I have been prescribed nortryptilene for my symptoms so will see if that helps. I have no obvious weakness in my legs so hopefully I will see an improvement over the next few months.Donald Corenman, MD, DCModeratorMay 8, 2011 at 10:30 pmPost count: 8614
It is difficult to injure an opposite side nerve during surgery as it is not in the operative field and literally about 3/4 inch away. When under the microscope, that distance is the equivalent of about two miles away in the non-medical world. I guess that injury could happen but very unlikely.
Pain in the opposite side nerve could occur under three circumstances. One is a phenomenon called cross-over pain. The nerves in the opposite sides of the body eventually cross over in the spinal cord (you remember from high school that the left side of the brain takes care of the right side of the body). The cross-over or decussation allows the nerve to come in contact with each other. It is theorized that there is “cross-talk” between the nerves at this point.
The second possibility is that there is a small hematoma (collection of blood) in the canal that is causing temporary compression or even inflammation. If this is the case, most of the time this hematoma will resorb and not be a problem in the future.
The third but unlikely possibility is that there was a fragment of disc material that migrated across the canal or the discectomy caused some collapse of the disc height and there is some compression of the opposite nerve. This should also become quiet over time.
Dr. CorenmanPLEASE 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.AnonymousGuestMay 9, 2011 at 1:44 amPost count: 8
That’s very reassuring. I look forward to a steady improvement. Thanks again.
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