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Hello Dr. Corenman,

I had a microdiscectomy at L5-S1,4 weeks ago, after 8 months since everything started.
The pain I had before the surgery was the most intense in my buttock and the exterior of the hip and less intense down the left leg up to the ankle on the exterior of the calf,and it ocuured mostly when seating and when getting up ,or when bending forward.
Right after the surgery, I was feeling a little bit of pain on the exterior of the calf but not in my bottock, then in the first week post op.the pain was also present in my buttock, at a mild level, not as it was before the surgery, my surgeon told me that is normal if the pain is not very intense.
I started walking outside the house in the following days and the pain got more intense,sometimes greater than before the surgery or comparabale and sometimes it fells a little different than before and on a larger part of my leg, the difference between before and after is that the pain is not so bad when sitting or getting up, but is greater when walking or standing up or even when laying down.
Initial recommendation was to begin kinetotherapy 2 weeks after surgery, buy I informed the surgeon about the pain and he said to not do anything yet.
I took diclofenac and mydocalm for a few days,during this time I felt better, but my concern is that taking this meds I will never know my real level of pain or recovery.
Should I continue to take meds?
If the nerve is not compressed anymore, should I still feel this kind of pain, or shouldn’t that go away little by litlle every day?
Should I wait for the pain to completly go away in order to start any excercises, kinetotherapy?
Is phisiotherapy also indicated?
Is an MRI relevant on this stage of recovery? Would the images reveal the real or actual nerve situation or would that be prevented by the scar tissue?

Thank you very much.

Most likely, this is part of the healing process as long as these sensation don’t occur consistently with any particular type of back motion such as extension.

Dr. Corenman

If you have continuing symptoms and pain in the pathway of the C7 nerve root, you can elect to wait but after a year, your fusion should be solid. If it is not, then where is the pseudoarthrosis? A CT will reveal the non-union (along with flexion/extension X-rays). If a pseudo is present you could have revision ACDF, ACDF with posterior fusion or posterior decompression and fusion.

Dr. Corenman

First of all, having a 4 level ACDF fusion has a higher chance of pseudoarthrosis (lack of fusion) so immediately, my thoughts start with that possibility. Pseudoarthrosis is best diagnosed with CT scan followed closely by X-rays including flexion/extension.

You have significant foraminal stenosis at C6-7 left (“moderate to severe left neural foraminal narrowing”) so you could have a Left C7 radiculopathy either from a residual compression or a developmental compression from a pseudoarthrosis. See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/

The way I would consider a workup is to have the CT and X-rays, determine fusion status, then use a SNRB at C6-7 left (https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/) to determine if the C7 root is involved. If the SNRB is positive (gives you temporary relief), then you have two choices.

If the CT scan shows a solid fusion, you can have a posterior foraminotomy. If you don’t have solid fusion, you can have a revision ACDF and clean out the foramen from the front at the same time or have a posterior foraminotomy and a posterior fusion at the same time.

Dr. Corenman