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#32672 In reply to: buttock nerve pain post microdiscectomy |
You are only 4 weeks out from your decompression surgery and doing better that prior to surgery. It can occur that inflammation increases as you increase your activity. This pain will refer to regions that were previously painful but with less intense pain and won’t radiate down the previous pathway nearly as far. I hope you are in PT to recover and have guidance. If not, ask if you could go to a good physical therapist. Also, you might consider an oral steroid which can be helpful in the post-surgcial period.
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.Hello.
17 days ago I had a microdiscectomy and decompression at L5/S1. Prior to surgery I exhausted conservative treatments starting with PT, NSAIDs, and my first epidural injection. The sciatic pain lasted for 3 months, each month getting worse, until after the injection I could no longer walk and was bedridden for 10 days before surgery.
Initial MRI was in March, the followup MRI in May reported the following, “At L5-S1 there has been slight increase in right subarticular disc protrusion resulting in severe right subarticular zone stenosis. The protruded disc contacts and posteriorly displaces the descending nerve roots, slightly worsened in comparison to prior examination.”
The first 10 days or so following surgery I felt great. 85% of the right leg pain was gone, no pain in the back (although my symptoms were never in the back per se.) I have slight calf weakness (cannot stand on my tippy toes for more than 5 seconds.) I had this symptom during the 2nd month but I regained the strength in my calf prior to surgery. Heel feels numb, or as if I am walking on rocks. But nothing major, or nothing unexpected I should say.
Suddenly, day 14 or so I began getting shooting pains in my ‘good side’, the left side which was unaffected prior to surgery. Shooting pains reminiscent of the nerve pain in the right (glute, hamstring area.) It is not persistent. It usually happens when transitioning my position, or when reaching for something.
At this time, the pain in the right leg also started to increase in intensity. Still NOWHERE near where it was before surgery. I can stand for 20 minutes now without pain, walk for almost 1.5 miles. Prior to surgery, like I said, I couldn’t walk 10 feet! My pain level was a 10/10 which landed me in ER one day after the epidural injection.
45 y.o. male, good health, normal BMI. Currently taking 220mg naproxen twice daily, 500mg Tylenol twice daily. Ice and heat as needed. Incision is pretty much healed. Experienced no complications following surgery.
My question and concern is this: why am I now getting pain on my ‘good side’? I asked the N.P. that works with my surgeon and she told me that it should resolve in ‘a few weeks’ and is typical. It sure doesn’t feel typical and I am looking for more of a medical explanation as to why my left side is now symptomatic.
Thank you for reading my story.
#32648 In reply to: Lumbar Radiculopathy from L4-S1 |The question that has to be considered is if you have instability and/or a degenerative spondylolisthesis at L4-5. This would fit with many of your symptoms and findings on MRI (“L4-5: There is a disc bulge. There is facet arthropathy. There is a small central disc protrusion. There is mild bilateral neuroforaminal narrowing. L5-S1: There is a disc bulge. There is facet arthropathy. There is a right paracentral annular tear. There is moderate and mild left neuroforaminal narrowing”.
I do think a diagnostic epidural steroid injection at L4-5 is a good consideration. See https://neckandback.com/treatments/diagnostic-vs-therapeutic-injections/and https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/.
Flexion/extension standing X-rays are important to look for instability or slip.
It is highly unlikely that you have cluneal nerve entrapment.
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.#32640 In reply to: finding pain generator post op |Thanks. Yes it feels a lot like pre op. I did have the flexion/extension x rays done and they told me no instability. My MRI also says I have “moderate foraminal stenosis at L5/S1” but it doesn’t say if anything is compressed.
My surgeon has basically told me it will go away on its own, but sounds like I need to get him to go over the MRI with me and explain why I got relief with the block and steroid but it didn’t last long.
Thanks for the help.
#32638 In reply to: finding pain generator post op |It seems like your symptoms are the same intensity and distribution as before surgery, correct?
There are other things that can cause nerve compression other than lateral recess stenosis. Instability and foraminal stenosis come to mind. Do you have standing X-rays with flexion-extension laterals? These X-rays can help determine if either of these two conditions exist which might be missed on an MRI.
Since you did have a nerve block of the L5 nerve which gave you excellent relief, the focus obviously should be on that nerve root. It can get caught at the L4-5 level posterolaterally or at the L5-S1 level in the foramen. Finally, unlikely as it is , this could be a chronic nerve injury
See:
https://neckandback.com/conditions/foraminal-collapse-lumbar-spine/
https://neckandback.com/conditions/lumbar-spine-instability/
https://neckandback.com/conditions/chronic-radiculopathy/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.#32626Topic: finding pain generator post op in forum BACK PAIN |Hi. I had a laminectomy done about 3 months ago for recess stenosis at L4/L5. I had some improvement post op, but after about a week a major flare up in symptoms which got a little better with prednisone. Since then, I’ve had constant radiculopathy just like before surgery–worse with walking and extension.
I got a new MRI, which shows “contact with possible slight compression” of the L5 nerve root and “granulation tissue or inflammation in the lateral recess.” I assumed L5 contact/compression was the cause of my continued symptoms, but doctor says that when he looks at the MRI he sees no compression. I had another neurosurgeon look at it and he also said he didn’t see any significant compression of L5.
I had a nerve block done at left L5 which gave me total relief, then a steroid that helped a lot for about ten days. My surgeon says that this will calm down eventually, but should other tests be done? Could this be from the disc itself there, which is bulging and has a tear in it (I read about leaking onto the nerve root even if not herniated)? I’m very confused the radiologist saw compression but two neurosurgeons do not.
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