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Dear Dr. Corenman,
As promised I am writing with a follow up since my last post regarding my L4-L5 revision microdiscectomy two weeks ago. As I await my six week visit during the week of October 21, I’d appreciate additional insight you may have.
I discussed my continued nerve pain with my surgeon at my three week visit, but he wanted to wait on an MRI. He believed that my pain was inflammation based on the size of the fragment removed during the revision surgery (4cm, my first was 5cm) and wanted to give my nerves more time to calm. I should note I also have a bulging disc at L5-S1 and a visibly puffy seroma.
Since that visit, my nerve pain has waxed and waned with the back pain decreasing and becoming mostly stiffness. Things actually seemed to be improving at four weeks —- I even had a pain free day —- and so I held back on pushing a new MRI. However, as week five comes to a close, my pain has recently taken a turn that has me questioning my recovery. Specifically, I’ve noticed: an occasional uncomfortable tightness along my mid-spine when taking a deep breath while lying down; tenderness on either side of my low back (where my primary back pain was with the herniation); and some deep pain in the incision area. My sciatic pain, which is typically better while walking, has become a bit more frequent at a level 2-3. It is worst in the parts of my left calf/foot that have residual numbness (all weakness but my big toe is 90-95% resolved), though my right leg experienced nerve pain too
(and has since the second herniation). I’m not having unbearable standing or shooting pain like pre-surgery, more of a mild ache in different parts of my legs. I took a 45 minute walk today that was totally okay, though I have some leg pain at rest as I write.Mostly, I’m curious about this mid-back sensation and new tenderness? Could this be related to reherniation or scar tissue? Is there any chance I’m just feeling extra sensitive given the degree of my injuries? I felt I was progressing positively albeit slowly but am starting to worry my back is too compromised. I am being super careful, but did accidentally sneeze over the past few days due to allergies. I expect to have a new MRI in a week but don’t think I can push things forward sooner.
Best,
LCDear Dr Corenman,
Thank you for clarifying.
The recovery room experience and commute home was very difficult — so I suppose it is possible that my pain was more than typical post-op pain. I will for now stay hopeful that I am not one of those rare cases. I am not free of nerve pain, but it does seem to be improving a bit each day. Last night was the first time that I did not have evening pain, and my low back discomfort in the morning is also decreasing slowly.
I’ll share an update once I know more. I appreciate your time and insight.
Best,
LCThank you, Dr Corenman. I will give it time and hope it is inflammation or seroma, but understand that a fusion is something I may need to consider in the future.
Having noticed discussions here and other sites that note inflammation-related nerve pain can take weeks to resolve, may I ask if or why you believe there is a strong likelihood of reinjury in my case? I may be mistaking caution for belief, so my apologies if so.
As I mentioned, I had continued leg pain in the hospital recovery room before even attempting to walk, which is why my surgeon is not yet raised reherniation.Have you seen instances of an immediate reinjury?
Many thanks again.
Best,
LCDr Corenman,
Thank you for your response. I am trying to listen to my pain but my high tolerance has made it hard to judge throughout. If I have pain while standing, but not walking, does this mean I should be resting? I have found that the leg pain comes upon standing still or after activity while resting but very rarely hurts while in motion.
If a reherniation, I would like to attempt conservative treatment for a few months before diving into a fusion unless that is considered too risky? I am concerned that having had two surgeries so quickly, my body has had little chance to heal on its own. For now, I am crossing my fingers that it is mere inflammation as I have been quite cautious since the surgery.
Either way, I will follow up to share how things go. Any other guidance re: questions I should be asking my surgeon would be appreciated.
Warmly,
LCDear Dr Corenman,
Thank you for your response. I had been holding out hope that it wasn’t a reherniation because I had sciatic leg pain in the recovery room, and did not think it could have injured that quickly. I was also told that the new herniation was fairly large and that he also had to remove scar tissue and bathed the root in steroids. I understand that my nerves have been through a great deal of trauma, and hope they just need time.
If it is inflammation, do you agree with limiting activity to 8-10 five minute walks (45 min) a day after the two week mark? There is not weakness, but I do feel myself wasting away the strength that I regained.
And in the event it was a reinjury, is there any chance it could heal conservatively? The idea of another surgery is quite disturbing.
I have a follow up with my surgeon next week, and will discuss with him.
Best,
LCDear Dr Corenman,
I am writing with an update and question since my earlier post re: my L4-L5 reherniation. As I wrote before, I reinjured my disc on July 25, 10 days after surgery while doing recommended gentle post-op stretches in bed. My original injury had taken place 3 weeks prior, causing severe left leg weakness and foot drop. A microdiscectomy on July 16 removed a large 5cm disc fragment, and totally relieved my left leg pain until the reherniation brought on new pain in both legs.
The reherniation and revision microdiscectomy process, unlike my first surgery, has been painfully complicated. It was originally scheduled for August 22nd after two courses of steroids did not alleviate tailbone pain and sciatica. Unfortunately, my procedure had to be further delayed until September 9th because a UTI came up in my labs and required multiple antibiotic courses to clear. So, I spent 1.5 months with the reherniation, after 3 weeks with the first herniation and a brief pain-free period in between. Happily, I regained nearly all of my leg strength during the waiting period despite the reherniation. The sciatica also began to diminish when walking — I comfortably walked 5 miles the day prior to my procedure. However, the pain continued to be severe while standing or sitting, and a new MRI showed no improvement in the disc, so we moved forward with the revision which removed another very large fragment.
Now I write you with hopes of gaining more perspective re: my expectations for this recovery. Unlike the first surgery, I have had continued sciatic pain since waking in the OR two+ weeks ago. The pain diminished somewhat with the help of a Medrol pack, but I continue to feel flares in my legs when standing for more than a few minutes and it is worse at night. I am limiting my activity to only 8-10 five minute walks a day per my surgeon, so this pain comes on fairly easily.
My surgeon believes this is not a cause for concern yet and that it is simply nerve irritation from the two injuries and surgeries. Still, I am unable to shake the concern that I could have somehow reherniated again despite my lack of activity. My injuries happened first with a cough and then with a stretch, and I was able to walk without pain despite a large herniation, making it difficult to know when to be concerned or how to mitigate risk.
So my questions: Is my nerve root really simply battered, and should I just expect several weeks or months of pain before it settles? If that’s the case, is so severely limiting my activity to my benefit? I work at a demanding nonprofit administration job in Manhattan, and wonder what my expectations should be of myself for a return to work, as well.
I am admittedly frustrated — I am now three months out from my original injury, but only two weeks out from my revision surgery. While I am willing to do whatever it takes to recover, I have watched the seasons pass and miss my daily life.
Thank you for your time.
Best,
LC -
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