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L5,S1 and Fasciculations
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L5,S1 and Fasciculations

Thank you in advance for any help you may provide.

My husband (37 y/o) had neurosurgery two years ago for a badly herniated L5 S1 disc.  This provided relief from terrible muscle spasms in his back and left leg and foot, weakness in left leg and foot and reduced sensation.  Six months ago he started to have fasciculations in his left calf.  Over time the fasciculations spread to his entire leg and increased in severity and frequency to the point of creating fatigue in his leg.  He revisited the neuro group.  They put him on Tegretol which helped a little but not really significantly.  Neurontin was tried next which helped even less.  The neurologist had an MRI done just to check.  Sure enough the same disc was badly herniated on the same side.  He was also found to have a narrow spinal column (congenital).  The compression on the sciatic nerve definitely warranted surgery.

Surgery was completed two weeks ago. A gel was painted on his nerve to help with build up of nerve tissue.  The fasciculations have lessened a little in both severity and frequency.  His leg is still weak which doesn't surprise me and his back is too, but that seems part of the healing process from surgery.

My questions are:
1.  Is it probable that the fascicultions will continue to diminish over time?
2.  Will the nerve continue to heal and if so how long is typical in the healing process?
3.  I understand the gel has recently been approved by the FDA.  What is the buzz on the effectiveness of this gel?
4.  How likely is a disc to herniate a third time?  More likely or no more likely than an individual who has never had a herniated disc?

Thank you!
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Dear Diana:

What did your neurosurgeon say?  I am not trying to be "smart" but these type of surgeries are so individual, each patient returns to optimal function at different times.  If the source of the nerve damage is corrected, fasciculations should improve.  As those nerves who are destined to die, die off, the fasiculations will cease in those dead muscle fascicules.  Those nerves who remain irritiated, those muscle groups will continue to have fasciculations.  Yes, the nerves from the spinal cord are peripheral and they can regenerate.  There are too many factors that are unknown to me, thus I can not say, but the general rule is that 18 -24 months is the outside time frame for regeneration.  The data is not entirely clear about large numbers of patients.  From what I hear, the data is encouraging but I would not bet the family fortune on it being the cure all for nerve damage.  In fact, I have reservations about the effectiveness long term.  But, I think it will help.  Whether a disc will herniated again is a compound question/answer depending on the etiology.  If it is osteo then likely it will not get much better over the long term.  But, it also depends on how your husband changes his lifestyle and habits.

Sincerely

CCF Neuro MD
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Dear Dr.I thank you in advance for you're expertise...

I had a severly herniated disc at the L4-L5 with compression to the Cauda Equina...surgery was done in June 98...microsdiscetomy,, laminectomy and spinal decompression...following 5 months of compression.

These "fasculations" that people discuss...is that what is happening in my leg when my leg "spasms and jerks"? Both my legs do this, the right worst than the left. I remain with no ankle reflex on right along with diminshed knee on both right and left leg, and diminished reflex on the left ankle as well.

I am not concerned with it, I assume it is from nerve damage to the right leg...I have severe back pain when standing especially, also severe when sitting on a hard surface...walking is not too bad, although limited...when you say nerves regenerate at 18-24 months...is there a chance I could still have some recovery even tho it is 16 months ago from surgery?  

I had a new MRI that shows scar tissue compressing the L5 nerve root, and also scar tissue in the area of the L5 where the disc was removed...do you think I would improve if I had the scar tissue removed with additional surgery?  My Neurosurgeon made no suggestions other than that I will have to take muscle relaxants, pain meds, and arthitis med for the remainder of my life...I am 43 F...any suggestions?
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Dear Deborah:

You really need to talk to your neurosurgeon as I previous stated.  Most likely the scar tissue would just recur.  Surgery is usually the last resort and outcome is always guarded.  The recover depends on rehab and the performance of the surgeon.  Since your lesion is surgical but the etiology? so I can not say too much about regeneration but at this point I think you have what your going to have.  Sorry, but there are no good answers after surgery.  Stick to your rehab, do not overload your back, use proper form in all activities, and make sure you keep your self fit and in condition.

Sincerely,

CCF Neuro MD
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Thank you Dr. MD....I was just hoping you may say something different than my Neurao...he is an excellent NS and I trust him and his judgement...thanks again!
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your welcome.

CCF Neuro MD
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What do you mean by the etiology? You made reference to it in my earlier post...regarding the possiblity of nerve regeneration and the fact that I have scar tissue compressing the L5 nerve root and it is also in the L5 disc area where the disc was removed...thanks
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Dear Deborah:

Etiology means the reason for the scar tissue, and the disc problem.  If the etiology was due to arthritis then the outcome would be different than let's say congenital abnormality, or obesity, or furniture lifter.

CCF Neuro MD
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I hope I can answer the etiology ???  I slipped on ice in the parking lot resulting in a large central to paracentral right disc herniation in the L4-L5 in Jan 98....in June 98 I underwent spinal decompression, laminectomy and microdisectomy....the myelogram showed severe compression to the L5 nerve root...which was causing right foot drop and a complete right leg and foot feeling of "deadness" along with back pain...the MRI done in 98 did show Arthitis, DDD, and spinal stenosis...none of which caused any problem prior to the herniation...

Following surgery my Neurosurgeon this past June 99, after a new MRI was done...which showed the epidural fibrosis...scar tissue compressing the L5 and within the area where the disc was...I was told that I would be on pain meds, arthitis meds & muscle relaxants for life ...that I have residual Cauda Equina Syndrome and Chronic Radiculopathy....I am 43 F....so even tho it is 16 months later..do you think L5 nerves could regenerate?? maybe...? ;-)  thank you
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Dear Deborah:

I think that it has been too long.  Your injury occurred in Jan of 1998 if I read your posting correctly.  The passage of time has been too long.  

Sorry, I don't have better news.

Sincerely,

CCF Neuro MD
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Yes, you are correct that the injury was in January 98....I thank you so much for answering me honestly regarding nerve regeneration....you and the other N/S and Neurologists are such a blessing...the work you do blesses so many!!  Chin up and on with the show, right....thanks again!
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Good morning I had a herniated disc had a partial discectomy on Oct 7 1999 for S1L5.I had a left and central hurniation .I am still having the same pain that I had before the surgey leg, bum, and back pain including numbness in the right foot.I also experienc cold wet fellings in my bum when I sit down and at times in the legs they come and go.I have pain most of the time increased when sitting standing and driving.I also experiencing nerve pain shooting down me leg!!! I saw my surgent the other day and he assures me that all I need is therapy to work on my back muscles!!!! Why have these symtoms (symptoms) not improve with surgey??? I do not feel pain in the area of the sugery any more it feels just like it did before surgery !!!He did a leg raise test and said that there is no nerve problem????Then why all the pain????I am also still taking my tylenol #3 for the pain he wants me to start reducing my meds how will I cope with the pain if he does that !!! I am in so much pain all of the time it even keeps me up at night at times please help desperate in Gloucester!!!!!
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Dear Pat Gorman:

Sorry that your experiencing pain.  Many times surgery has little effect on the immediate reduction of pain, in fact, unless there is mechanical nerve pain (pain with movement), most surgeries have little benefit except keeping the lesion from worsening.  It is still early in the rehab process and I would recommend talking to your rehab team about what you need to do for maximum rehab.  I am afraid that pain is something you will have to live with for awhile.

Sincerely,

CCF Neuro MD
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DearDr.

I was scuba diving in August 99 when I felt a sharp pain in both ears.  Later in the day my ear right ear felt pressurized and I went to the ER.  The Dr stated ear infection and provided antibiotics.  After 2 weeks my ear still felt different and I scheduled a visit to the ent.  ENT Dr claimed I had a retracted eardrum and should be better within 1 month, hearing test should mild hearing loss but was unchanged over the past 3 years.  She Rx nasal steroids.  

In the beginning of October I still had my ear problems and went back for reevaluation.  She said it needed to be given time to heal and It was OK to Fly.  She gave me a prescription for .5mg of Zanax to help me sleep at night and calm my anxeity fears.  A day later, I was informed that my 6 month old daughter required open heart surgery.  

One week later while I was traveling in California I awoke in the middle of the night with fascilations throughout both legs.  The fascilations have appeared throughout my body (calfs, upper legs, knees, shoulders, face, forearms) but mostly in the legs over the past month.  My arms and legs were stiff and cramping, however, this appears to have diminished.  I wrote these symptoms off to being nervous about my ear and my daughters pending surgery, the fascilations seem to come ang go but mostly after I do some sort of exercise ( yard work, lifting boxes etc.)  

One week after my daughter's surgery I am still having the muscle twitching.  I went to an internist and he Rx Buspar claiming the symptoms were from anxiety.  He also gave me selson blue for a slight rash that I developed on my back and chest area.  I would like to hear your opinion.  Should I go see a Neuro specialist?  Thank you in advance.
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DearDr.

I was scuba diving in August 99 when I felt a sharp pain in both ears.  Later in the day my ear right ear felt pressurized and I went to the ER.  The Dr stated ear infection and provided antibiotics.  After 2 weeks my ear still felt different and I scheduled a visit to the ent.  ENT Dr claimed I had a retracted eardrum and should be better within 1 month, hearing test should mild hearing loss but was unchanged over the past 3 years.  She Rx nasal steroids.  

In the beginning of October I still had my ear problems and went back for reevaluation.  She said it needed to be given time to heal and It was OK to Fly.  She gave me a prescription for .5mg of Zanax to help me sleep at night and calm my anxeity fears.  A day later, I was informed that my 6 month old daughter required open heart surgery.  

One week later while I was traveling in California I awoke in the middle of the night with fascilations throughout both legs.  The fascilations have appeared throughout my body (calfs, upper legs, knees, shoulders, face, forearms) but mostly in the legs over the past month.  My arms and legs were stiff and cramping, however, this appears to have diminished.  I wrote these symptoms off to being nervous about my ear and my daughters pending surgery, the fascilations seem to come ang go but mostly after I do some sort of exercise ( yard work, lifting boxes etc.)  

One week after my daughter's surgery I am still having the muscle twitching(R).  I went to an internist and he Rx Buspar claiming the symptoms were from anxiety.  He also gave me selson blue for a slight rash that I developed on my back and chest area.  All blood results were normal.  I have lost 20 lbs over the past 3 months. I would like to hear your opinion.  Should I go see a Neuro specialist? Thank you in advance.
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Dear Greg:

I would seek a thorough neurological exam by a good neurologist.  Your symptoms could include a variety of diseases, both benign and worrisome.  It sounds like you are under a great deal of stress and maybe that is why you have lost the weight, but I would get a physician's opinion that can physically exam you and get the details of your medical history.

Sincerely,

CCF Neuro MD
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What type of diseases would be possible with my symptoms.  I am scheduled to see the internist again on 12/14. I have never really been to see a physician since this all started and I'm only 35 years old.  My physical in September was good except for 213 Total Cholesterol.  I lost 12 pounds in September, 8lbs in October and has stabilized since then.

I put up over 3500 christmas lights this past weekend, set up a christmas tree and train set, my fascilations appear to have diminished in frequency, just sore muscles after the weekend activities.  Also my arms have a slight tremor after excerise for about 1/2 hour. Thank you for your help I really appreciate it

Greg
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Dear Greg:

The possibilities are endless and would fill up the posting space.  The important thing is to rule out the worrisome diseases and that can be done by some simple labs and GOOD neurological exam.  Do these things first and then worry if there are things to worry about.  

Sincerely,

CCF Neuro MD
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Thank you I will set up an appointment for the beginning of

January
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your welcome.

CCF Neuro MD
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ok you have not had time to reply since I send the last message but since then I have been experiencing alot of numbness in the face  alot it is starting to scare me so this is not only herniated disc problems please need a response asap pleaseeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee
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Dear Pat Gorman:

You need to see your neurosurgeon/neurologist.  I am not sure what you mean by "you have had time to respond".  I answered your posting.

Sincerely,

CCF Neuro MD
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From my understanding fasculations are either a result of a benign process or a symptom of ALS.  Is there any other diseases asociated with fasculations?  Thank you for your assistance.

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Dear Jamie:

Yes, there are many other conditions that can give you fasciculations.  Many of the polyneuropathies, Issac syndrome, infections, muscle disease other than ALS, etc.

Sincerely,

CCF Neuro MD
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Why do myelograms make the injured area more painfull after they inject the dye in you!! I had one done a few days ago and since then I have had alot of pain "nerve" pain in the legs and back pain and starting to have bladder problem loosing control not alot just enough to notice???
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Dear Pat Gorman:

I would contact the physician who performed the myelogram and let them know what is happening.  

Sincerely,

CCF Neuro MD
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Hello,

I am a 41 year old female. In good shape. Never smoked, not
over weight. I had a laminectomy 7 years ago.

Last year I started having problems again. My neurologist
did an MRI and it showed the beginning of my disk
herniating.

Uptill now, I have been able to survive taking motrin.

But recently I've experienced the numbness in my left
buttocks and pain radiating down my back and buttocks.

These symptoms are all too familiar from what i had 7
years ago prior to surgery.

My question is::::::
Should I undergo more surgery? I've also tried cortisone
shots but they didn't last long.  

At this point, would more surgery be beneficial?

Looking forward to your reply.

Susan
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Hello,

I am a 41 year old female. In good shape. Never smoked, not
over weight. I had a laminectomy 7 years ago.

Last year I started having problems again. My neurologist
did an MRI and it showed the beginning of my disk
herniating.

Uptill now, I have been able to survive taking motrin.

But recently I've experienced the numbness in my left
buttocks and pain radiating down my back and buttocks.

These symptoms are all too familiar from what i had 7
years ago prior to surgery.

My question is::::::
Should I undergo more surgery? I've also tried cortisone
shots but they didn't last long.  

At this point, would more surgery be beneficial?

Looking forward to your reply.

Susan
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Hello just got the results from my myelogram that I had 2 weeks ago and to my surprise there is no new hurniation!!!How can tha be???if I am experiencing the same type of pain muscles and nerve pain on the opposite side???And since that test I have been having problems with my bladder??My doc seems to think that I have MS Somehow I do not feel the same I think it has to do with the nerves the disc or something????I also have alot of trouble with the cold my nerve in my bum back leg and foot goes nuts in the cold it is so painfull feels like a tooth ache that is exposed to the cold but in the  area where the dics would be causing problems!!Would a mylogram show siatic (sciatic) nerve damage or spine damage???? I will be going for a MRI soon will that help??? I understand that the myelogram is the best test that shows everything better than a MRI?????My legs also are very weak feels like I am walking in water when I walk  and standing is very hard  to do as well it gives me alot of pain and weakness sitting is out of the question it just kills me when I do and getting up well the nerves in my bum back and legs don't like that at all hehehehehe they let me know real fast!!! I also get alot of burning in my foot and numness???SO confused and would appreciat you thouhgts
Thanks Pat Gorman
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Dear Pat Gorman:

I can not tell from what you have told me without seeing the films and doing a physical exam.  I would wait for the results of the MRI.  The sensitivity of the MRI is sometimes better and this might tell you something.  It may be that there is just inflammation in the spinal nerves, but a good neurological exam and the MRI will help matters.

CCF Neuro MD
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Thank you for answering my question.So what would be causing inflamation (inflammation) in the nerve area then???Would it still be the surgery I had and if not????Is this permanent??
Pat
happy new year
and thanks again
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Dear Pat Gorman:

Inflammation can be due to systemic illness such as rheumatoid or osteo arthritis, lupus, collagen vascular disease etc.  It can also arise from surgery in the area.  It can be the result of irritation from long term misuse of the area such as a job where lifting occurs.  It can arise from trauma.  So the list is pretty long.

CCF Neuro MD
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ok if it is what can be done to make the nerves go back to normal???And can this be seen on a MRI??

Pat thanks again
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Dear Pat Gorman:

It depends on the extent of the disease.  No, an MRI will just show changes, you need to have various testing done to see if the etiology is due to the diseases mentioned.

CCF Neuro MD
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Hello
What kind of testing should I have???
Pat thanks again
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Good morning
As previously discust is it possible that the tylenol that I am taking causing all of my symtoms (symptoms) mimaking a herniated disc symtoms (symptoms) I know I am grasping at straws but realy must look at all possabilities!! I take 8 tylenol a day #3's for the last year for
my hurniated disc that I had surgery for in October 1999.
Pat thanks again
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Dear Pat Gorman:

I think you need to talk to your neurologist about pain management and what tests that need to be done.  Tylenol would not mask the symptoms nor give you the symptoms you have described.

Sincerely,

CCF Neuro MD
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Dr Doctor
Thank you very much for your info you have help me out and answer more questions than some of my own doctors and I truly am gratefull!!!
Can tylenol #3 cause a higher level of enzynes???and if so what
are the symtomes if any???

Pat
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Hello,I have a couple of problems I would really like input on. In June 1999 I had "emergency" back surgery on a herniated disk. They took out 40% of L5. felt great!
  3 months later i felt worse than before surgery. MRI results have come back saying the same disk has herniated again but the scar tissue has grown into my sciatic nerve. I need not go into the amount of pain. My question is why can't laser surgery be done on the scar tissue? Is "pain management" the only thing left?
  In the "natural" books I have read claim that a lot of heat, especially saunas break down scar tissue. Do you think this is false hope for us who at this point are desperate for relief?
Final question, can the scar tissue eventually paralize me?
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Dear Dee Nokes:

No, head will not break down scar tissue.  Lazer is not a precise enough tool to remove scar tissue from the nerve.  It is either surgery (likely the scar tissue will return) or ?  Sometimes rehab helps, pain management helps some, but I am afraid there is not much other than surgery one the first two fail.

Sincerely,

CCF Neuro MD
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    Thank you for your response even though not quite what I wanted to hear. Here is a question, I know it may sound shocking to some (it did my family) but ...instead of all this pain management stuff and medications that will cause side effects, what if a surgeon went in and "killed off " the sciatic nerve,cut or whatever ? Wouldn't I just be paralized on my right leg side and then resume life better? I'd rather have a bumb leg than continued pain.  
    Second, I've heard of a clinic in Cal. that claims their natural medications work better and are safer. is the FDA/MDA looking into natural or are they against each other?
                 thank again,
                        Dee    



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Good morning
I have just been told that I have Myofacial Pain syndrome .In October I had surgery for a hurniated S1L5 hurniated disc...I take 8 tylenol #3 a day for the pain...can you tell me what causes this syndrome and if it is reconized as a disability...and will I ever be able to return to work???What could have triggered this???
Pat
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no comment on myofascial????
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Dear Pat Gorman:

There is no really known etiological agent for your condition.  The pain can be intense and cause many problems with lifestyle.  There are many approaches to the control of pain and we usually try to use non-sedating and non-addicting medications first.  Most of our patient function well and are living active and productive lives.  There are always patients who do extremely well and some who do not seem to respond well.  

This is a free service and demands cannot be always meet on time. Sorry.

CCF Neuro MD
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Good morning
I just received the "total test results" of my myelogram
I am told that I have deg disc and facet lessions....can't this
condition be repair by surgery or am I stuck with this for life???In the last 4 months I have seen several doctors.. here are their findings
a...Ms... not proven yet... family doc
b...myofascial... not proven yet ...neuro doc
c...hurniated dics but... not proven yet ...neuro doc
d...deg disc and facet lessions (myeologram)proven... ortho doc
I am awaitting as previously mentioned for a MRI...I have had a nerve conduction study test it came out ok but could not do the EMG because it was causing to much pain the the neuro doc moved the needle around..she is the one that thinks that I may still have a hurniated disc...is it possible the facet lissions and deg disc are giving me the symtoms (symptoms) for hurniated disc...numbness weak legs vibrating feeling in my right groan and leg foot feeling could muscle spasms in my back etc all of the fun stuff a herniated disc would do to you?????
Thank you
Pat
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Dear Pat Gorman:

Yes a severely herniated disc could cause the symptoms you describe.

Sincerely,


CCF Neuro MD
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A related discussion, post Micro lumbar disectomy pain was started.
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