Peripheral Neuropathy or Damaged Sciatic Nerves?

    
      Re: Peripheral Neuropathy or Damaged Sciatic Nerves?
    


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Posted by CCF Neuro MD on July 15, 1997 at 21:16:58:

In Reply to: Peripheral Neuropathy or Damaged Sciatic Nerves? posted by William H Manby on July 08, 1997 at 17:49:28:
    Eleven years ago I, coming off the golf course, I was struck by a sever
  back pain, I had chronic bach ache and treatments for several years.
  This was different, extremely different it was almost disabing.  I made
  it to the hospital where I was given a cortisone injection which eased the
  pain somewhat.  The next 72 hours were a living hell.  Both legs
  exibited acute pain from the thigh to the ankle. I went to the Pain Clinic
  again and he referred me to the neurosurgery clinic were I was
  admitted.  L4/L5 lambidectomy (sp) was performed.  Upon awakeing from
  the anestetic, I did not feel pain, but in 12 hours the pain was back.  I could not pull my toes up at the doctors request.  i ws kept for 10 days and
  dischrged, still with extreme pain and given Percoset as a pain reliever.
  This helped immensely at first but the dosage needed to be increased
  to coe with the exreme leg apin ( It was described as a "stocking" pain.
  The pain engulfed the whole leg; it did not pinpoint any joint or muscle.
  I lost 23 pounds and returned to the Neurosurger Clinic for relief.  I wssentot the Neurology clinic.  I was hospitalized for three weeks  during which time
   tests for diabetes, heavy metal ingestion or toxic vapor inhalation were
  run with no diagnostic results.   I was pronounce with "Peripheral Neuropathy" and sent home.  I was told the pain would  slacken after about 3 weeks;  it did.
  I had to learn to  walk again, firs with a  "stand" type walker, then with
  Canadian crutches then with eglar armpit type crutches.    I was fitted with
  leg braces to keep my foot  from dropping when I walked.  I was totally
  disabled from any ambulatory activity for 3 months. Gradually  learning to walk and balace, I persevered.
  I still can't walk for over 200 yards. But my problem is weakness of the
  ankles and lower leg.  My calf muscle is qu9ite large and strong but none
  in the front of my bleg that will allow my foor to rise when walking.
  I have fallen many times, tearing my fight shoulder rotator cuff which
  required major surgery to repair ( I have 70% ability i it. now)  Another fall
  produced  a facila laceration requiring 17 stitches; this was caused by the
  rim of my glasses cutting my face around my right eye.
     That has been 11 years ago. I would like to know if I have any hope of
  improved ambulatory capablity or if there is anything that will restore my
  muscular balance capability...Or anmhy other Rx that might help.
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Hello, William,
  Sorry to hear that you have been suffering from such a chronic painful condition for such long time.  Apparently, you sustained an injury to your back, which made the laminectomy (?) necessary at that time. It is unclear to me what contributed to the worsening of your symptoms that resulted in a three-week hospitalization years later.  However, with the way your symptoms presented, it sounds reasonable to preform a thorough work -up including peripheral neuropathies.
Although, without knowing your exam and imaging studies now and then,I can not say to what extend and how much if at all this was related to your surgery 11 years ago, it is conceivable that the nerve roots can be damaged during the surgery.  As far as what can be helpful in such a situation, I can offer you some scientific perspectives.   In general, quite number of patients who have had this kind surgery will have various degrees of back and leg pain.  A small persentage of patients require further surgery.  The first step of investigation in such patients usually is to do MRI looking for any abnormality that is still there.  If such a re-evaluation fails to disclose any problem, the second step is to do some non-invasive procedures, such as steroid injection or nerve root blocks.  After these manuvers, the next step is to consider the further exploration of the spinal canal looking for root compression or adhesion and try to correct them accordingly.  Most of these procedures can be sucessfully performed at a pain center.  
  Regarding your question about how much improvement you can eventually achieve on ambulatory capabitiy, without knowing your exam and the entire evaluation I won't be able to give you a satisfactory answer.  However, what we can offer, to the extend of our capability and specialty, is a full evaluation at our Center For The Spine, which offers a unique, coordinated approach that a problem as complex as yours demands.  Please call toll free [phone] ext. 42225, or [phone] for an appointment at your convenience.  
  
  This information is provided for general medical education purposes only.  Please consult your physicians for the diagnostic and treatment options of your specific condition.