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Neurology (Expert Forum)
Post Laminectomy (L3/L4) leg pain
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Post Laminectomy (L3/L4) leg pain
by Sassagirl, Mar 03, 2003 12:00AM
Hello...back in August I was getting out of a chair..felt pain in my left hip which eventually radiated over to my groin and into my leg & foot. After 3 days of this pain...my doctor ordered an MRI which showed a rupture disk (L3/L4). I was sent to a neruosurgeon who recommended surgery to repair the rupture. At that time I had no reflex in my left leg, and it was very weak. I had the surgery on Aug. 15...and had immediate pain relief and eventually gained back 90% of the strength in my leg & foot. My problem is that during the last couple of months I have began to feel some tingling in my foot as well as pain that radiates from my buttock down into my left leg and foot...especially when sitting in a car or lying on my side in bed. I have done some swimming (per order of the doctor) to help gain strength back. I dont know weather to contact my doctor to describe this pain...I am afraid to hear that there may be more damage. Please advise. Thank very much.
Doctor's Answer
by CCF-Neuro-M.D.-JT, Mar 03, 2003 12:00AM
May be a new problem lower down in the back or could be related to the prior surgery depending on how extensive it was, hardware placed, etc... I certainly would let your doctors know about the new symptoms and let them check you out. You may need a repeat MRI and possibly an EMG. In the meantime, take it easy for a while. No heavy lifting. And would stop swimming until you get the ok from your doctors. I can understand that you're reluctant to hear about potential disc problems or nerve damage, but it's important to nip this in the bud. Best of luck.
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went to my doctor and he said it was the nerves coming back to life.it got unbearable by november,went and got an mri and the same disk had blown completly out the left side and was jammed against the siatic (sciatic)(poor spelling)nerve, doctor couldn't believe it.they removed the disk on dec.20 and replaced it with a cage.hip and leg pain is gone but back still hurts(fourth surgery)you described the same problems,get an mri.hope this will lead you in the right direction,don't put it off,when it blows your gunna know it.
Anyway...my symtons are much like yours. The neurosurgeon went back in to remove a bit more disc and scar tissue, then put a GelFoam (silicone like gel) on the nerve to keep the scar tissue from reforming on the nerves. I know how you feel! Years later though I am having problems so if anyone can answer my question, I would deeply appreciate it. I had a laminectomy at L5-S1 (75% removal of disc and foraminotomy on the right-1983), laminectomy at L4-5 (85% removal of disc-1991) and 3 discectomies at L4 and L5-S1 (Fragment/Scar tissue removal-1992-93-94). Six months ago, the sciatic nerve problem has returned after I re-injured myself at what I think is L5-S1, but could be wrong; reguardless, sciatic nerve pain on the left buttock, pelvic area, leg ankle, side and top of my foot, and around my knee, accompanied with tingling in the side of my foot and toes. Went through PT and taking neurontin with no help. I recently had an MRI with contrast and the here is the results of the FINDINGS:
I am arbitrarily calling the last full disc L5-S1.
There is marked loss of disc height at L4-L5, as well as disc signal intensity. There are Modic type 1 degenerative endplate chages at L4-L5. There is also loss of disc signal and height at L5-S1. The vertebral body heights are maintained. The spinal cord terminates at L1-L2. No spondylolisthesis.
IMPRESSION:
1. Advanced degerative disc changes at L4-L5
2. Moderate degenerative disc changes at L5-S1. I do not see evidence of a significant disc bulge or herniation, nor significant scar formation. On the axial images there is narrowing of the inferior aspect of the left L5-S1 neural foramen.
I am having a EMG next Wednesday on the left leg to determine what and how many nerves are affected. I saw the MRI films and it shows very little space at L4-L5 which means that it is probably trying to fuse on its own; and straight I may add, but L5-S1 is far different. The vertebra are not aligned with L5 to the right and S1 off to the left. I know the worst senario; double fusion as I was told this after the last discetomy in 94.
MY QUESTION IS:
With not much disc left and and not in alignment and all information in mind; do you think that a double fusion is the only answer and inevitable?
Summary: I have had terrible hip pain since Oct 00, diagnosed & treated as bursitis. One year later after two laminotomys at L5-S1, I still have severe back spasms, and numbness in right leg. Final diagnosis- degenerative disk at L5-S1, L5 nerve root compression, causing the hip pain and inflamed bursae. Selective Nerve Root block in Nov 02 and today, 5 March 03 have substantially diminished the hip pain. I may not be able to clean the house, but I can still scuba dive!
The Long story:
I am 40 yr old female, working full time, and a scuba diver since 1989. I had back pain growing worse since 1993 and diagnosed in about 1995 with a bulging disk. In October 2000, I began having terrible hip pain which become so bad at night, I could not roll over without my husband's assistance. I cried many nights from the pain. Doctor's diagnosed bursitis and I endured cortisone shots in left & right thighs every 3 months.
Finally, in December 2001, I could not stand the pain and was referred to Rheumatoid arthritis specialist and underwent all kind of tests - all negative.
In January 31, 2002, my right leg gave out and I could not stand upright or have my left leg touch the ground without severe pain. A visit to Urgent Care and I was in the hospital that night. I had immediate surgery (laminotomy) on L5-S1 in on 3 Feb 02. Three weeks post-op, I was doing better although I had lost most of the feeling in my right leg. Suddenly, I developed excruciating pain where I could not move without screaming. I was rehospitalized and another surgery was performed - I had re-herniated L5-S1. The hip pain subsided but then returned with a vengeance after I returned to work in May 02. I kept after my DR insisting that this was not just "bursitis", especially after an unbelievably painful cortisone shot in the left thigh that I felt go crunching into the bursae. Finally, in October 02, my Ortho doctor speculated that my L5 nerve root was still compressed due to the degenerative state of my L5-S1. He referred to me for a Selective Nerve Root block. The Pain Spec. injects lidocaine in the back area and then under the guidance of a flouroscope, kind of an X-ray, finds the affected nerve with a needle, and injects the medication, thereby blocking the pain signal. When he hit L5, I felt a "tapping" on the nerve running from my hip to left calf. I could clearly see on the Flouroscope the small and flat size of L5, as compared to L4 and higher. Within a day or two, my hip pain should dissolve again. I have been told that I am a candidate for fusion which I am refusing at this point. I am steadfastly planning to hold out until FDA approves Prodisc. The bottom line is that we are the steward of our own health. I believe if I had not been adamant (but polite), I would still be treated for bursitis - a symptom but not the cause of my pain.
1. You are only about 6 months post-op. Maximum recovery is estimated to be about a year.
2. Over the year, symptoms which have gone away for me:
limp, severe leg spasms/cramps in my right leg, heel pain, severe back pain upon sitting, fatigue. I can now sit for a short 3 hr airline flight, although blocks of 45 minutes seem to be my best fit. I still work 9-10 hours a day!
3. Ask your Dr. why he is recommending surgery to remove scar tissue. We all have scar tissue as a result of the surgery. Does the MRI show it to be very intense?
4. Ask for a copy of your post-operative surgery report to see what they did while they were in there! As an Human Resources specialist, I routinely read other people's post-operative reports so I figured I should get to read mine! Dr. was surprised when I asked for it but readily gave it to me.
5. Ask your DR. about a Selective Nerve Root Block. This is a diagostic and pain relief tool. It takes about 30 minutes, and would postpone or eliminate the need for your proposed second surgery. It would identify a problem nerve.
6. The 2 surgeries I had cleared the herniated disc material, releasing the entrapped nerve. After surgery, the disk space at L5-S1 is now so narrow, that it is basically bone on bone. Therfore, the Dr. theorized that the hip/leg pain was caused by the nerve still being compressed by the narrowed space.
The Dr. said if the Block works, then our theory is correct.
If it did not, he would explore other problems (scar tissue).
7. After another MRI in Nov 02, I was referred for the Block.
It was successful in Nov 02 and yesterday.
8. Bad news for me: we have proved disk degeneration affecting L5 nerve, so I am only buying time and pain relief right now before a third surgery. That is why I am waiting for Prodisc, the artificial disc to be approved by FDA. It puts the space back in between the discs without the trauma of a spinal fusion, the current solution for my problem.
9. I have 2 very reputable doctors here in San Diego CA:
a. Ortho spine Surgeon at Scripps Hospital, in La Jolla, CA
b. Dr. Wagner, who specializes only in Pain injections.
He's excellent and precise with the needle!
Even though both are excellent, I believe we have to help them with information to help them with our diagnosis.
Sorry so long but there is so much you can do before having another surgery. Don't forget to read all the latest at www.spineuniverse.com
So to anyone who has had spinal surgery and have had scar problem eg increased pain and pulling of the scar due to skrinkage. Do your research on the surgeons and get a few opinions of what it better for you situation.
I would like to talk to anyonewho has had scar problems, could anyone please email me at ***@****
Sassagirl can you please email me as i can discuss this with you better as my situation is almost the same as yours.
Lindy
I had a second MRI of back -Ortho says it looks OK. I had Mri and x rays of knee - Mri came out clean and so did the Xrays.
I went to a neurologist and he is setting me up for an EMG.
The Ortho says the sciatic nerve needs to recover- the Neuro said that the disk off the sciatic should have brought immediate releive. My Physcial therpist- says that The sciatic nerve is not near l3/l4 and that it is a nother nerve.
Who do I beleive?
Do I have to wait for a pinched nerve to heal after a disk surgery? How long? Is it my Sciatic nerve or something else?
I need some direction- this is driving me nuts?
Can anyone offer some assistance?
Thanks;
Ken