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Re: Constant Knee pain following back surgery-Recurrance?
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Re: Constant Knee pain following back surgery-Recurrance?

Posted By Deborah on June 10, 1999 at 10:36:30
Dear Dr...I thank you in advance for this forum,it is a blessing!...I had spinal decompression, microdiscectomy & laminectomy in June 98...at L4-L5....I had severe nerve compression on the L5 nerve root for almost 6 mos. before surgery...the nerve root was total block to contrast on Myelogram before surgery...I continue w/loss of feeling in back of right thigh, outer right calf and right foot drop, as well as numbness in my foot...I had a 16 wk recovery followed by 3 mos. PT. I have tried to stopwearing the AFO and using the cane, unless I walk a long distance.
My neurosurgeon is a compassionate & wonderfully honest Dr., and he made sure I was aware that there were no guarantees with surgery and that it could increase my back, leg & foot pain. He further stated that surgery was to STOP further damage to the nerve. He also stated that I was at increased risk for another herniation as a result of the severity of the herniation, DDD, and surgery. I have/had cauda equina (bladder only..it continues altho better), spinal stenosis, DDD, and spondylosis...however there was no slippage (spondythesis (sp) before surgery so he decided against spinal fusion.    
To make a long story short, my back pain continued following surgery pretty severely and consistently, until almost 3 months ago when the pain moved to my right knee. I began to experience stabbing, piercing & constant pain in my right knee.  I waited a month in hopes it would go away...finally I contacted my family Dr. who recommended (phone call) returning to my Neurosurgeon as it was related to my back.  I spoke with my Neuro, he wanted me to see an Orthopedist so he would not miss anything and assume it was my back, (he said my back would look bad on an MRI now from the injury/surgery)....I saw the Ortho May 25th...he did an exam & x-rays and found nothing wrong w/structure of my knee..he did recommend riding a bike one hour a day to increase leg strength....which I can't do now as I can barely bend the knee/leg back and the knee pain is constant....although eases when I sit in a reclining position or lay down) my Neurosurgeon has scheduled an MRI for June 21 and a return visit to him for results June 25th....my question is this...does this sound like spinal slippage? requiring spinal fusion? or scar tissue compressing the nerve again, and if so, will surgery correct it? could it be residual radiculopathy? the disc right below the L5 was black on MRI & films (Neuro showed & explained)...in June 98, L5-S1 (?) with arthitis...do you think I have another herniation?  I trust my Neuro and my husband and I have resigned ourselves to God in handling continuing back problem(s)....would you please give me your professional opinion...and advice as to what you suspect is going on and how to proceed...thank you!...Deborah.  




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Posted By CCF Neuro[P] MD, RPS on July 04, 1999 at 10:39:06
Dear Deborah:
Sorry about all the pain and suffering that you have gone though.  After spinal surgery such as yours, it is difficult to pin point a new lesion in the same area.  Post operative surgery often masks new problems on neuroimaging, and sometimes can produce symptoms by producing scar tissue.  One thing to try, we often find new knee pain after surgery and rehab due to a patient's change in gait.  By altering gait, a person puts new and often adverse stress on the knee.  As the knee is really the weak link in our walking, it is usually affected first.  I would get your gait evaluated with and without your AFO and see if this might be compounding your problem.  I would also agree with your neurosurgeon to initially see an ortho person.  To answer your question, yes scar tissue could affect the nerve on that side causing knee pain.  It might involve an altered gait, weakness in a muscle group that causes strength changes in the way you stand etc, or it may be a sensory nerve problem near the L3/L4 areas.  I would think the MRI might help alittle to identify inflammatory changes and if any structural change has occured that might be part of the etiology of your problem.  Sorry I can be more definitive.  I hope your problem resolves itself.
Sincerely,
CCF Neuro MD










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Constant Knee pain following back surgery-Recurrance? Deborah 7/14/1999
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Constant Knee pain following back surgery-Recurrance? Deborah 7/06/1999
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