HELP - L5 S1 disc herniation, saddle problems & pain
I hope you can kindly help me understand what may be going on as I have had surgery for a huge L5-S1 disc herniation and have suffered pain and other problems since nerve root injection and l5-S1 Laminectomy and decompression in April 09.
I had a fall up some stairs and bruised some ribs and fractured a digit when i fell November last year, I also suffer quite alot from hypermobility in the joints and previous sciatica. A week later my back would not spasming and constant pain, I had put up with it until feb 09 when I had wet the bed which obviously send alarm bells ringing.
I had an urgent MRI which found a paracentral disc protrusion at L5-S1 and L4 annular tear plus the lumbar discs are DDD. The specialist said i didn't need major surgery even though i could walk or upright. They offered me an injection to bathe the nerves. I had further falls as i was riddled with pain and was finally hospitalised. After screaming with pain they cancelled the mri and gave me a caudial epidurial when i was awake due to sleep appnea. Since the injection my leg went dead and as if a tornaque was inside crushing the leg. I had lost sensation of my groin, saddle, left buttock and left leg. I was told it would wear off!!!! they even gave me physio on it. I was put on morphene and a week later i was in such a bad way that they finally gave me an mri (see profile pics) which found a huge herniation at L5-S1 which had compressed the left S2 and sqaused the spinal cord and nerves. The surgery was completed and the Dr who said i didnt need surgery carried out the operation and said the disc came out under pressure when they remove the lamina!!
I have had small amounts of physio since the op however im left with saddle, buttock and back of my left leg numbness and which progressivley got worse with excersize which the sciatic nerve feels like its protruding and sitting is painful. I also have penial numbness and and the left side of the genitals, I cannot feel the flow when i urintate etc plus deep perineal pain when sitting and walking is now difficult as of the spasms. I have to stop every so often and bend over to relieve the spasms, I am getting alot of muscle twitches in the legs and my feet feel under pressure/swollen with a wet feeling. The big to is painful and if i walk a distance the smaller toes are difficult to move and feel odd. If i lay on my back then try to stand im in alot of pain and my back feels like it is locking up so i have to use the top of the wardrobes to stand up.
I recently soiled my self and didnt realise due to the numbness however there is no further compression of the cauda equina on another mri even though there is scare tissue at this level encroaching the L S1 nerve and the remaining cauda equina roots. They have put me on the morpine and amitriptiline et al to kill the pain, which they feel has been caused by the original damage and op so im left with chronic pain at 31 years old.
Im due to see a neuro specialist in Dec but feel i have not been told any answers and have got little support from UK specialists. My GP/Dr feels the discs (2 still protruding) should be fused or some sort of neuro intervention to help relieve the pain and explain if their is any nerve damage????
I would be grateful for any help or suggestions.
MRI SCANS OF THE SPINE April 09
FORMAT: sagittal T1 and T2 weighted sequences obtained through the whole spine. Axial T2 weighted sequences obtained through the cervical spine and T1 and T2 weighted sequences obtained through the lower lumbar spine.
Note is made of marked loss of the normal cervical lordosis which may indicate muscle spasm. There is already spondylotic change noted but the canal is capacious and no evidence of any cord or thecal sac compression and no obvious nerve root compression. The cord is entirely normal in its appearance.
At the L5/S1 level note is made of an extruded disc fragment which fills the canal compressing the left S2 nerve root prior to its entering into its lateral recess (image 16 of 19). The right S2 nerve root is uninvolved. There is also some thecal sac compression at this level. The S1 nerve roots are normally positioned within their lateral recesses. No other thecal sac or nerve root compression present. There is mild L3/4 and 4/5 disc dehydration noted with high signal present posteriorly within the L3/4 disc. No other abnormalities of note. No para-vertebral abnormalities present.
1. Large extruded disc fragment compressing the left S2 nerve root and the thecal sac at this level.
2. There is evidence of an L3/4 annular tear.
July 09 MRI report
FORMAT: examination performed as per standard protocol supplemented by post-contrast T1 sagittal and axial sequences.
Comparison is made with the pre-operative MRI study from 15/4/2009. A left L5 laminotomy is noted. The previously noted larged extruded L5/S1 disc fragment that was in the sacral canal is no longer present. There is, however, enhancing tissue surrounding the left L1 nerve root within its lateral recess, extending posteriorly to the anterior surface of the remaining cauda equina roots. The appearances are consistent with post-operative epidural fibrosis. Although there is a small residual central focal disc protrusion this does not appear to be compressing. No residual sequestered fragments are demonstrated elsewhere. A small collection measuring 19mm x 8mm axially by 4cm longitudinally is present within the base of the subcutaneous tissues overlying the surgical incision. No other significant interval changes are demonstrated.
Epidural fibrosis within the surgical bed, surrounding the left S1 nerve root and encroaching upon the anterior surface of the remaining cauda equina roots. No significant residual discal components are identified.
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