Nerve damage Question ??

[RJF614]

Hello, and thank you for your help in advance. I have had several lamenectomies in the past at L4-L5 and L5-S1. I also had a fusion at L4-L5 in December 09. After the surgery I woke up with pain and numbness in left leg with partial foot drop and severe low back pain. In March I had MRI, which only showed extensive epidural fibrosis at L4-L5 surrounding thecal sac and exiting L4-L5 nerve roots. I had an EMG/NCS test done a few weeks ago and results said chronic radiculopathy and chronic motor unit changes in both left and right legs along with active deinervation in left leg at L4-L5. The doctor said it is permananent nerve damage. I still have numbness/burning pain in both legs and severe back pain. My Pain management doctor wants me to do a permanent SCS for the pain. Should I seek a second opinion from another neurosurgeon? My neurosurgeon has said he does not see anything on MRI and has has no answers. Also, will my drop foot eventually get worse? Does the muscles associated with the nerve damage deteriorate? Thank you again, have a nice day!!

[RJF614]

Thank you Doctor, I appreciate your assistance. Just to note, the reason they did not fuse to S1 is that the L5-S1 area had autofused and when the NS tested during the L4-L5 fusion surgery it had fused very strongly. I am going to take your notes and seek an opinion from another NS here in the area. Thank you again!!

[Dr_Nassim]

Thank you for your nice introduction and your good knowledge about your case.

I would like to stress on the fakt of l4-l5 fixation with 4 screws and 2 rods in particularly after a previous surgery at l5-s1 level؛ I could insert a wider arthrodesis, from l3 till s1 or from l4 till s1.
It is well known that above and beneath the level of pathology (already fused) the movement may be increased and may cause a kind of facet syndrome, I name this ''The Spinal Adjacent Syndrome''.

Lastly I am inserting a device for posterior spinal stabilization named ''Coflex'' (months later  published in some place like in the panarab journal of neurosurgery, apr 2010) above the fused level. This small device is capable of distracting the intervertebral and subsequently the foraminal space relieving the joint overactivity and neural compression. This device which I used in more than 10 cases is a real revolution in the domain of vertebral dynamism when patient is adequately qualified. Some similar cases like yours were poorly warranted by other surgical measures. SCS is not the adequate tool in your case. As it is not our latest resort (better used in abused cases with terminal state).
I dont think that your dural sac dont need more surgeries, a meticulous surgery should liberate the area of excessive fibrosis and insert  corticosteroids at this region. Soon, I will launch a new technic of muscle infiltration with steroids to prevent excessive fibrosis formation. What I also would like your surgeon to pay attention to؛‎ is the removal of the post operative drain around 24-48h post ambulation not later because the small noncompressive quantity of blood which may stay around the thecal sac seems to be very important for Fibrolysis phenomenon (as I noticed).
Now about the drop foot, I can say a lot without examining you, but I can reassure you that the presence of pain in your foot dermatome means that we still have a chance to regain some motricity, and I think that the drop foot will not become worst but become better with a better liberation and stabilization.
Hope my information was helpful to you and your pain specialist.
Dr N. Abi Chahine