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Old 08-06-2011, 05:46 AM   #1
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How long does it take a damaged nerve (and others) to recover?

I've had some problems with my feet following a fusion, including a foot drop. They've told me it's impossible to know exactly why or when, but they feel it was a minor stretching of some length of the nerve. I've had one doctor say it will take a maximum of six months to heal, while others have said up to two years. The doctor who said six months gave as his reason that since the damage was limited to a small area in my back, once that was healed, the problem with my foot drop should be healed, as the rest of the nerve system was unimpaired.

However, I think my other doctors have said that the entire length must heal at the rate of 1 mm or so per day, even though the original damage was limited to a nerve in my back.

So, who is right? Do all the involved nerves, even those not damaged during the surgery, have to recover at the same rate as the originally damaged nerve? Is my optimistic doctor not giving me the correct information?

 
Old 08-06-2011, 06:37 PM   #2
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Re: How long does it take a damaged nerve (and others) to recover?

I know you'd prefer to here from someone other than me, because I sound like a broken record...but since no one else has responded....here goes.

Are you noticing a pattern here? There is no "right" answer for you. It isn't a matter of one specialist being "right" and another "wrong." It is a matter of there not being one answer because they do not know what is going on for sure. They are all giving you their best educated guess based on their training and experience.

No one knows specifically why you awakened from surgery with a weakness in your foot or why other so as well, and other people wake up and everything is fine.

One tells you it is because how you are positioned on the table. Another says maybe the nerve was stretched during surgery (stretched how and what caused it to stretch?). You really are torturing yourself by asking questions that you will never know the answer to -- unless you just decide to believe one doctor more than another...but, in reality, you're never going to know for sure what caused it.

Don't forget that the nerve signals not only run down, but they also run back up the nerve as well.

 
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Old 08-06-2011, 07:39 PM   #3
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Re: How long does it take a damaged nerve (and others) to recover?

You are absolutely right, teri. They don't know what happened. But they appear to be coming to a consensus: The damage occurred during surgery at the around the L5 nerve root. My surgeon was the one who thought it was positional. Though I haven't seen him since then, my pain doctor has talked to him. Based on his conversation, it seems that my surgeon, pain doctor, neurologist, and second EMG neurologist all say that the point of origin of the problem is at the L5 nerve root. However, when I was first given this diagnosis by both neurologists, they gave a prognosis of two years or permanent damage. Though this was before the CT myelogram, are they really so clueless as to not be able to determine whether my present state is permanent? The nerves are still functioning and delivering messages, they just can't do it properly yet. Do you think the permanent part was hedging their bets whie waiting on the myelogram results? Will I hear a completely different diagnosis come Monday?

And my pain doctor, who has seen all the evidence and discussed things with my surgeon still believes six months. That would seem to indicate that I'm going to hear the same from the surgeon, who now readily admits that he is stumped as to how the damage occurred during the surgery. Is it possible to have damage at the L5 nerve root, whatever the reason, and be recovered in six months? My pain doctor said he believes so. He said that as soon as the small area that was damaged heal completely (and he believes six months for the entire process), everything should start working. I can't imagine that he would feed me a line making that kind of prediction with no medical reason.

Here's the deal: It's plain that the method of damage isn't known. But is this a case where it doesn't matter? If someone gets a scrape on the arm, it doesn't matter what did it, you just treat it and wait for it to heal. Is this the same thing? Do some PT for the fusion, maybe give an injection of cortisone for some swelling, and wait for a few months for the nerve to heal? Could it be that the pile of evidence -- Ct myelogram, EMGs, physical examination of my legs and feet -- don't give a definite cause but are enough for a pretty definite prognosis? Or am I stuck assuming that things won't get better unless I just happen to have been damaged in such a way that allows recovery that no doctor can predict?

 
Old 08-07-2011, 03:41 AM   #4
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Re: How long does it take a damaged nerve (and others) to recover?

I think that they may be thinking that an adhesion or scar tissue (which isn't visible on CT) may be 'pinching' the nerve, and when the swelling goes away/with regular movement/the dog jumps on you, the tissue will ease up on the nerve and you weakness is lessened. That is what I was told after all three surgeries. I was told the nerve damage/regrowth story after the 3rd. The doctors really don't know unless they see a stenosis where the nerve is exiting the spine. If the nerve is damaged, it can regrow at the rate they say, but it doesn't try to reattach to the other side of the damage - it has to grow all the way to the 'normal' end of the nerve.

So I think that's why they're throwing all the different numbers at you - depending on if it's a 'soft tissue' adhesion, it can break away anytime in the next couple of months, or longer, or even not break away. If it was damage, it'll take about a year to regrow if the damage was close to the spine. And the surgeons don't know which, usually.

 
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Old 08-07-2011, 04:21 AM   #5
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Re: How long does it take a damaged nerve (and others) to recover?

I recently had knee surgery (Distal Femur Osteotomy) my thigh nerves have been damaged and I have been told that the nerve takes 3 months to heal 1 cm. this information was given to me by my physiotherapist. Hope this helps. It doesn't help me as I dont know how much of my nerve is damaged and my surgeon doesn't seem to want to except liability at this time. They are doing test on my nerve damage on 11th August as this will be 3 weeks after surgery. I have no feeling in my thigh at all but can feel myself touching it.

 
Old 08-07-2011, 06:11 AM   #6
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Re: How long does it take a damaged nerve (and others) to recover?

Yeah, surgeons will never fess up. I had an infection in my hardware from my first surgery, and everyone said they have no idea where the infection came from. It was magic, I guess...

 
Old 08-07-2011, 06:32 AM   #7
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Re: How long does it take a damaged nerve (and others) to recover?

[QUOTE=Jazdaddy;4817662]I think that they may be thinking that an adhesion or scar tissue (which isn't visible on CT) may be 'pinching' the nerve, and when the swelling goes away/with regular movement/the dog jumps on you, the tissue will ease up on the nerve and you weakness is lessened. That is what I was told after all three surgeries. I was told the nerve damage/regrowth story after the 3rd. The doctors really don't know unless they see a stenosis where the nerve is exiting the spine. If the nerve is damaged, it can regrow at the rate they say, but it doesn't try to reattach to the other side of the damage - it has to grow all the way to the 'normal' end of the nerve.

So I think that's why they're throwing all the different numbers at you - depending on if it's a 'soft tissue' adhesion, it can break away anytime in the next couple of months, or longer, or even not break away. If it was damage, it'll take about a year to regrow if the damage was close to the spine. And the surgeons don't know which, usually.[/QUOTE]

This is interesting stuff that I've not heard before. Back in February, I had emergency small bowel surgery due to an ahesion, so I think I have some idea of what you mean.

Maybe I completely misundertand the mechanism of nerve healing. I figured that it healed along the damaged part until it reached the end of the damage and found the first nerve tissue that escaped the crushing or stretching or whatever the damage was. Are you saying the nerve completely regrows from one end (say in the back all the way down to the other end (say in the foot). even of the damage was only a couple of centimeters long. Essentially, the old pathway is completely discarded and a new one is made, so any axonal damage renders the entire old section of nerve unusuable, good parts and bad. Is that the way it is? If so, that would explain what they are saying.

 
Old 08-07-2011, 07:28 AM   #8
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Re: How long does it take a damaged nerve (and others) to recover?

Bracer, that's exactly hot it is, according to my spine doc - it'll grow along the nerve sheath that's there, but if it does regrow (it may or may not), it'll grow to the terminus of the nerve. It may or may not grow all the way back, and any branching it may have normally may or may not regrow. If it was clipped and incompletely damaged, the damage may or may not regrow the non-responsive nerve tissue. All up in the air.

Adhesions/scar tissue pinch the nerve, and may not cause permanent damage. The pressure on the nerve will cause some or a lot of interruption, and may or may not release in time. It's all up in the air once the surgeon does the decompression. They can only do so much, and post-operative recovery is not cut and dried, unfortunately. You may have continuing leg numbness/pain. That can be dealt with if there's still spinal compression. If it's soft tissue, then we'll see. If it's back pain, then it's less likely that it'll go down/go away. That's where pain management comes in. From feedback therapy to putting electrodes in the spine to modify the pain sensations, it's definately an option if you have continuing pain.

 
Old 08-07-2011, 09:50 AM   #9
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Re: How long does it take a damaged nerve (and others) to recover?

Scar tissue or adhesion is a frequent cause of post-surgical nerve pain. I can't vouch for CT scan, but it can often be seen on MRI. This is one reason why walking is so important after any lumbar fusion as it keeps the spinal nerves stretched out and helps to prevent the fibrosis from attaching to the nerve.

 
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Old 08-07-2011, 09:53 AM   #10
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Re: How long does it take a damaged nerve (and others) to recover?

[QUOTE=Jazdaddy;4817737]Bracer, that's exactly hot it is, according to my spine doc - it'll grow along the nerve sheath that's there, but if it does regrow (it may or may not), it'll grow to the terminus of the nerve. It may or may not grow all the way back, and any branching it may have normally may or may not regrow. If it was clipped and incompletely damaged, the damage may or may not regrow the non-responsive nerve tissue. All up in the air.

Adhesions/scar tissue pinch the nerve, and may not cause permanent damage. The pressure on the nerve will cause some or a lot of interruption, and may or may not release in time. It's all up in the air once the surgeon does the decompression. They can only do so much, and post-operative recovery is not cut and dried, unfortunately. You may have continuing leg numbness/pain. That can be dealt with if there's still spinal compression. If it's soft tissue, then we'll see. If it's back pain, then it's less likely that it'll go down/go away. That's where pain management comes in. From feedback therapy to putting electrodes in the spine to modify the pain sensations, it's definately an option if you have continuing pain.[/QUOTE]

Jazdaddy, first let me say you are great. I absolutely love the info you have and the way you present it.

OK, if you don't mind, let me narrow things down for you. I'm not really concerned with my back pain right now, because I think it will get mauch better as time goes by. I can live it (even with meds), no matter what.

My right leg hurts. The foot and toes feel like they are badly sunburned. The pain gets worse the longer pressure of any type is applied, which is why I can't wear socks, open toed shoes, or sleep under a sheet. Most of the sole (from toes to start of heel) feels like I'm walking on hot asphalt -- once again the feeling gets worse the longer pressure on any type is applied. Walking is miserable, but Lyrica has made it bearable. The doctors have told me that this a result of the L5 problem. I hate the pain and the thought of living with it the rest of my life is not pleasant, but it is still not my biggest concern.

My biggest concern is the foot drop. There is no pain associated with it. I have no pain to speak of in my left leg or foot. The foot drop and numbness (in my calf, top of foot and bottom joint of big toe) are the biggest concern since I guess they are related. I'd keep the numbness forever if the foot drop would go away. The foot drop is the big deal, since it interferes with my active life -- which is why I had the surgery to start with. I had almost no trouble at all in my left leg, but the pain in my back and other foot (which was getting worse) led me to have the surgery so I could do physical activities without pain. Being able to run and walk normally are the most important things to me.

OK, my tests have conclusively shown no clipping or cutting of my nerves at all. That is absolutely not a possibility. The only realistic possibility is that a nerve was stretched or compressed by soft tissue during the surgery. Perhaps when he was moving around some soft tissue or putting in the hardware, something happened in a moment that stretched a portion of the nerve OR swelling immediately after the surgery co,pressed the nerve and caused the problem (It had to be during that time frame, because the foot drop weakness was noted prior to my discharge. I've reviewed the OR notes (from the hospital, not from the surgeon) and everything else that was monitored (and they used the latest technology) went perfectly. Since it had to be stretching or compression, it's my understanding and hope that I can regain most or almost all of my original strength. It's just a matter of time. I may be wrong there. If there's a flaw in what I've said, please let me know.

All right, stretching or soft tissue compresion, they don't know when or where it happened. It's also my understanding that doesn't really matter (unless the soft tissue is still compressing. I've been told that is not likely, but it could be a slight bit still occurring. Due to this, my pain doctor wants to due a epidural (caudal) just in case.)

Anyway, the healing process has been going on since just about the time the surgery ended. If everything I've said is the case, what kind of time frame am I looking at? You said that it grows along the nerve sheath.oes that mean it will follow it and the branches all the wat to the foot? If so, shouldn't that mean that as time goes along, I'll notice improvement and regain function in muscles that right now are not really receiving signals as they should. Perhaps some of the numbness will start to disappear as well. Do you agree with all of that?

If I have the situation down right, then I should have milestones as things heal. Do you have any idea whatI should be looking for to make sure healing is really going on. Hopefully, there is some way to make sure things are getting better. If it's a gradual process, then I should get stronger in the "dormant" muscles as time moves on and I do PT. The drop should get better and the slap, slap, slap should get less noticeable.

I appreciate you (and anyone else) reading this. Due to the efforts of nice folks here, my doctors, and the research I've done, maybe I'm actually close to understanding this problem. If so, now I can feel more in control and lose some of my unhealthy anxiety. Please set me straight on what I have right and what I have wrong. Thanks so much. I don't think you can begin to understand the difference you and others have and are making in my life.

Thanks again.

Jeff

Last edited by bracer; 08-07-2011 at 09:55 AM. Reason: a bit of spelling fixing

 
Old 08-07-2011, 10:12 AM   #11
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Re: How long does it take a damaged nerve (and others) to recover?

[QUOTE=tetonteri66;4817814]Scar tissue or adhesion is a frequent cause of post-surgical nerve pain. I can't vouch for CT scan, but it can often be seen on MRI. This is one reason why walking is so important after any lumbar fusion as it keeps the spinal nerves stretched out and helps to prevent the fibrosis from attaching to the nerve.[/QUOTE]

Yep, and you gave me this advice just like the doctor did. The big difference is that you give reason for doing the walking rather than just the directions. It makes a really big difference to me to know WHY I am doing something. It makes me more likely to do it and gives a sense of control over the healing process. I think too many doctors just feel like patients should follow orders without question. To me, this is an egotistical error. I believe people are more likely to follow an instruction if reasons for doing so are given -- as well as the consequences of not following the order. After all these "orders" aren't of the military variety, to be followed without question. Some doctors, especially surgeons, need to realize that.

 
Old 08-07-2011, 10:38 AM   #12
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Re: How long does it take a damaged nerve (and others) to recover?

Jeff,

Well said regarding Teri's advice on walking. Nothing was ever explained to Phil regarding the importance of walking.

Jazdaddy's explanation of the healing of nerves was especially helpful.

We have received more information and help on these boards than at of the doctors we have seen.

Most of all, it has given us hope, that with time, Phil's drop foot will heal.

Thanks to all.

Linda

 
Old 08-07-2011, 11:34 AM   #13
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Re: How long does it take a damaged nerve (and others) to recover?

I have found that with all the spine specialists I have consulted with, they dole out information in direct proportion to the detail of the questions asked by patients. I have learned a tremendous amount from my doctors patient responses to all my questions -- often taking the time to draw diagrams, refer me to good studies, etc. A doctor's initial explanation will include as few details as he feels is appropriate for that particular patient. It all depends on the patient's interest and seeming involvement in his own care.

I know a very well educated man, a very successful professional who has had 3 lumbar surgeries and he could not tell you even the name of each procedure, nor apparently, does he care. His surgeon (my surgeon) is not going to waste time going into the whats and whys with this man--however, my surgeon always immediately books a second appointment when he tells someone he needs surgery. He tells them to return in a week with a spouse, or friend so they can hear the details, and he goes over everything at that point. he has learned from experience that as soon as he mentions the word "surgery" most people's eyes glaze over and they never take in another word after being told they need to have spine surgery. After they've gotten used to the idea for a few days, they come back with a second set of ears to hear all the details of the surgery and recovery.

I think most younger specialists are much more used to talking to patients like they are fellow intelligent consumers than the doctors who trained years ago when it was more normal to think of a doctor as someone whose advice you took without question.

That being said, surgeons have, as a profession, well-inflated egos. But, think what it takes to cut into a living human being....most people would not want that responsibility.

 
Old 08-07-2011, 01:47 PM   #14
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Re: How long does it take a damaged nerve (and others) to recover?

Teri (or anyone else):

Just curious -- The last time I saw my surgeon (July 11) he was telling me that my foot drop was going to be gone in 3 to 6 months. This was at the appointment where he gave me the results of my first EMG. That was the one that the surgeon himself ordered for the EMG specialist in his own office to do. You know, the one that said all me nerve problems came from compression of the peroneal nerves in both legs, likely due to positioning in the ER. I questioned him over and over because, as you probably know, I need to hear something several times and have it explained in more than one way before I can begin to let it go. He actually grew aggravated and told me he didn't know how to say it any more clearly -- My foot drop was going to be gone in 3 to 6 months, with obvious improvement in 2 weeks.

Now that a new EMG contradicts those results, but we had a clear CT myelogram, what do you think he's going to say this time -- especially when I tell him I'm still hopeful about the 3 to 6 month recovery period that he promised me over and over again the last time around?

Oh, yeah, Teri: I have the OR notes from my surgery that you were curious about. Now that the peroneal nerve issue might be a moot issue (but maybe not -- we'll see what my surgeon says), do you still have any questions? I'll be glad to look through them.

Last edited by bracer; 08-07-2011 at 01:50 PM. Reason: add extra note

 
Old 08-07-2011, 02:13 PM   #15
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Re: How long does it take a damaged nerve (and others) to recover?

I'm facing the same thing, although the foot drop is less pronounced (I can't lift the foot as high as the other). The leg pain/numbness is due to nerve pressure/damage - it may be from any of the reasons that have been mentioned, but IF there's nerve regrowth, and IF it happened at the level of the spine, then IF it regrows all the way, it'll take about a year to reach the foot, if you're about 6 foot or so. A lot of if's - that's the problem. No one can give you an absolute - if it's from an adhesion/scar tissue, the adhesion could pop away tomorrow and you get leg function back, or the nerve could never recover, or you get partial recovery, or the injection allows the nerve root to reverse the swelling and let it recover. The only possible 'guarantee' is if you don't have any relief in a year, chances are it won't improve much. Unless, of course, it takes a while for the nerve to start regeneration. Again, I'm facing it as well, and I feel your frustration. A day at a time. Support from friends and family helps a lot.

I'm also going through reduction in the pain meds - my doc wants me off the opioids, one of which I've been on for 3 years. Right now it's hell - the pain is pretty consuming. But when I'm off the pain meds, I'll know what the baseline is for the leg and back pain. Then hopefully I can start pain management to see if that helps. An acquaintance has been dealing with his pain for over 30 years, and finally got electrodes placed in the spine. His pain level has decreased dramatically. So there's always a chance to feel better.

 
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