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TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??


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Old 02-20-2018, 10:45 PM   #16
teteri66
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

You probably don't want to know what I really think! I think you are LUCKY you went to a surgeon that had the level of skill and experience that yours does! I think you presented quite a complex set of problems, what with short pedicles, osteoporosis, etc...many of which were not known until they got in there to operate. It seems to me you could have ended up with many more issues post surgery in the hands of a less talented surgeon!

I think you need to develop some patience and learn to relax a bit. Your body endured a great deal of trauma and it will take time to heal! You had a very complex surgery with a lot of assault on the bone, which tends to be more painful. Plus things just happen when work is done around nerves. They do not like to be touched or moved and it is not unusual to come out of even a small back surgery with some "new" nerve pain symptoms that usually clear up after a period of many weeks or months.

Obviously I am not a doctor...but I don't see anything on the surgical notes that jumps out as a possible cause for nerve damage.

I had a very simple procedure (compared to yours) done Sept. 22nd and I still am dealing with symptoms that are a direct result of the tugging my surgeon did on a spinal nerve in order to free it up. Progress is very slow!

 
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Old 03-09-2018, 05:59 AM   #17
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

You haven't posted in awhile. How are things going?

 
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Old 03-17-2018, 09:25 PM   #18
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hello Teteri66,

thanks for checking on me. Not much to report except more electric shocks pain that last for hours. I still try to tell myself that it's healing and NOT getting worse. But of course nobody know as you said before. I took gabapentin and baclofen at bedtime to combat those shocking pain.

Numbness still the same, I kept thinking if the progression of nerve healing that starts with numbness and then tingling/pain when nerve wakes up. Should the numbness be REPLACED/resolved by the tingling/pain? I thought so but it's not what I am experienced now. I still have the same numbness plus the electric shock pains? It's so hard to convince myself that my nerves are healing instead of getting worse?!

From what I understand on the dermatone, the peroneal nerves(super and deep) innervate the knee, outer calf, top of foot and all toes except pinky. They in turn innervate via sciatica nerve from L4 and L5. So I know that my L4 and L5 were damaged/irritated during surgery. But my surgeon told me there are no nerve compression based on my Xrays and CT-scan. I thought only MRI can tell if there are nerve impingement. Am I wrong? please advice.

I do have another question regarding my left groin pain and left anterior thigh pain. I have this pain since surgery and they are mostly aching sore pain. I also found out my quad on the left leg that is numbed has atrophied-it's 1.5" smaller than the right. I do not have these issues before surgery. I don't know if it's related to the nerve root damages on L4 and L5 that caused by numbness and weakness on left leg. I was wondering if the prone position on the jackson table for 8 hours might have caused some damages to cause groin and thigh pain?? would that be related to the peroneal nerves or other peripheral nerves that innervate from the lumber nerve roots?

How are you doing? Last you said you felt stronger about 4 months post-op. I hope you are feeling better and the numbness get better over time. Do you take any supplements to help with nerve healing? I heard of ALA, GABA, broswellia, B complex and B12, and Omega-3. I have been on B-complex and B12 and Omega 3 for years. I am thinking to add ALA or GABA and broswellia. Do you have any advices on these or others?

It's always nice to talk to you and get more advices.

take care
glo

 
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Old 03-19-2018, 07:35 PM   #19
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

It is possible for nerve damage to occur from placement of the patient on the table. Some surgeons are more aware of this potential danger than others and really go out of their way to be sure the patient is properly padded for the position they are in. I had some femoral nerve damage in my thigh for awhile after my first lumbar surgery, which was the posterior fusion at L4-5.

I take a supplement for nerve pain that is a combination of stuff, called Nerve Renew. It is primarily B 1 and 12, r-ala, vitamin D, bentofoliamine and a blend of some herbs and roots. I believe it helps me feel a little less numb in my feet...but it doesn't make a huge difference for me.

When do you see your surgeon again?

 
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Old 03-19-2018, 08:38 PM   #20
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Smile Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hi Teteri66,

thanks for your reply.
my 6 months post-op 4/24/18. I will ask the surgeon for an MRI with contrast to see if there are any nerve impingements. my understanding is CT-Scan and xrays don't show nerves and tissues, so the CT I got at 3 months post-op will not show any nerves issues. Is that correct?

I will also ask for a EMG/NCS for nerve damage. Would EMG tell you which nerve roots were damaged.
I'd gone through 2 rounds of PT and they are not helping me much. I do stretches at home, walk daily and swim 2-3 times a week. The only thing I got from PT were the electric stimulation with hot pad for 20 minutes each session. Do you use electric stimulation Does it help you? I have a TENS unit at home that I used before my surgery. Would it be OK to use with the hardware in the spine?

Anything suggestions to ask my surgeon at my 6 months post-op?

How are you doing? Did you feel stronger about 4 months post-op. I hope you are feeling better and the numbness get better over time. Did the last surgery reduce your numbness? Do you have nerve pain too?

thanks for always respond to my questions....
take care,
glo

 
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Old 03-24-2018, 09:01 AM   #21
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Sorry I didn't get back to your questions sooner. I was off the board for a bit.

Yes MRI will show more of soft tissue, nerves etc. than CT which is good for imaging bone.

An EMG can identify nerve damage. I'm having one on Monday. They aren't fun. There is lots of info, videos, etc. explaining the procedure online.

My last surgery was six months ago by now. I feel like my nerve damage is worse since the surgery. My surgeon thought the effects from surgery would be gone by now...but, if anything, it is worse...thus the EMG.

 
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Old 05-02-2018, 12:17 PM   #22
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hello Teteri,

this is an update after my 6 months post-op at UCSF last Tuesday. here are the outcomes:
-no improvements on numbness, pain level and weakness on left leg
-pain spread to hip and buttock and calf on left leg
-surgeon is at a loss as my xrays were ok, no screws pull out per surgeon
-he ordered EMG and MRI with contrast but won't have appointments until 6/7/18.
-if no structural issues from EMG and MRI, he will refer me to spinal cord stimulator for evaluation.

I guess my case is another Failed Back Surgery Syndrome!!!
I sure don't want another surgery to implant more foreign objects into my spine!
Any advices and suggestions?
- find more surgeons for 2nd opinion on FBBS?
- would neurologist or Anesthesiologists help with FBBS?
- ???

any helps would be greatly appreciated.
How are you doing? Is your EMG result OK? I hope you are doing better than me.

thanks,
glo

 
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Old 05-03-2018, 09:48 AM   #23
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

I'm probably not the right person to ask these questions of due to my personal history and past experience. I don't recall if I've ever told you of my experiences after my first surgery which was a PLIF at L4-5. Don't have time to go into it now...but surface to say, my surgeon said he could see nothing "wrong" and recommended a referral for a spinal cord stimulator trial. I refused and thus began a three year search for answers and a solution! My story had a happy ending, but it took a great deal of perseverance on my part, many visits to various specialists until I found someone who could figure out my issues and was willing to do something, a good bit of luck with my third surgery, etc.

And of course, our situations physically are different...but I think your instincts to not immediately pursue a SCS make sense. I don't know how it is in your part of the country, but many surgeons will not take on a surgical patient of another surgeon's until after one year has passed. In the case of fusion, six months is still early in recovery.

Have you had any improvement in the foot drop? Have you been working with a PT or some sort of bodywork therapist?

One suggestion: get the thought of FBBS out of your head and conversation. First, it is a made-up term to describe a situation doctors do not understand. Second, if it gets back to an insurance carrier, that can mean the end of new treatment for this surgical case. Third, it is discouraging to you and keeps you from thinking optimistically and acting proactively!

 
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Old 05-04-2018, 08:07 PM   #24
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hello Teteri66,
thanks for your reply.
Yes I won't pursue another surgery until they know what is causing my pain, numbness and weakness.
My foot drop is still there but slightly better, but my knee is still weak and buckled! I just finished 12 sessions of PT but it's not helping much...mostly exercise to strengthen my core and lower body.

Thanks for the tip on FBSS. Also my surgeon at UCSF asked the neurologist to check on peripheral neuropathy, radiculopathy, and causalgia on his order for the EMG test. I googled causalgia and found out it's an old name for CRPS type II. It's a chronic non-curable condition with intractable pain that is centralized in the Central Nervous System, even when the pain source in the peripheral nervous system has been resolved. I'm not sure if I have this condition, and I sure don't want to develop into this! Are you familiar with CRPS type II?

Please advice.
thanks,
glo

 
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Old 05-21-2018, 04:29 PM   #25
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hello Teteri and any fellow members

I would like to give an update to my nerve root injury. It's over 6 months since my MIS TLIF on L4/5 and I had an EMG/NCS test last week. Here is the report from the neurologist at UCSF:

Description: The results of nerve conduction studies are <strong>abnormal </strong>for :
1) reduced amplitude of the left superficial peroneal sensory nerve potential (SNAP) compared to study from 9/2017. The results of EMG studies are <strong>abnormal </strong>for : 1) fibrillation potentials in the left tibialis anterior (TA) and tensor fascia lata (TFL),
2) an increased incidence of long duration motor unit action potentials (MUAPS) in the left TA, TFL, vastus lateralis (VL), tibialis posteroir(TP) and peroneus longus(PL),
3) an increase incidence of polyphasic MUAPs in the left TA, and
4) reduce recruitment of MUAPs in the left TA, TFL and TP.

Impression:
These abnormal electrodiagnostic studies provide evidence for:
1)a sub-acute left L5 radiculopathy, and
2)a chronic left L4 radiculopathy.

Comment:
the decrease in the left superficial peroneal SNAP amplitude compared to prior study would suggest the lesion includes the dorsal root ganglion or possible the lumbosacral plexus. Clinicial correlation is advised.
Compared to the study from 9/2017, <strong>the left L4 and L5 changes are NEW</strong>. The relative sparing of the peroneus longus and tibialis posterior is unusual. Would consider an MR neurogram of the lumbosacral roots and plexus to confirm anatomic location.

I would greatly appreciate your help in understanding the extent of the nerve root damage...
How bad are the damages?? Are DRG or lumbosacral plexus part of the spinal cord? How to repair them?
Are the damages reversible? correctable?
if not, I was told radiculopathy can spread from extremities to the trunk!

Any advises and recommendation would be greatly appreciated.

thanks,
glo

 
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Old 06-09-2018, 11:38 AM   #26
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hello everyone,

I posted a month ago about my post-op numbness, pain and weakness. My surgeon finally ordered a EMG/NCS and MR neurogram at 6 mos post-op and results were very discouraging!

Some background: grade 1 unstable spondy, DDD, transforaminal stenosis and had TLIF on L4-L5 last November with dural tear and soft bone during surgery. Woke up with numbness, knee buckled and mild foot drop on left leg, severe nerve pain 2 months later! EMG was abnormal with L4-L5 radiculopathy compared to EMG before surgery which was normal. Neurogram(MR) showed severe transforaminal stenosis on L4-L5, and scar tissue surrounding L5 nerve. Went to see 2 new surgeons(orth.spine and neuro) yesterday and both confirmed nerve damage on L4-L5 during surgery probably caused by dural tear, nothing can be done to reverse the damage. 😖 Both told me to wait until 1 year mark to see if symptoms improved, if not, then it's PERMANENT! Anyone has similar experience or advises? please share! Thanks

 
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Old 06-10-2018, 07:03 AM   #27
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hi, I guess I didn't respond to the posting of EMG results because this is the one test report that I don't feel comfortable talking about. I recently had a study done too, and found it equally baffling. Have you gone back to the doctor who performed the tests to get the results or talked with your surgeon since?

From what I can tell, I think it at this point it may be scar tissue as a result of the difficulties that arose during the surgery that are pressing on the spinal nerves at L4and L5. I would assume the surgeon removed all the other stuff when he did the original surgery. Unfortunately not much can be done about scar tissue. If you were to have additional surgery at some point, (like L5-S1) they might be able to clean it up a little at the same time...but it is nothing to count on.

You were fortunate to be able to have a neurogram. That technology is not available widely. At least you can be reasonably sure they know the reason for your ongoing symptoms.

Did either of the new surgeons advise you to return after the year is up?

 
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Old 06-10-2018, 09:24 AM   #28
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hello Teteri,

thanks for replying to my post.
Regarding the EMG study, I asked her about the results she provided but she referred me back to my surgeon...very frustrating! Plus the needle part of the test was excruciating to say the least.

I didn't get to talk to my surgeon about EMG and Neurogram, he had his team meeting(spine conference) and debunked the neurogram finding regarding L5 screw pinching on L5 nerve on the left side causing all my symptoms. He had the radiologist changed the report finding to "L5 nerve was encasing by scar tissue, not L5 screw".

regarding the neurogram, it's not readable due to existing hardware and radiologist recommended a regular lumbar MRI. The 2 new surgeons also agreed and their opinions were solely based on the CT scan at 3 months post-op. However, my surgeon will not order a regular lumbar MRI to confirm the nerve damage but sending me to have an ESI/nerve block at L5.

The 2 new surgeons also indicated the nerve damage was done during surgery, probably dural tear and also the way my surgeon approached from left lateral removing the lamina and inferior pedicle to access to the disc, one of the new surgeons is actually a professor to my surgeon at UCSF when he was a resident. He indicated he will not use this approach to access the disc as it's more risky.

Both new surgeons said pain mgmt is my only option now-ESI/SCS/pain med! Since I have moderate muscle atropy on my left quad and calf, the professor surgeon told me to do more strengthening exercises.....I really don't know how to strengthen as my leg hurts so much even riding recumbent bike at the lowest setting!

They both told me to return at one year mark and will confirm bone growth with a new CT. However the nerve damage might be permanent as longer it shows no improvements. Very discouraged! I spent 2 years to find the best surgeon that I can trust but ended up with permanent nerve damage that rendered being disabled! Sorry about the upset....wish I could be more positive!

thanks for listening.. as always
Hope you are doing better and please take care!

glo

 
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Old 06-11-2018, 06:03 AM   #29
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

It is devastating to end up with an injury, especially after you go to all the trouble of finding what you believe to be a top surgeon. I'm surprised the professor surgeon would give an opinion that ran contrary to the one of your surgeon who trained with him.

Are all these surgeons from the same clinic/practice/hospital...my friend who ended up having a pedi le screw through a nerve lives in Michigan. She got many opinions and none of them would tell her anything different from the original surgeon. Finally she found someone out of the Detroit area, not connected to the U of M, who was willing to run tests, etc. He was the one that found the bad hardware placement. All the others had either trained or practiced with her original surgeon.

Originally you were worried about arachnoiditis. Has that been ruled out? Did the other surgeons recommend having the ESI/nerve block? Is it diagnostic to see if your symptoms are coming from the L5 nerve?

All I can tell you from my perspective is to not contemplate the neurostimulator path at this point. And do not give up hope. But you may need to change doctors. The one operating on you when the damage occurred is going to look at things differently from another surgeon.

Please tell me about your current symptoms...where and when you have pain, etc.

I'm doing well, thank you for asking. My nerve pain that resulted from surgery in Sept. is gradually going away...and the EMG showed there is no new or worsening radiculopathy.

 
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Old 06-15-2018, 10:15 PM   #30
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Re: TLIF L4-5 Post Surgery foot drop and possible anarchnoiditis??

Hello Teteri,

Thanks for always reply to my post. You are the guardian angel of this forum!

The professor surgeon is from UCSF as is my surgeon. The other surgeon is orth.spine but not affiliated with UCSF. The neurogram didn't indicate anarchnoiditis but both surgeons said it's hard to read due to motion degradation. So their diagnosis were based on the CT scan done 3 months post-op. I want to get a regular MRI but the all told me to wait until 12 months....sigh!
My surgeon ordered the nerve block at L4/L5 and the orth.spine surgeon said I can try that or even SCS. The professor surgeon said he won't bother with nerve block but he didn't suggest SCS either... I kind of agreed with the latter of not doing any.

My current symptoms are mostly pin and needle, burning sensation, numbness, and random shocks along the left knee to toes. I also have soreness from left groin to front thigh. left foot still slap the ground after 15 min. of walking. My best time is when I wake up and worst is toward evening and bedtime. I took most of my pain med in the afternoon and at bedtime(double dose). They are baclofen and gabapentin and tylenol.

I compared the imaging before and after surgery as I am worry about the finding in the MR neurogram.

Neurogram done at 6 mos post-op:
Severe left neuroforaminal stenosis at L5-L6 with mild compression of the nerve root by surrounding scar tissue. The exam is motion degraded and not optimized for evaluation of the lumbar spine, therefore a dedicated lumbar spine MRI is recommended with possible oral anxiolytic administration.
In retrospect when comparing to the CT from 2/14/18, previously noted "compression by the adjacent left L5 screw" is not evident.

CT done 3 mos post-op:
L4-L5 (postsurgical level. Left foraminotomy. No high-grade bony
spinal canal or high-grade bony foraminal narrowing.
L5-S1 (facet joint degenerative changes and spondylosis without
high-grade bony spinal stenosis. Bony elements encroach upon the
right foramen possibly affecting the exiting L5 nerve sleeve.
Mild to moderate bony narrowing of left foramen also noted.
Bilateral SI joint spurring)

MRI done 4 months before surgery:
At L4-5, anterolisthesis of L4 on L5 is present in association
with a global disc bulge. There is posterior facet hypertrophy.
The canal and foramina are moderately reduced at this level.
At L5-S1, a central focal disc bulge is present. The canal or
foramina are widely patent.

From the MRI, it said I don't have stenosis at canal or foramina at L5-S1 level. But the stenosis is worsening per the CT at 3 mos and MRN at 6 mos post op. Would the stenosis caused by the surgery? Would I need a decompression at L5-S1 soon as it seems to worsen over 6 months? Any advice and insight would be greatly appreciated.

I am happy to hear that your EMG has stabilized and your symptoms have improved!
Please take care and let's hope we will do better in the coming months.

thanks,
glo

 
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