Possible Nerve damage?
Posted , 6 users are following.
About 2 and a half years ago I strained my back by over exerting and injured my back. I had herniated my L4-L5 disc. Workers compensation is a tedious system to say the least and I received my first surgery near January of last year.
I had a Decompression done on it and everything healed fine and I was on light duty for about 11 months before pain started coming back. Another MRI revealed that it had re-herniated and so back into surgery I went. This time it was Discectomy on L4-L5.
My back pain was gone again and I was back on light duty work until about March of this year. I started, and still am having, a lot of pain in my leg. Worse than ever before. Before I just felt pain in my butt cheek. I think this is usually refereed to as a sciatic nerve. But now the pain is in the back of my thigh, in my toes and on the outside of my calf near the shin.
I had an appointment with my Spinal doctor today to review the results of an MRI I took on the 20th. He says that the MRI doesn't show anything like a herniation. It is not a perfect disc but he says I shouldn't be having the extreme pain that I am having. My doctor is setting up an appointment for me to have a EMG test for my nerves.
To further explain my symptoms, I'll tell you that most of the pain is from sitting down. I cannot sit on my bottom for more than five minutes before pain starts to be unbearable in my leg. Once it gets to that point I am left walking like a hunch back and unable to straighten my back out unless I force my self though the pain or lay down. Laying down is much easier and once I do lay down for about 15 minutes I can stand up without problems and almost no pain. Also in my sleep it seems I move quite a bit and recreate the pain that I get from sitting down and it wakes me up.
To wrap things up I am not angry with my Doctor or specifically looking for any answers but more curious to see if anyone has had this problem also or if anyone has know anyone with this problem. Any input would be greatly appreciated.
0 likes, 6 replies
CHICO_MARX Jwatson
Posted
It really does sound like the sciatic nerve. Lower back or hip through the butt and down the leg...sometimes all the way down...
Sciatica
For me, chiropractic has always worked (except once...) especially when I was playing hockey for 45 years. Ended up with a case of it 5 weeks after a knee replacement three years ago...chiro fixed me up in a few weeks. I always go least invasive until I'm out of options.
But the exception I refer to in the discussion link really did require a surgical fix. Neurosurgeon went in (inconclusive MRI) and found a bone spur literally crushing the sciatic nerve root. Decompressive laminectomy L4 through S1...immediate sciatic pain relief...residual inflammation lasted about a week. Very successful. But since then, I've had two fusions and another laminectomy. Along with a metal hip and a metal knee, it seems that the sport took its toll. Just wish I could still play in an over-70 league right now...
If you have chronic issues in that lower lumbar area, don't be surprised if someday you'll need a fusion to keep those vertebrae stable. My first was a TLIF L3 through S1; the second was an LLIF L2/L3 from a case of foraminal stenosis (think of sciatica down BOTH legs). Excellent results all around. Note that the gold standard test for the spine is a CT/Myelogram with contrast...waaaaay more conclusive than an MRI. Talk to your doc about one.
Have fun at the airport...I'm the TSA's worst nightmare!!!
Jwatson CHICO_MARX
Posted
Thanks fr the input, Yeah my MRI doesn't really show anything wrong and I do believe I had an MRI with contrast. (Injection midway through the MRI). Doc is trying everything he possibly can to avoid a fusion. Both my L3/L4 and L5/S1 are not in the best shape so he is worried that ill need more fusions in the future because of it. The thing that is confusing everyone is that I have had injections in the past and they worked great as temporary pain relief, but now, no matter which level gets the injection it has zero effect. I tried chiro and phys therapy more recently and it actually made my pain worse. I asked him today, "Cant you just cut me open and take a look?" he got a chuckle out of it and told me that generally thats frowned upon because technically an MRI should be able to see where the issue is. He speculates that the nerve root might be getting compressed somewhere other than the nerve root.
24 btw.
CHICO_MARX Jwatson
Posted
Do the CT/Myelogram with contrast. I would really recommend it.
Seafarer123 Jwatson
Posted
Hi Jwatson,
So sorry to hear about your pain. I've been in a similar position with sciatica, to the point where I've had excruciating bouts of sciatic pain, unable to move and in tears, for days. I feel you. Let me offer a number of thoughts on what you mention based on my own experience, that of others I've spoken to, and what numerous doctors have told me over the years:
First - and this is only a palliative - be aware that there are very good medications for suppressing the neuralgia (nerve pain) that is sciatica. Medications like gabapentin and lyrica. They are non-narcotic and for many people (myself included) help suppress the sciatic pain tremendously. You can take significant quantities of these medications with only minimal side effects (mostly fatigue and sleepiness). Don't be shy about taking them - in my opinion they are better to take for sciatic pain than narcotics like vicodin or oxycodone.
Second - I've heard from several medical professionals that there is only a mild correlation between the level of pain some people feel and the observable damage that can be seen on even the best imaging (e.g. MRI with contrast). Some people have only mild compression and yet are in extreme agony, while others have clearly major impingement (large herniations, bone spurs, foraminal stenosis) and barely feel any pain. Doctors still don't know why there is such a variation between level of spinal damage and level of pain felt but the clear takeaway is - it is not uncommon to be in a lot of pain (especially sciatic pain) and for the doctor to not see the "normal" level of impingement that typically "should go with" that level of pain. Fight to get pain relief if you are feeling it, don't let the doctor tell you that you "shouldn't be in pain based on the MRI." GOOD doctors know there isn't always a strong correlation between reported pain level vs. damage seen on an MRI.
Third - I encourage you to get an EMG/NCS, as you said you were going to. In many cases this test is more conclusive than an MRI. Sciatica is caused by nerve compression and that nerve compression causes the nerve to die, or in medical terms to "denervate." The EMG will show the level and pace of the denervation. If you have what they call "active denervation" then something needs to be done, despite what the MRI might show.
Fourth - be aware, as one doctor told me, that if you have active denervation from nerve compression there is only a fairly brief window in which it can be dealt with before it becomes something of a permanent condition. I wasn't told that until my window did in fact close, and I now have permanent damage (the damage is numbness and tingling, thank god, and not permanent pain or foot drop, but that can happen too). Keep pushing your doctor for a solution if you do have active denervation because there IS a window for treatment which WILL close if you don't do something in time (and I am living proof of that).
Fifth - there are sometimes conditions causing nerve impingement that can't even be seen via an MRI. A friend of mine with severe back pain said that the doctor only discovered, once he started doing surgery on her, that she had a hemangioma (a collection of knotted blood vessels) compressing her sciatic nerve. Only surgery could see it, and only surgery could treat it.
That's about it. The most important thing I would say is - if you have active denervation, fight like hell to get it resolved. Don't let your doctors just kick it down the road. Take medications to fight the pain, yes, and do physical therapy when you can, but keep fighting until they truly resolve the pain. Because let me tell you, things can get MUCH worse...
Jwatson
Posted
Oh my, I never expected a response like this. Let me start by thanking you so much for the time you spent writing such a detailed experience. While my doctor is really good at what he does, he is being held back by Workers Compensation procedures. For example, lets say my doctor determines that I need surgery on my back. He writes out a "request" for surgery that is given to my insurance adjuster. The insurance adjuster then submits it on her end to the "higher ups". They get to it when they can and once they go back and forth with my Doctor a few times, they'll approve it. Once its approved then they have to figure out a surgery date which is usually one month out due to how many clients my doctor has. (I don't get to pick my doctor with Workers Compensation). All in all this whole process takes about a half a year.. Unfortunate but sadly I can't do anything about it.
It seems like I'll be depending on this EMG test for now. I am just so ready to get some sort of pain relief. I have tried Gabapentin but it has VERY little help with pain and more or less just helps me fall asleep through the pain. I don't sleep much. usually 1-2 hours here and there throughout the day. I have been up since yesterday at 3am EST with a hour nap last night at midnight. The only thing that helped my pain was alcohol in the beginning. but early last year my wife got pregnant and my daughter was born in november so l we decided to get sober then and have been since.. I'd much rather not depend on it anyways.
Seems like there are many different things that could be wrong with my back and I just have to go with the flow so to speak. I really enjoyed reading your reply and has given me a sense of hope that maybe my doctor is starting to figure out that this isnt a cut and paste disc herniation. I have been asking him to just do a fusion but he refuses until he is 100% sure where the problem is.
I've book marked this page and plan to follow up after the EMG test is done in case someone else is out there reading this with the same problem as me.
foxy32222 Jwatson
Posted
HELLO JWATSON,
I'M SORRY TO HEAR ABOUT YOUR PAIN. I HAVE SIMILAR PAIN. I JUST WANT TO ASK YOU HAVE YOU HAD AN SPINAL CORD STIMULATOR PUT IN YOUR BACK? I HAVE HEARD GOOD RESPONSE AND SOME BAD. HOWEVER I HAD ONE PUT IN ABOUT 1 YEAR AND A 1/2 AGO. AFTER LEARNING HOW TO OPERATE IT TO MY BODY. I FEEL GOOD MOST DAYS. WHEN I HAVE PAIN, WHICH I DON'T THINK I WILL EVER LIVE WITHOUT. I TAKE MY PAIN PILLS, TURN ON MY STIMULATOR, AND WHEN LAYING DOWN I USE A HEAT PAD ALSO. I AM DISABLE PERIOD. BUT MY DAYS ARE BETTER, I DO GET RELIEF FROM MY PAIN, THANK GOD.
SO YOU MIGHT WANT TO ASK YOUR DR. ABOUT IT. I DO SOME HOUSE WORK, I USE A SCOOTER WHEN IN A GROCERY STORE. I CAN'T STAND LONG, ALL IN WHICH I LIVE A NORMAL LIFE AS IT IS. IT HELPS MY PAIN, NOT IN PAIN ALL DAY, LIKE I SAID, I TAKE A PILL AND GO ON WITH MY DAY.
GOOD LUCK AND ASK YOUR DR. ABOUT IT.