Question: What Can Be Done about Nerve Damage From a Herniated Disc?
I suffered a severe disc herniation at L5-S1. The herniation occurred during lifting of my garage door and was catastrophic. I could actually feel the pulp extruding from the center of my disc, and I collapsed, unable to walk. I was taken to the hospital, where my condition was stabilized by injecting pain medication into my back. The doctor performed a test whereby he asked me to resist while he tried to move my foot and leg in various ways. He could detect no strength loss and told me I did not need immediate surgery, and I was discharged.
But when I walked out under the influence of the pain medication, I could feel knots in the muscles of my right leg, and had difficulty pushing off due to weakness. It took a week to get an MRI. Twelve days after the herniation, I saw a neurosurgeon, who also performed the test where he tried to move my foot and leg in various ways while he instructed me to resist. He said he saw no reason for alarm, and postponed my surgery.
I finally had surgery 3 weeks and 2 days after the herniation, but by that point had suffered permanent nerve damage, manifested by permanent weakness in my right leg, and loss of the reflex when the back of the ankle is tapped. I also am now worried that I have neuropathic pain because I have pain when I stand on my right foot, but the pain goes away when I take the weight off. Sitting for long periods is unbearable.
Looking back on the tests the two physicians ran (in which they pushed and pulled my foot and leg while they instructed me to resist), I now realize I simply overpowered both of them, and they detected no problem with weakness when there really was one. I was, and am, a very fit male (currently age 51) with very strong legs.
I now have a crusade to try to tell the medical community that they can make severe misjudgments when using the qualitative test I have described. A strong man's leg muscles can overwhelm the strength in the doctor's wrists and forearms, even when the patient has a serious problem with nerve compression due to a herniated disc. A strong man can lose a considerable amount of strength and can still overpower the doctor in the test I have described.
Please take my comments seriously, as I want to spread the word, so that someone else is not hurt as I was.
I am trained as an engineer and am thinking that a simple inexpensive test could be developed to replace the qualitative test I have described. It would involve the principle of having the patient use his foot to push on a device to register force on a load cell. It would have to be configured to handle measurement of force when various muscles are used, but it should be possible to handle that. In this way the strength of one extremity could be quantitatively compared to that of the other. With some experimentation, databases could be developed to let the physicians know at what strength differential to be alarmed.
I have one additional question. Is there any possibility of nerve healing after 6 years? Recently, my pain has become almost unbearable, especially when sitting, or standing on my right foot. The physician who did the surgery has referred me to a physiatrist, but I want to heal, not learn to deal with a life of chronic pain.
Doctor's Response: Nerve Damage Recovery and Indications for Immediate Surgery
You are absolutely right in that the gastroc muscles in a person's leg have to be very, very weak before a manual test can pick it up. Actually, a very sensitive way to pick up muscle weakness is to have a patient repetitively toe rise on one foot. Even very subtle weakness can be picked up with this test.
Unfortunately, even if the weakness had been picked up, it probably would not have changed your treatment or even your outcome. There is no evidence in the literature that surgery for a static nerve deficit is necessary, or that it in anyway helps the nerve heal faster. The nerve damage is probably done at the time the disc herniates, and unless it is decompressed within a couple of hours (which is not practical) early versus delayed surgery will give the same results. Your treatment sounds entirely appropriate.
The only two indications for immediate surgery for a disc herniation are progressive neurological deficit (weakness) or bowel/bladder incontinence (cauda equina syndrome).
As to your current pain, the characteristic of neuropathic pain is that it is there all the time. Pain when you step on to your foot would be more mechanical. Further conservative treatment may actually be able to help with this type of pain, so a referral to a physiatrist is appropriate.
The nerve healing usually is complete at 12-18 months, so it won't heal anymore. But, if the pain is mechanical, there may be some additional treatments that would be appropriate for you.
In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.