Leg Pain and Numbness: Doctor Responses to Patient Questions

On this page:

• > Questions: Spinal Stenosis Surgery, Leg numbness from Spondylolisthesis
• Questions: Pinched Nerve, Discectomy or fusion, soft tissue and continued pain
• Questions: Sciatica related numbness, progressive loss of leg strength

Peter Ullrich, MD

The following explanations, insights and advice about numbness and leg pain are provided by Peter F. Ullrich, Jr., MD, an orthopedic spine surgeon and Medical Director for Spine-health.com.

Patients frequently e-mail us questions about leg pain and numbness caused by back problems. While we don’t provide individual responses, periodically, Dr. Ullrich will take time to respond to the more frequently asked questions and we publish the responses in this section of the site.

Please understand that the following responses to questions about feeling with numbness and leg pain represent the opinion of one physician, and are intended for informational purposes only and not as a substitute for professional medical help or advice.

Spinal Stenosis, leg pain and other problems: is surgery the answer?

The Question:
My 65 year old mother has had spinal stenosis and sciatica pain down her left leg for 6 years. She is otherwise in stable health. She experiences some numbness, coldness, tingling in her left leg and foot but mostly just horrific pain that doesn't respond to any treatment. She has nerve compression at L4/L5, and fusion surgery at one level with decompression has been recommended by a surgeon. She has tried all of the conservative measures to avoid surgery, including multiple steroid injections, to no avail. She has mild osteoporosis and osteoarthritis in her spine. She also has scoliosis in her thoracic spine. She also has lumbar disc disease. The surgery would address only her pinched nerve and would not attempt to correct her spine in any way (due to the severity and complexity of her conditions). It would only be to relieve the leg pain, which is debilitating. She is only able to walk/stand for minutes at a time.

I have 2 specific questions. Would my mom be a candidate for an artificial disk with the decompression instead of the fusion? Next question - I read that waiting too long for surgery can be a mistake. We avoided surgery based on recommendations of the first surgeons we consulted. I want to know if you can give me any indication about the chances that the nerve down her left leg has been compressed so long (6 years) that even after the decompression is done, the nerve will continue to cause extreme pain. This is my biggest concern - if she goes through the risk of the surgery, will it be for nothing if the nerve is severely damaged? Thank you so much for any guidance you can provide.

Doctor's Response:
She would not be a candidate for an artificial disc. Artificial discs are designed only to treat pain due to degenerative disc disease. They do not stabilize the spine (as a fusion would) and do not provide for decompression of the nerve roots. They are absolutely contraindicated in anyone with osteoporosis or in patients over 65 years old as they will subside into the vertebral body.

From the information in your e-mail, it does sound as though a decompression would be reasonable at this time. In spinal stenosis cases, it is rare to see permanent nerve damage. The majority of time, the surgery for spinal stenosis works as well if it is done now or at a later date, and that is why a lot of physicians will encourage patients to wait until their pain becomes debilitating. The main goal of surgery is to relieve the pain and allow the patient to function better. In general, it is usually not necessary to do surgery to prevent nerve damage from spinal stenosis.

However, there is always a small chance that any surgery will not work. The most important thing is that the potential benefits of surgery outweigh the risks. A one level decompression and fusion is a reliable surgery for the most part, and if your mother has already had all other conservative treatments, and is now debilitated, I would think the potential benefits far outweigh any risks. Good luck.

Leg numbness from spondylolisthesis continues after treatment

The Question:
I have spondylolisthesis of L5 on S1 grade 1-2. Two steroid epidurals helped the back, leg and foot pain very much, but due to increasing weakness and muscle atrophy of my right leg/foot and numbness of the lateral part of my right foot, I opted for surgery 4 weeks ago. The numbness has been present from the outset of problems. I had decompression of L5 and S1 nerve roots and fusion of L5 and S1. I was given no guarantee on the numbness. What is your experience with numbness being corrected with surgery and how long would you expect it to take if the numbness is relieved?

Doctor's Response:
Usually the numbness from a condition such as spondylolisthesis is the first thing to start and the last thing to go away. The numbness can take up to a year to get better, or even longer. Most times it improves or goes away. If you had a lot of nerve damage (as would be evidenced by the preoperative weakness), I would probably expect that you would have some residual numbness. The bottom line is you won't know what you have until the nerve is done healing and this takes at least a year. If the numbness is still there at a year, then unfortunately the numbness is probably permanent.