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Hello everyone ----- getting by and looking forward to new solutions.

Hi everyone

I have had back problems for years. I initally injued my back in the late nineties. I have had three minimally invasive micro discectamy ( minimally effective) surgeries, injections, and mutilple PT treatments.
My main problem has always been leg and foot weakness. I never really had an issue with pain.
EMG tests have indicated nerve damage to my S1 nerve. I also have atrophie in my calf muscle and permanent weakness in my foot.
I manage my "weakness" conditions mainly by excercise (treadmill, stationary bike, resistance training , pilaties, swimming) chiropractic adjustments, and massages.These steps are effective at maintaining my remaining leg strength. However I'm concerned that these steps aren't enough to prevent further nerve/muscle damage. My guess is that I'm merely slowing down the nerve degernation. I've had EMG tests but they dont produce quantitative results. I monitor my strengths and measure my calf muscle circumference.

I'm sure that the next surgical step will be Fusion. This seems extreme considering I am able to work and have no significant pain.

I'm just hoping that some less invasive disk replacement/repair solutions come available soon!

Any tips / advice is appreciated.



  • Yeah it's a hard call.

    Was in the same situation but only had 1 microdiscectomy. Had no nerve damage or foot drop before the Discectomy.

    Immediately afterwards, the nerves (L5 & S1) continued to have "progressive" ongoing nerve damage (based on EMG) and compromised muscle motor function. This led to partial foot drop with dorsiflexion (pulling back / upwards) muscle atrophy. This was a 1 or 2% chance but I got it. During this phase, as the nerve regenerated and was re damaged in a cycle, it produced regeneration pain that was controlled with high levels of Lyrica and paracetamol. I wore a foot drop splint to stop the foot from flopping onto the floor at each step and prevent ankle roll and further stretching of the atrophied muscle.

    Was given 50 / 50 chance of permanent full foot drop without surgery. After much consideration and 3 opinions, I decided to have the spinal fusion to L5 / S1.

    Immediately after surgery and decompression, the nerve started working again and the muscle motor function returned. Muscle function was weak but much stronger. The muscles have continued to increase in strength with specific PT for atrophied muscle rebuilding. Now 11 weeks post op, I can lift my toes off the floor when standing and nearly walk on the heel with toes in air. May take some time to get there but it's progressing in the right direction.

    However, have to wear a foot drop splint when going out to prevent ankle roll and risk of falling and damaging the knitting bones of the fusion. I look forward to throwing the device out soon and never wearing it again.

    The nerve regeneration pain is still there in the foot but reduced and the Lyrica medication is reduced to 150mg at night and paracetamol oesteo 2 x 3 times per day.

    If I was stable and could function, I would have waited. Or if I could have travelled by plane, I would have considered paying for an artificial disc and travelling to where surgeons had a good success rate.

    For my situation, An 80% chance of success was much better with fusion than a 50% chance that it would be much worse by having conservative treatment. However, with fusion there was a 5% chance that it could have been much much worse. It's about weighing the risk verses the benefit for your circumstance.

    Getting a number of opinions is important. Fortunately, I was able to get an unbiased opinion from a semi retired consulting Professor of Neurology who was able to recommend a very good surgeon (ortheopedic) and help me understand the what the opinions meant. Surgery success is very "operator" (sik intended - my GP) dependent and one should try real hard to get the best "operator" to get the best success.

    Hope this helps.
  • Hi Dave

    thanks for sharing your story. It sounds like you made the right decision to have the surgery based on your drop foot condition and odds. Wow I never heard of nerve regeneration pain. - I hope it diminishes over time. Perhaps you could put a positive spin on it by the fact that the pain is a sign of your nerves getting stronger.

    Good point about getting multiple & unbiased opinions. Surgeons make a lot of money on fusions and it makes me wonder how unbiased their opinions are. My GP & Chiro both keep on eye on my conditions. Also I had a neuromuscular doctor check me out a while back. She said I'm doing a good job with the exercises and but also could not confidently say whether fusion would make it better. I'll likely get a some opinions from neurologists next.

    When you say to get the best "operator" what criteria did you use or what helped you make the choice?

  • Not an easy one to answer universally. For me, I had the Prof who gets to see a lot of patients needing revisions, knows surgeons track record. Plus my GP also a number of patients referred to surgeons and saw the outcomes and outcome trends. So I listened to them. The Prof did say if I had had a limber tumour he would have recommended one of the other surgeons I saw. Horses for courses.
    I guess asking for recommendation from sites like this (via private message) may be usefull.
  • Dave I recently had a visit with a pain specialist. I'm going to get a steroid injection next week in order to reduce inflammation around the nerves. The doc also subscribed Gralise (a Gabapentin product similar to Lyrica). He thinks the Gralise will help build leg strength in the long run. I'm a bit skeptical as It seams that Gabapentin primarily treats pain.
    He also subscribed a product called Metanx which is a high dose B6B12 pill and will help regenerate nerves. This drug is typically used for diabetic patients with leg numbness. I think may help in my case. Perhaps consider asking your doc about the benefits of these medicines in terms of building leg & foot strength.
  • Thanks for the suggestion of those vitamins.

    I expect your doc concludes that if you feel less pain, then you will be able to do more exercise, resulting in stronger muscles? does this sound likely? Plus, if the steroid reduces the inflammation, then less nerve pain, more exercise, etc?

    On the subject of injections, there has been recent discussion on this topic here. DiLauro, mentioned an anecdotal correlation between nerve damage and injections that did not use fluoroscope guidance. In other words, if the needle is not guided based on fluoroscopic screen, then it probably has a lot more chance of doing nerve damage. Just a hint. May be a question to ask the doc.

    Good luck.
  • PLEASE DONT HAVE A FUSION if you can treat your pain another way a fusion is a massive operation with a very long recovery ...like up to 3 years .and its a very invasive /painful operation .i had ALIF fusion last 29 dec 2012 and i have had 2 previous spinal operation {{both now where near fusion spinal work } } a fusion ALIF/PLIF will make you unable to moves as you can now like cleaning yourself after going to the loo .even getting to your feet to clean then /cut your toe nails // .you may expect urinary problems including sexual {which you wont be having .any time soon ! and you may have more problems with you lower legs ..;like swelling and weakness and swollen feet .{{{i have this}} its horrible ..if you can avoid surgery any surgery then do so
    1997 laminectomy
    2007 repeat laminectomy and discectomy L4/L5
    2011 ALIF {L4/L5/S1}
    2012 ? bowel problems .still under investigation
    2014 bladder operation may 19th 2014
  • i forgot to mention a fusion is done to stabilise the spine .not for pain .....pain should the fusion remove it ..well that's a bonus ..also you will be in awful pain post op and for a few days later ...with every operation i have gotten a lot worse and weaker and unable to do simple skull and i am only 46.i have suffered for 16 years .been there got the tee shirt ..as wee say here in the uk ...A fusion will dramatically change you like {one way or the other and consultant tend to sugar coat the outcome}
    1997 laminectomy
    2007 repeat laminectomy and discectomy L4/L5
    2011 ALIF {L4/L5/S1}
    2012 ? bowel problems .still under investigation
    2014 bladder operation may 19th 2014
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