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Hemilaminectomy, Foraminectomy

After a knee operation I had two years ago, I've had migrating pain or tingling or some numbness in my left foot and constant calf pain - soleus and gastronemius.

I had 4 emg's which contradicted each other, years of physical therapy and have gotten nowhere. I've been working with a physiatrist for longer than that as well plus seeing other physiatrists.
I've been working with two podiatrists.

No one has been able to positively pin down the pain as coming from my spine or coming from my leg and foot.
I've had epidurals at L4 and L5 which helped with some back pain, but no help for the foot.

I've had transforaminal cortisone and anesthetic shots at left L4 and left L5, one of the shots at L5 seemed to help with the foot pain briefly, the second time I tried L5 it made the foot feel a lot worse.

I saw 3 surgeons. The prominent neurosurgeon wanted to do a L4-5 hemilaminectomy plus an onlay fusion on L4-5

Prior to the issues with my foot, I'd been having nagging back pain for 4 years which PT did not resolve.
However during the last year the back pain has been less prominent.

The other surgeon which I chose to do an operation is going to do a hemilaminectomy plus foraminectomy, but no fusion because he says my L4-5 disc is just about gone and I'm naturally fusing anyway.

I'm scheduled for the operation in a few weeks. It is day surgery at the top orthopedic hospital in Boston.
I'm getting anxious and fearful of how my recovery will be since I live alone and can only corral minimal help from friends, mainly because they don't live close by.

I was told initially that I would not be able to sit for more than a half hour and it would take 6-8 weeks before I can sit long enough to work all day.

I do fear what it will be like after surgery. I have to care for myself as far as food preparation. I'm told I will have a visiting nurse for help with the bandages etc.


  • Hi, welcome.

    There is lots excellent info here. Feel free to look at the FAQ, where the answer to your question is.

    Also quite a few articles on recovery. Feel free to search for 'recovery' or 'preparation' or 'hint' or 'tip' in this forum/s. Many, many hints for your situation.

    It's unusual to hear your procedures done without the fusion component. Wish you luck.

    With a fusion, those time frames would be ambitious based on my experience, hope it works out like that for you. Have found surgeons are quite optimistic, which focuses the patient on a high output level. Is often not achievable by all.
  • charlestekccharlestek Posts: 18
    edited 11/06/2012 - 3:25 AM

    Thanks for the welcome.
    I specifically asked the surgeon why no fusion and he feels it is not necessary as I already have bone on bone which appears to be knitting. As a matter of fact the surgeon did similar surgery on a famous retired NFL quarterback whose particular situation did not need a fusion.

    The difficult part is that I live alone and have limited support from others and from that I am most fearful. I have been out of work and will need to start a job search after the initial recovery.
    My unemployment is ending soon and I will be living off savings. Those things alone keep me up at night....
  • So keep in touch by posting how things are going with your preparation and post surgery ups and downs.
  • charlestekccharlestek Posts: 18
    edited 11/06/2012 - 9:38 AM

    How are you doing? Your signature says you've been through a lot.
  • Doing more physio now. Reducing the medication. Foot / leg getting stronger. Got an excellent surgeon and PT.

    Have you finished preparing for op yet? Glad for you that you got a top surgeon.
  • Yes, originally I was going to have the neurosurgeon at the same hospital do the surgery, he is supposedly very highly skilled, but even after seeing him once a year prior, it takes 4 months to get to talk to him to answer any questions. I saw him, then had more questions, but no way I could speak to him without waiting months. And it took over 3 weeks for his PA to get back to me to discuss some questions. The last straw was when I told the office to go ahead and schedule surgery and he took over 6 weeks to do paperwork so I could actually get a surgery date. By then, I was trying to save time because I needed to recover and get back to job hunting asap.
    The other surgeon whom I'm using is easy to talk to and has a staff that gets back to you right away. His online reviews are extraordinarily good, though he started his training as a general surgeon not a neurosurgeon.
  • I've got my pre-op workup tomorrow. This afternoon I saw my PT who was working on my calf, where he believes there is a tear (been there for a couple years now) that he believes could be responsible for putting pressure on the branch of the sciatic nerve that goes to my foot and may be contributing to the foot pain and numbness symptoms that I've had for awhile.

    The foot has been doing better the past few months, but I scheduled the surgery almost two months ago. I'm having second thoughts about 1) the surgery limiting me in taking care of the household and 2) whether it will fix my foot symptoms.

    I feel pretty agonized tonight.
  • I saw the surgeon for pre-op and he says he is inclined to do a hemi-laminectomy on the left side only because that is the side that is symptomatic. At the L4-5 level, I am narrowed down about 80% of normal. He will do both sides if I wish, but notes that there is a risk of disturbing nerves on the right that aren't bothering me so I have to consider the risk/benefit..

    This is throwing me in a big loop. I don't know further down the line what my health insurance will be like, so I'm inclined to want to have both sides cleaned out but I'm not sure if that is wise or not.
  • Have to get up at 4am to get a cab at 5am to get to the hospital by 6am for surgery at 7:30am.

    That alone is going to screw me up!

  • Hopefully it will be day surgery only as you said. Must MISS (minimally invasive) to not stay for a few days or more.
  • Dave, I had surgery around 7:30, was in recovery by 9:30. Was home by noon.
    Biggest limitation is that I can't lift more than 5lbs due to internal stitches.. Wound is superglued together with waterproof bandage on top.

    They tell me I will feel a lot worse tomorrow, the day after is supposedly a killer.
  • Slept reasonably ok, back is sore and stiff while laying down. Took a small walk around the block.
    I live alone so this is a difficult thing to face, but I'm coping.
  • Are you on many pain meds? Sounds like its going good so far. How's the pain compared to before the op?
  • Since I haven't had any acute pain for about a month and a half, it is hard to tell. Surgeon was almost going to cancel the operation the surgery morning, but elected to do it anyway because I was having issues for a two years except the last few months.

    I was doing great up till late yesterday afternoon when I started to get sharp pains in the upper portion of my left butt below the incision. Pain is bad so I have trouble walking and getting stuff done around the house. Sitting is ok, which is opposite of what is supposed to happen. I had been taking Vicodin, but it was doing nothing for the walking pain. Got a hold of the night doctor at the hospital and he said it was ok to take some Ibuprophen, which helps a bit, but it is still painful walking. I called the surgeon's office this morning but the assistant was not much help, said the ibuprofen was ok, and "have a nice Thanksgiving" blah blah.

    I'm having trouble moving around to get myself fed and get minimal things done around the house.
  • Today I'm at 1 week into recovery. Back and pain in upper buttocks is not too bad, more occassional than before when I move in a certain position.

    Foot seems to be ok today. Hopefully I will continue feeling better.
  • DaveFusionDDaveFusion Posts: 476
    edited 11/26/2012 - 1:34 PM
    Hope you continue you improvement. There will be bad days but trend line will be up from here more than likely.

    Hang in there.
  • Dave, thanks. Next week I have a two week follow up with the surgeon and most likely will be able to return to some driving.
    I hear it still is 6 weeks total before I can lift heavy things though.
  • I think it's 12kgs now. Up to 3mths it was 2kgs.

    So I would be surprised if you were allowed to lift heavy things after 6 weeks. But we're all different.
  • I spoke with the doctor and the weight lifting restriction is not because of the spine not being able to carry a load, it is strictly to make sure I don't tear out any internal stitches. So I was expecting at 6 weeks that the internal stitches would be healed.
    Right now I have a 5 lb weight limit which is ridiculous.
  • I've developed some definite big toe tingling and irritation the last two days. There is no doubt that this was not there before.
    I don't know if it is related to my sitting a lot. I am very frightened because I wonder if the doctor should have done a discetomy as well and he did not. If this is coming from what is left of the disc then it was a waste not to go in there and take out the remainder of the disc.
  • I suspect that he will say its normal and will recover.

    However, you should ask how long sitting should be limited to. I was told 20 mins for first 3 mths.

    Hope you appt goes well.
  • I think sitting is as tolerated and I appear to be able to sit for a fairly long time, though I know I must get up and move periodically.
  • How are things going for you now?
  • charlestekccharlestek Posts: 18
    edited 12/28/2012 - 3:24 PM

    I'm doing pretty well. Had some toe tingling, but changed orthotics, it may also be due to torque on the upper part of my foot.
    Got a snow storm coming. Technically I am at the 6 week recovery point and should be able to lift what I want, but 6 weeks plus follow up with the surgeon is not till Jan 8th. I have a self propelled snow blower and guess I should be able to steer it.

    As far as weight lifting, my back seems to be ok, though I have not lifted anything heavy yet.

    The surgeon said that the 6 weeks is for the stitches to heal. The only reason for weight limits he says is to prevent the stitches from pulling out until the muscle strips he separated have time to heal back to normal.
  • Charlestek, hi. Good to here you are doing good.

    Read a post here this morning of a chap that had a micro-d then went back to work lifting heavy stuff. About 6 months later, well you can guess it. Reherniation. He then had to have fusion surgery and got issues. He said he wished he hadn't gone back to lifting.
  • charlestekccharlestek Posts: 18
    edited 12/29/2012 - 8:54 AM

    Yeah, but I did not have a discectomy, only had a laminectomy and foraminectomy. So assuming the disc is the way it is (slightly bulging), I would be the same as I was before the operation, with theoretically having more space for the nerve to move around. The surgeon repeatedly told me 6 weeks, and the 6 weeks is for the muscles that have been sewn back in place.

    So I'm not dealing with a herniation here.
  • Dave,

    Thank you for the care and attention you've given me in my recovery. I understand how the weight limitation could be important.
    I do want to be cautious when I attempt to lift. I did lift a two gallon gasoline can yesterday when getting gas for my snow blower, and I felt that it may have caused my toe to tingle more, which is not a good sign.

    The surgeon said he did not do a discectomy because the disk was nice and smooth and trimming it may cause the nerve to hang up on it, which I find hard to believe. If the tingling is still being caused by the bulging disk then I have cause to be very mad, because the operation would have been a waste.
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