First time poster here, though I’ve been lurking/reading for over a year. Thanks to the site founders and moderators for this informative resource. Hopefully, sharing my story will not only help me, but also others grind through and beat their pains.
Today is the eight week anniversary of my minimally invasive lumbar decompression surgery, specifically a L4/L5 Laminotomy and L4/L5 + L5/S1 Foraminotomies. I am a male in my early 40’s who had several episodes of lower back pain in his late 30’s that always resolved within a few weeks without significant radicular symptoms. The final episode began about a year ago with symptoms that started in the usual lumbar area, but this time traveled into the right glute and ultimately the ankle/foot. I opted for surgery after months of physical therapy, ART, MAT, acupuncture, massage, chiro adjustments, and steroid injections into L4/L5, Piriformis, SI Joint and Ischial Tunnel, as well as a Botox injection into the Piriformis.
The Botox injection significantly relieved my SEVERE gluteal pain that made sitting for more than a few minutes difficult. New muscular type pain developed in my upper hamstring area when sitting, but nowhere near as bad as the glute pain. More concerning, nerve type pain (burning, numbness) developed in my ankle and foot. When I perceived several days of relief to the ankle/foot symptoms from a transforaminal L4/L5 steroid injection, I decided to schedule the surgery with a respected neurosurgeon in the Denver area. The MRI’s showed stenosis that multiple surgeons described as “not that bad,” but my symptoms were bad and had been around for almost a year.
A few days following surgery, I began experiencing nerve pain many times worse than anything before surgery – intense burning into the top of my right foot, bottom, all toes and both sides of the ankle. The upper hamstring area muscular pain stayed the same, no better or worse. I have had little to no pain continuously down the leg or into the calf before or after surgery. The ankle/foot pain has persisted and though it’s maybe 10-20% better than the weeks immediately following surgery, it is still much worse than pre-surgery levels – more intense, widespread, and consistent… every day, especially late in the day. At six weeks, my neurosurgeon suggested the increased pain was likely attributable to the nerve being compressed for so long and to come back and see him in three months (Dec!) when he’d write an order for another MRI if I wasn’t any better. At seven weeks, I had a physiatrist perform an EMG, which showed no signs of lumbar radiculopathy. The physiatrist suggested that the outer layer of my nerves were likely irritated during surgery and they usually, but not always, get better in time. I am managing symptoms with 400-600 mg. of Advil throughout the day and 200-400 mg. of Neurontin late in the day. I know I can increase dosages of each, but would prefer (like everyone else I’m sure!) to identify and fix the pain generator.
Sorry for the novel length description of my case, but it’s complicated and I would appreciate any comments that might help me stay positive, patient and/or refine my currently uncertain treatment direction. Here are my top concerns / questions:
1. Post-surgery nerve pain: If my nerve pain is similar, but more intense and widespread than before surgery, does that give me a “smoking gun” for the pain source / generator… meaning the surgeon messed around in the right area? Or could it still be coming from somewhere else and surgery + inactivity just aggravated it? I’ve read that most people experience immediate relief to their leg symptoms and increases in pain are uncommon. After eight weeks of little to no improvement, what are my chances of getting better or even back to pre-surgery levels over the next few months? What can I do to maximize my odds for improvement?
2. Piriformis: Before surgery, I had an expensive provocative EMG and Neural MRI scan supporting a Piriformis Syndrome diagnosis. Even though my glute pain has been better since the Botox injection, I still have upper hamstring pain when sitting even for just a few minutes. I stopped going down the piriformis road because it is so controversial and was convinced by my neurosurgeon that the piriformis was unlikely to generate nerve pain into my ankle/foot. The ankle/foot nerve pain developed after the botox injection and one physical therapist suggested the injection could have caused it because my body was protecting itself from more serious extremity nerve damage with the gluteal pain that was numbed / paralyzed by the Botox. Anyway, should I now circle back and consider more piriformis area injections and/or a release surgery?
3. Ankle/Foot as Pain Generator: Since my nerve pain is largely confined to my ankle/foot and does not follow a continuous path down my leg, I consulted with a podiatrist who suggested tarsal tunnel syndrome is a distinct possibility and he could address it surgically. An ankle/foot MRI came back negative, but he still thinks I’m still a good candidate for ankle surgery. I know TTS is rare, but the pain pattern does seem to start in the ankle and spread to the foot and toes... I can't trace it down my leg in a continuous path. Thoughts on TTS diagnosis / surgery?
4. PT: My current physical therapist (referral from neurosurgeon) wants me focused on Mckenzie extensions and sideways nerve glides every 2-4 hours with just walking + stationary bike for exercise. He has banned core strengthening exercises and swimming until my foot pain is “under control.” This contradicts what I’ve heard from other PT’s… thoughts?
5. What would you do if you were me?
Thanks again for any comments you may have to help me and others. Best of luck to others out there going through something similar… we must keep going and persevere!
Any advice given by members is based on personal experiences and is not to be considered medical advice. Recommendations for surgery or treatment should be made in consultation with your medical providers.
August 2014: L4/L5 Laminotomy; L4/L5 + L5/S1 Foraminotomies
Steroid Injections: L4/L5, SI Joint, Piriformis, Ischial Tunnel; Botox Injection: Piriformis