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4th day after Foraminotomy on L4-5 and S1

AnonymousUserAAnonymousUser Posts: 49,554
I had a lumbar foraminotomy on Thursday the 9th..The Surgeon said the S1 area was not too bad but L4-5 was way worse than he had expected. He said he could not use the usual "roto-rooter" tool that he normally uses in that area because the nerve was so squeezed in he couldn't get that tool through (what ever that means)...he had to use the smaller instruments he normally uses in cervical foraminotomies to "chip" away at the area.....Anyway, the surgeon said the op. was in his words successful. The first 2 days I felt like I had been run over by a truck...day 3 was a little better, but every so often the sciatic pain would rear its ugly head in the effected leg....is this normal?...can I expect each day to be better?....It's day 4 now, and it seems a little better...I am definitly going to follow the orders and do nothing but rest for 2 weeks...that way if things don't work out right it won't be because I didn't follow doctors orders....The surgeon said it would probably take 3 months to see if this procedure did the job.....any comments would be appreciated.


  • If the foramina at L4-5 were that bad, the nerve would have been badly compressed, so that, in and of itself, is a good reason for the continued sciatic pain. That also means that the surgeon probably had to mess with the nerve more than he would have liked. They try to avoid having to touch the nerve, gently pushing it aside instead. But in your case, he probably didn't have that luxury. If that is the case, the nerve is probably a bit irritated from the surgery itself. These two factors account for any sciatic pain you are now feeling.

    I hope the surgeon also told you that nerves recover VERY slowly...so you will need to be very patient as the nerve heals. Hopefully in time the nerve will regenerate and leave you without pain. In the meantime, just as you said, follow the doctor's instructions and walk as much as you can. If you find it hurts to walk, do it anyway, but shorten your stride and do not walk on an uneven surface. Walk slowly if need be. But walk, as that is the best way to stretch out the nerve. Also it will help to keep scar tissue from developing around the nerve.

    Do not feel discouraged if you are not a little bit better each day. With nerve pain, you will have some good days and some bad days. You will have recovered from the surgery in three months time, but the nerve could take longer than that to get back to normal.

    Remember, you can use ice on your lower back if that helps with the pain. You probably still have some inflammation.

    Good luck and let us know how you are doing!!
  • Hi Gwennie.....Thanks for the words of encouragement..You hit it dead on regarding the nerve being badly compressed and the surgeon having to touch it more than he wanted.....his exact words were "that nerve is very mad at me, and will be for a while". He said he has done many of these procedures (he's the #1 spine surgeon at UCSD in San Diego) and that I'm in his top 5 of all time "clogged up" L4-5 foramina. My sciatic pain started in about 2001, and slowly progressed...I had many epidurals throughout the years, and they worked great. A transforaminal would work (at first)6-8 months (just one shot)..then it went to working a little less, then a little less...etc.(including series of 3 injections) until they no longer worked....So here I am....I will certainly follow your advise....it's exactly what the Doctor instructed also....thanks for your concern......steve (woodysdad)
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  • I think that is an encouraging sign that you had relief from the ESIs prior to your surgery.

    Try not to be discouraged or to let your imagination run wild imagining what else "might" be causing the pain. Chances are very good that it is the nerve and that it will take quite awhile for it to calm down.

    Your surgeon was very honest with you and told you exactly how hard he had to work to free up the nerve.

    I just went back and reread your first post. You are VERY early in your recovery. I would wait until you are further along, maybe about 4 weeks. If you are still in lots of pain, call your surgeon. He may want to put you on a course of oral steroids to try to knock down any remaining inflammation from the surgery.

    I was in a similar situation and had a foraminotomy on Jan. 20th after having had a fusion in Jan of 2008, so I can really relate to your situation.

    Be sure you WALK. Do not worry about distance. It is better to take a shorter walk several times each day. You do not need to walk fast. The idea is to get freshly oxygenated blood to the site and to stretch the nerve without further aggravating it. For this reason you do not want to do more aggressive stretching or exercise. Walking is the perfect exercise. When you get back, you might want to put a little ice on it for awhile. If you don't have one of those gel ice packs, you can use a package of frozen peas or corn. Since you have back problems, you might want to invest in the reusable gel packs -- http://www.colpac-supply.com/ -- or something similar. Ice your lower back for 10 to 15 minutes per hour.

    Do not be discouraged if you are not pain-free in 3 months. If you nerve was as badly squished as your surgeon told you, it may take longer to recover. 3 months is not very long when it comes to a nerve injury.
  • Just to let you know I had a laminectomy/discectomy on 3/2/09, and felt no residual nerve pain for the first 13 days, and then, whammo! It came back. Now I'm just over 6 weeks out, have started P.T. and things are calming down dramatically, much to my great relief. All of Gwennie's advice is always on target. I have to admit that when the nerve first started acting up I was FREAKED OUT! Cried too much, got too scared, looked at too much internet and consequently, got myself into a very worried and anxious state. That was obviously counter-productive to healing well. Once I calmed down, walked as much as possible (crazy weather here!) that damned old sciatica started to feel better. So, if you still feel the twinges, don't worry...its perfectly normal. Good luck! As a former Californian (I wonder if one can really ever be "former"), I wish you very well, indeed.
  • Thank you both for your replies and uplifting comments...It's only day 5 post op. and so far (knock on wood) I think I'm doing really well....So far since I've been home I've had none of the extreme sciatic pain prior to the procedure...Now, my leg has "tingly" feelings which the surgeon says is good news ....I used to have pain (very severe at times) from my hip to my shin area and down into my foot...so far only a "dull" feeling in my shin, but nothing in my hip or foot (except the tingling). As far as walking I'm doing a lot of that...I've got a course in back of my house thats flat...it's a long par 4 (about 400 yds.) I've done it 3 times today and it's only 1:00...I'll do a couple more this afternoon...so far so good....I know I could possibly have a setback but I'll deal with that if it happens....thanks for all the encouragement.
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  • Well its day 8 after the foraminotomy at L4-5 and S1....I feel really good....been taking the Doc's orders very seriously, as I don't want to possibly have problems in the future that could have come from me being too eager to return to normal activities....I've been walking a 400 yrd. course 4 times a day very slowly....so far, no leg pain, and there's no way in hell I could have made these walks without at least moderate pain if not severe pain before this procedure. At times my leg does's "tingle", but the Doc says that's a very good sign that the nerves are regenerating...just once in a while I do have a slight "dull" feeling in my shin....but that seems to be subsiding also...but no more hip or foot pain. At the incision site it feels a little tight, but no big deal....I have not taken one pain med since leaving the hospital....Granted, it's exremely tough to do nothing, but my first post op. appt. is in 6 days, so I will "couch potato" it until then....will post after the pre op appt. to let you all know what the Doc says.....
  • How long did your dr tell you it would take for your nerve regeneration to be complete? My dr wants me to take valium for the pain and i'm hesitant. Any suggestions?
  • Welcome to the board. I would need a few more details to be able to answer your question. Any surgeon will tell you that nerves regenerate at an ungodly slow pace -- no one can give you an accurate statistic, but it is something like 1 to 4 mm per month. Depending on where the nerve is compressed and how far the damage goes, it can take anywhere up to two years to know for sure whether a nerve is going to recover, or not.

    However, if the nerve has not been compressed too long, you can have surgery and feel relief when you wake up from the anesthetic. Some people awake from a discectomy to find their sciatic pain is completely gone.

    I have never been that lucky.

    Why are you hesitant to follow your surgeon's instructions? Your healing will be slower if you are in more pain. If the valium lessens your pain, there is no harm in taking it for awhile.

    Please post more with your comments and questions. This board is full of wonderfully knowledgeable and supportive people.

    Be well.

    xx Gwennie
  • Well I'm almost a month (2 more days) post op. from my procedure....I've had a few set-backs along the way, but now If I could stay as is I would be happy....I can actually feel the nerves regenerating....feels like 1000 needles "tingling" in my leg...but the tingle does not hurt..As far as how long does it take the nerves to regenerate, it's probably different for each person....My surgeon said probably 3 months to a year.
    Take Gwennies advice....If you hurt, you will heal faster if you're not in pain.....And when you start feeling better still take it easy...that's what I've been doing and it looks like it's paying off.
  • That's great news. I'm so glad to hear you are starting to feel better. Continue to listen to your body and do not push it. I really think that is a big part of a successful recovery. But, on the other hand, keep walking. Even when you feel you can do more, walking remains the best form of exercise for your recovery. You hopefully will just continue to feel better and better.
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