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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....
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  • 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.
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  • 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 wish you well.
  • 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!

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