What Could Be Causing Back Pain, Leg Pain And Gait Problems?

My Mri Report: Lordosis abnormal lumbar may be due to spasm L4-L5 minor para central disc herniation indenting the theca. L5-S1 Left paracentral disc herniation with annual tear narrowing the lateral recess and left neura foramen causing impingement of the left S1 nerve root. There is further scarring and granulation tissue inflammatory changes of the sit of surgery but no obvious abscess. Surgery done on 16/10/14, MRI with contrast (Jan 2015) Recent surgery has been performed that is discectomy at L5-S1 level Laminectomy. Signal abnormality and enhancement along the surgical tract and enhancement adjacent to the S1 nerve root. Granulation tissue. Central buldge of the L4L5 disc. My surgeon says ankle is weak. My physiotherapist and pain management dr says I have foot drop. From what I know i should not have footdrop for my case. Nerve test and NCV says normal. I am currently having leg pulling sensation at my left leg all the way all my five toes. My both sides of my left ankle are tight.. I am not sure what gait I am having. Are those discomfort cause by granulation tissue and what is granulation? Are granulation tissue same as scar tissue. first symptoms started in June 14. But my question are base of my current symptoms and what causes it since I have 2 surgery done. The last surgery 4 months ago.
  • Posted By:
  • 'Kar Mun Chan' on
  • 02/12/2015
  • 1675
  • 1 Answer

Answered By:

  • Pramod Kerkar, MD, FFARCSI, DA
  • Pramod Kerkar, MD, FFARCSI, DA

Thanks for detailed presentation of MRI report, EMG and NCV test results. It seems your symptoms are caused by failed back syndrome. I am not sure about signs of foot drop. Foot drop causes atrophy of foot muscles. The foot drop will cause thinning of left foot as well as inward bend of toes and foot towards ground. The history and MRI findings suggest you have S1 radiculopathy. The S1 nerve is irritated or pinched by scar tissue. Radiculopathy are the group of symptoms like pain, tingling, numbness and weakness. Laminectomy surgery creates large space for nerve so nerve is not irritated or pinched. Patient's symptoms are substantially reduced after laminectomy in most cases. There are few unfortunate individuals who may suffer with pain after surgery because of scar tissue pressing on nerve. The surgical wound heals with scar tissue, though few individuals develop higher volume of scar tissue that occupies larger space around the nerve. The scar tissue then causes pressure on nerve resulting in pain, numbness and weakness. Weakness is temporary in most cases and gets better once pressure is removed. If pressure on nerve continues then nerve damage become permanent and then numbness and weakness become permanent. Weakness results in foot drop.

You should consult Interventional Pain Specialist with several years experience. You should consider series of trans-foraminal epidural injection, which is performed under X-Ray image. You should avoid spinal fusion surgery until you try 3 to 5 cortisone injection and 6 to 8 weeks of physical therapy. You should avoid opioids. Opioids are excellent pain medications but also causes dependence and addiction.

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