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Hello, I had a microdiscectomy on 6/28 at the L5/S1 level. I had a dural leak and had to lay flat for 24 hours post op. Immediately after surgery I had burning and stabbing pain down my right leg mostly on the lateral portion of my right calf, my 4th and 5th toes and the lateral part of my right foot. The pain was so intense I was put on a hydromorphone PCA pump and kept in the hospital for a day longer than expected. After discharge the pain in the leg improved slightly but is still intense. my back pain is, I think, as it is expected to be; Soreness around the incision with muscle pain with position change. Incisional pain.. My question is, how long is this pain in my leg supposed to last and is there a high risk of permanent nerve damage. I am taking gabapentin 300 TID, Percocet 2 tabs Q4 (basically around the clock), Robaxin 500mg Q8 and ibuprofen 800 Q4 opposite of the Percocet. I have tried to decrease teh amount of medication that i'm taking but the pain is too intense. I have been in pain before, and i am no baby. This is excruciating 10/10 pain in my back/right calf/foot. I don't know what to do. I am an RN that works in a very busy ICU and this injury has kept me from work and if my leg stays this way i fear i will never be able to do it again. Prior to surgery I had significant back pain, right buttock and shooting pains down my right leg with weakness due to the herniated disc and nerve impingement.
I see you posted this to neurology... I think i can help... if you would prefer to wait for a neurologist I can opt out though I am not sure we have any online at the moment.
so the pain you are having is concerning for two things....
and especially with the dural leak
there is a concern that while the surgery removed the impinging disc that you could have something that mimicks the previous problem, perhaps an epidural hematoma at the op site.
The pain you describe is radicular for the most part and in the same distribution as an L5/S1 lesion
I think you need an MRI and that you need it now
I believe you when you say that you are no baby and I know with your RN background you understand that you are on a pretty good pain regimen and had to be on a dilaudid PCA
I myself have had a microdiscetomy at the same level and I walked out of the hospital with no pain. Your pain is not typical for someone s/p microdisc.
I fail to see how a dural leak would cause this type of pain given it's radicular distribution.
I would, if I were you, call your surgeon and tell him/her that you are having a rough go of it and that you have pain in the exact area you described and that it is not getting bettter. I would ask about the possibility of an epidural hematoma.
If you develop problems with urination or defecation then this becomes an emergency as this could indicate an expanding lumbar epidural hematoma, just so you know.
The second thing, though less likely given the pain distribution is to consider the possibility of DVT.
It would not explain all your pain
but should be considered nonetheless as you are in the window and at risk s/p this surgical procedure.
As to permanent damage to the nerve no, I do not believe that is a problem right now.
Let's say you do have an epidural hematoma at the op site
There is an urgency to correct this but it is not an emergency
You would need to let this go for weeks to months with the current symptomatology to suffer permanent damage
Nevertheless, I DO think you need to get in touch with your surgeon today, and, I know it's a holiday weekend, please do not minimize your symptoms.
HERE IS A CASE REPORT FOR YOU OF SOMEONE IN A SIMILAR SITUATION
So again, this is an urgent issue and I think treating the pain only right now is the wrong answer.
You need that MRI
and it might be reasonable to get it not only of the lumbar spine but of the deep pelvic veins to as DVT in those areas does not show easily on US, but an US of the leg might be reasonable as well.
This amount of pain, particularly in this anatomical distribution means to me that there is a problem, and we need to take post op epidural hematoma off the list.
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Thank you so much for your detailed answer, that really means a lot to me. I have a call out to my neurosurgeon now.
The scenario you described with 'walked out with no pain' was what i had anticipated and i was sure would be me as well. After everything I think that maybe I shouldn't have had the surgery but i really couldn't function prior. I suppose its a double edged sword.
Thank you very much.
you are most welcome.
Please do let me know how this turns out.