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911Doc
911Doc, MD
Category: Neurology
Satisfied Customers: 5094
Experience:  I am an expert at neurologic emergencies.
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Hello,I had a microdiscectomy on 6/28 at the L5/S1 level.

Customer Question

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.

Submitted: 1 year ago.
Category: Neurology
Expert:  911Doc replied 1 year ago.

911DOC :

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.

911DOC :

so the pain you are having is concerning for two things....

911DOC :

first,

911DOC :

and especially with the dural leak

911DOC :

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.

911DOC :

The pain you describe is radicular for the most part and in the same distribution as an L5/S1 lesion

911DOC :

I think you need an MRI and that you need it now

911DOC :

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

911DOC :

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.

911DOC :

I fail to see how a dural leak would cause this type of pain given it's radicular distribution.

911DOC :

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.

911DOC :

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.

911DOC :

The second thing, though less likely given the pain distribution is to consider the possibility of DVT.

911DOC :

It would not explain all your pain

911DOC :

but should be considered nonetheless as you are in the window and at risk s/p this surgical procedure.

911DOC :

As to permanent damage to the nerve no, I do not believe that is a problem right now.

911DOC :

Let's say you do have an epidural hematoma at the op site

911DOC :

There is an urgency to correct this but it is not an emergency

911DOC :

You would need to let this go for weeks to months with the current symptomatology to suffer permanent damage

911DOC :

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.

911DOC :

So again, this is an urgent issue and I think treating the pain only right now is the wrong answer.

911DOC :

You need that MRI

911DOC :

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.

911DOC :

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.

911DOC :

I do not see you in the chat. I am going to switch to the Q and A format to facilitate this discussion. If your question has been adequately answered I do so appreciate positive feedback. If you have further questions or desire clarification simply type your response in the box below and click ‘reply’ and I will be back with you as soon as I can.


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Thank you

911Doc, MD
Category: Neurology
Satisfied Customers: 5094
Experience: I am an expert at neurologic emergencies.
911Doc and other Neurology Specialists are ready to help you
Customer: replied 1 year ago.

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.


 


Christina


 


 

Expert:  911Doc replied 1 year ago.

you are most welcome.

 

Please do let me know how this turns out.

 

best

911doc

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I am an expert at neurologic emergencies.