Nerve pain left leg after L5-S1 fusion

[wpfk4life]

I had surgery on my back in 11/2006. For the first year my back was fine not much of problems besides at cold weather time. Now towards winter my back is acting up. I noticed a change. My left nerve in my leg hurts. Starts at the just above my surgery site. If I lift anything it hurts. Bending over hurts. I have pain going down my left leg. I am also getting weakness in my left leg. That is intermittant. I believe it is my siactic nerve that is giving me the problem. I can sit down but I can not straighten my left leg out straight. It hurts from my upper buttocks area down my leg. He has said that the nerve is damaged from the buldging disc there previously. He has no idea when or if it will heal.

I have had cuddle injections (ESI). Is there a difference between a nerve block and this ESI?

I have had a few for the past 2 years. They seem to only work for 2 weeks or less then I am back to the way I was. The last one did not do anything to it. I have a tens unit. Cold compress only works on my back. It is only temp. I work in a sit down job. My back seriously does not like the chairs. You can bounce a coin off of them. And catch it.

I am at a lost. They put me on different meds. Either makes me gain wieght either that it makes me not want to sleep. They just put me on lamectal and over the week. I increased my dosage as per scribed. Then I started to get headaches. The headaches made me feel like I had to vomit which does not help my spasms in my back. That lasted for 2 days. It was not even a migraine. Those are different feelings in my head. I sweat in places I normaly don't.

I honestly feel that my dr has given up and does not know what to do anymore. He is a pain mangement dr. I am seriously thinking about changing drs since I am getting that vibe. I did express myself to him that I am frustrated. I feel like I need to give up. Seems like there is no light at the end of the tunnel for my pain and it may be something I need to deal with the for the rest of my life which is my nerve pain.

I am seriously thinking about getting a second opinon to find out weather if there is something someone can do or something that they might feel that is going to be good alternative. Like I said I am at a lost right now and not sure what I should do.

Thanks,
wpfk4life

[Tom Plamondon PA-C]

Hello,
Thanks for writing in.

You have reported a history of LBP with surgery in 2006. The back has been doing well up until this winter when the sciatic nerve is bothersome. The pain starts in the back and radiates down the leg. Worse with sitting and bending. Pain management has been marginally effective.

I agree that this is sciatic nerve involvement. The question becomes where or how is the sciatic nerve being affected. Therefore an MRI would help reveal any disc bulges or intervertebral foraminal stenosis - both can cause sciatica. If a disc is bulging and pinching the nerve, then injections probably would not help - it really depends on the placement accuracy of the injecting needle.

Once the MRI results come back, then the next decision can be made: conservative treatment vs surgery.

All the best to you. Keep us posted and take care.

[Kim S. RN, COHN]

Hello,
I just wanted to add a few things. You say that the chairs at work are very uncomfortable. There is something you can do about that. According to the law that covers people with disabilities, the ADA, your work place needs to provide you with a comfortable chair. Under the EEOC ADA Title I ACT (1992) an employer who has over 25 employees is covered under the act and they must provide "reasonable accomodation" as long as it causes no undue hardship on the company.
Under the ADA law reasonable accomodation may include "acquisition or modification of equipment or devices". Buying you a chair that is comfortable and ergonomically correct, as in it fits your body and provides support while you work work is not considered an undue hardship. this website has info on the ADA law.
http://www.dol.gov/odep/archives/adahealt/health.htm#general

I agree that you need another MRI as you may have excessive scar tissue that is now causing the same sort of symptoms as a disc herniation. It is not uncommon to have an excess of scar tissue cause compression or pressure on the sciatic nerve. Another test to consider would be a Nerve Conduction Study of your legs which would tell your doctors which of your nerve roots is irritated and causing the flare up on the sciatic nerve.

There are additional treatments available and I would definitely see about another doctor if you are not satisfied that your doctor is trying to solve your problem.

Let me know what your work says when you ask about a new chair. Please let them know that it is an ADA requirement. They are not allowed to retaliate against you in any way for requesting the accomodation of a better chair.

Thanks, Kim

[Tom Plamondon PA-C]

If considering doing an NCV, also do an EMG. This can be arranged through the family physician.

The info from these tests will tell you if the nerve tissue from the back into the legs is doing its job.