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Forum Name: Neurology Topics

Question: Post L5-S1 Laminectomy toes and foot problem


 WThomp - Thu Dec 10, 2009 5:06 pm

I had a Laminectomy at L5-S1 two years ago. Before surgery I was having severe hip, leg and heel pain as might be expected in light of the fact that I later learned that the disk had calcified and the doctor said it was beginning to cause abrazion of the nerve sheath itself. When I woke up from surgery, all pre-surgery pain was gone, but I suddenly had no feeling in most of the right leg from the knee down and about 3/4 of the foot. Within days the toes were on fire and only calmed with ice. That passed, but I still have no feeling in the muscle down the right side of my leg below the knee. The real question I have regards the toes. The three toes furthest from my big toe are a constant problem. They work like a rusty hinge. They and the bottom ball of the foot below them is a constant pain issue, particularly with the middle toe. I am aware of neuropathy and I definitely have that, but this feels different. There is a constant severely agitated nerve between two of the toes. Most of the foot - toe pain is most noticable when there is no pressure added to the foot. I have more pain when at rest, less when I stand on the foot, but it never goes away. The fact that the toes hurt more when I sit or lie down at times makes me wonder if there is some something causing it more than just neuropathy. The surgeon said he had to chip the calcified disk out and manipulate the nerve and that I was lucky I didn't end up with drop foot. He also said I had very little disk left. After several follow-up visits and a myleogram I was given the impression nothing appeared to be still pressing on the nerve and that it was just something I had to live with. Sometimes it is bad enough that I hate my toes. I still use ice to alleviate the toe problem at night. All of this was post-surgery. It doesn't sound normal. Am I missing something or is this a normal thing? Should I see another doctor?
 Dr.M.Aroon kamath - Thu Dec 17, 2009 5:30 am

User avatar Hi,

You seem to be having rather atypical radicular pains along the S1 segmental distribution.

Failed back surgery syndrome (FBSS) is a disabling complication related to the failed herniated lumbar disc surgery (among others). FBSS is not rare, as approximately 3–15% of patients undergoing lumbar spinal surgery for a prolapsed intervertebral disc suffer from recurrent pain.

It is characterized by severe chronic pain, which is generally resistant to pharmacological management & physiotherapy.

FBSS has various causes ranging from anatomical lesions that are demonstrable to psychosocial reasons. The most frequent causes however,are recurrent or residual disc herniation, post-operative epidural fibrosis (EF) and periradicular fibrosis,.
EF occurs in 1–2% after discectomy.

EF is a fibroblastic invasion of the nerve roots and the peridural sac exposed at surgery.
The resulting epidural and periradicular fibrosis, located critically near a lumbar nerve root, may result in dynamic neural tension especially during repeated movements, and lead to a recurrent radiculopathy.

The pain does not always respond satisfactorily to physical therapy, anti-inflammatory drugs, or analgesics.

Caudal epidural steroid injections have been tried.Two weeks later, if patient has significant pain relief from caudal injection, then a caudal epidural steroid injection may be tried.
If patient had no significant pain relief from caudal injections, then a transforaminal epidural injection is another alternative.

In the management of FBSS every patient is different, and a patient’s continued treatment needs to be individualized.Therefore, in your case, you must discuss the management plan with your orthopedic surgeon, which will be the most suited for you.

Best wishes!

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