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Normal Delivery, Foot Drop Condition,. Done Lumbar MRI. Is It Normal, How Long Will It Take To Heal?
Question: Hi, I recently had a baby, XXXXXXX 5th 2012, a csection had been scheduled later that day as my previous baby had to be delivered csection for failure to descend, however the baby came early that morning, and i delivered him vaginally.it was not a long labor, 2 hours at most. i pushed while on my back, and did have my legs in stirrups, not sure how long. After the anesthesia/epidural wore off, I no longer could lift my foot, foot drop. I was seen by a neurologist and physical therapist while still at the hospital, both stated my prognosis was good, nuerologist suspected it was "sciatic nerve compression" and asked to see me in 4 weeks for follow up. since then I have had an MRI/lumbar without contrast completed, the findings which I am inquiring about are the following:
L4-5: Normal sagittal plane alignment with 2.5mm AP dimension broad based disc herniation. More focal left posterolateral disc herniation of 3 mm in AP dimension with abutment of the extraforaminal left L4 nerve root. No significant foraminal stenosis. Small bilateral facet joint effusions.
L5-S1: Normal sagittal alignment. 2.5 mm in AP dimension broad based disc bulge with abutment of the S1 nerve roots in the lateral recesses. No significant foraminal stenosis. No abnormalities identified along the course lumbosacral plexus on the sagittal images.
I have seen improvement in the use of my leg since I left the hospital. The numbness has decreased somewhat, I can lift my toes, point my toes down, outward, and slightly inward. I can bear weight on the ankle, climb stairs. From what I recall, all of my toes were numb while at the hospital, as of today, only 3 are. Please tell me that this condition will go away on its own. Im really nervous, and I wont see the orthopedic for followup for another couple of weeks.
L4-5: Normal sagittal plane alignment with 2.5mm AP dimension broad based disc herniation. More focal left posterolateral disc herniation of 3 mm in AP dimension with abutment of the extraforaminal left L4 nerve root. No significant foraminal stenosis. Small bilateral facet joint effusions.
L5-S1: Normal sagittal alignment. 2.5 mm in AP dimension broad based disc bulge with abutment of the S1 nerve roots in the lateral recesses. No significant foraminal stenosis. No abnormalities identified along the course lumbosacral plexus on the sagittal images.
I have seen improvement in the use of my leg since I left the hospital. The numbness has decreased somewhat, I can lift my toes, point my toes down, outward, and slightly inward. I can bear weight on the ankle, climb stairs. From what I recall, all of my toes were numb while at the hospital, as of today, only 3 are. Please tell me that this condition will go away on its own. Im really nervous, and I wont see the orthopedic for followup for another couple of weeks.
Hi XXXXXXX
First of all,I congratulate you for having normal vaginal delivery despite first Caesarian section.
This is a case of Foot Drop due to having legs in stirrups in same position for a long time and due to presence of local disc bulge in your spine.
Your spine has got definite disc prolapse that must have been there without symptoms for quite sometime and was just abotting the sciatic nerve roots
but did not actually compress them so no symptoms, when you were put in Lithotomy position the bulge compressed the nerve root due to the stretch and resulted in weakness.
You could not feel pain because you had received Epidural analgesia by then.
This injury is produced by subminimal pressure is called neurapraxia, it is mostly self limitting and you should recover fully by two-three months.
Your Neurologist is right, you will have excellent prognosis, but I think you will
need decompression and stabilisation surgery in long run.
Meanwhile have regular mobility, walking with support and limb physiotherapy.
I think that answered your query.
First of all,I congratulate you for having normal vaginal delivery despite first Caesarian section.
This is a case of Foot Drop due to having legs in stirrups in same position for a long time and due to presence of local disc bulge in your spine.
Your spine has got definite disc prolapse that must have been there without symptoms for quite sometime and was just abotting the sciatic nerve roots
but did not actually compress them so no symptoms, when you were put in Lithotomy position the bulge compressed the nerve root due to the stretch and resulted in weakness.
You could not feel pain because you had received Epidural analgesia by then.
This injury is produced by subminimal pressure is called neurapraxia, it is mostly self limitting and you should recover fully by two-three months.
Your Neurologist is right, you will have excellent prognosis, but I think you will
need decompression and stabilisation surgery in long run.
Meanwhile have regular mobility, walking with support and limb physiotherapy.
I think that answered your query.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply Dr. Choudhary. If i may ask a follow up question. Above you mentioned "but I think you will need decompression and stabilisation surgery in long run". Are you referring to decompression and stabilization of my back? Also, the numbness runs down the outer side of my calf and over my toes, the big toe is especially numb. Will the numbness continue till the very end? I'm very anxious to return to daily activities. Thank you again. Mariana-Texas
Hi XXXXXXX
I did not mean that you will not recover,
I have every hope that you will recover to achieve your previous level of health. Since you have pre-existing disease of the disc which over the time tends to deteriorate and need surgical correction.
The decompression surgery is done only at the back where nerves emerge from vertebral spaces and not the leg.
I hope that clears your doubts.
Regards
I did not mean that you will not recover,
I have every hope that you will recover to achieve your previous level of health. Since you have pre-existing disease of the disc which over the time tends to deteriorate and need surgical correction.
The decompression surgery is done only at the back where nerves emerge from vertebral spaces and not the leg.
I hope that clears your doubts.
Regards
Above answer was peer-reviewed by :
Dr. Aparna Kohli
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