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Dr. Andrew Rynne

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Exp 50 years

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Hi my husband had pain down his leg to his

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Dr. Mahboob Ur Rahman

General & Family Physician

Practicing since :2012

Answered : 2267 Questions

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Posted on Sat, 9 Feb 2019 in Bones, Muscles and Joints
Question: Hi my husband had pain down his leg to his foot an the right side and sometimes the left. got referred to orthopedic surgery center..MRI results as follows..L1-L2 circumferential disc bulge no high grade spinal canal stenosis no high grade foraminal stenosis
L2-L3 circumferential disc bulge. no high grade spinal canal stenosis no high grade foraminal stenosis
L3-L4 mild circumferential disc bulge no high grade spinal canal stenosis no more than mild foraminal narrowing bilaterally
L4-L5 There is a broad based posterior disc-protrusion with some disc material extending caudally in the right lateral recess posterior to the L5 vertebral body no severe spinal canal stenosis there is lateral recess narrowing bilaterally
L5-S1 minimal grade 1 anterolisthesis of L5 on S1. The disc is uncovered and mildly bulging. no high grade spinal canal stenosis. no more than mild foraminal narrowing bilaterally
The si joints are unremarkable

What does this mean ? He had steroid injections which did nothing he had physical therapy no change he had a disc discectomy on L4-L5 and from the time he got out of surgery his pain has been worse and now his hip hurts and his leg hurts and some numbness in leg...his doctor says that he will need to burn the nerve in his back ? why is the pain worse now than it was before ?
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Answered by Dr. Mahboob Ur Rahman 2 hours later
Brief Answer:
Please see detailed answer.

Detailed Answer:
Hi and Welcome to Ask a Doctor service. I have read your question and here is my advice.
I feel really sorry for all the sufferings he has been through lately.
His clinical history and MRI are quite consistent with prolapse disc in the spine which press in nerves in the spine and hence causing pain down. Its quite common problem, most people are fine after physiotherapy. However surgery may be necessary in few cases.
It's unfortunate that drugs and physiotherapy, and even steroids Inj did not work for him. In such cases surgory is needed. In this surgical process the pressure is removed from the nerve. Hence many people feel good after surgory. However it's not rare that pain may persist after the surgory and sometimes even increase. There are many reasons for why the pain may persist. Following are few.
1. Failed back syndrome. This is that the pain is not healed after surgery, it does not mean that the surgery was not successful but even after the targeted aim is achieved, the pain continues. It's not rare after back surgory. Reasons are that the pain might have multiple reasons or other reason than which was corrected.
2. Re_stonosis. Sometimes disc prolapse reoccur.
3.failed surgory, ie unable to relieve the nerve.
4. Complications of surgory like edema, infections, or nerve damage which are not common.

So there are few reasons for the failure of surgory to heal the pain. Workup is needed following surgory to know as what might be causing the pain. We follow with MRI and blood works to see the cause.
Many medicines can be used for pain relief, but radio-frequency ablation (burning out the nerve with heat wawes) may be done for long lasting pain relief if other fails.This is done if there is no weakness from nerve.
I wish him best luck. Many people do better at the end.

Hope I have answered your query. Please feel free to ask if you have any further questions or concerns. I will be glad to answer your questions.
Kind Regards
Dr Mahboob Ur Rahman.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Follow up: Dr. Mahboob Ur Rahman 18 hours later
my husband does not want to have the nerve burning. is there any other options ? medications ect… his doctor will not prescribe any pain medications ….I don't know why
and why will no other doctor see him until 1 year after his discectomy not even for a second opinion ...very frustrated and cant stand to see him in so much pain all the time..

how do you get to see a pain management doctor ? can you just make a appt or do you need a referral ?

My husband has a very high tolerance for pain but this pain ruins his quality of life..
doctor
Answered by Dr. Mahboob Ur Rahman 3 hours later
Brief Answer:
Please see detailed answer

Detailed Answer:
Hi, thanks for writing back to us.
I really feel sorry for him and can understand the severity of pain and his discomfort.
Regarding the management, you have definitely the right of having the choice not to go for nerve burning or any treatment option. And yes many people may not like this treatment.
Similarly you have definitely a right to get another opinion.

There are a number of other possible options for the pain. Physiotherapy, cold /heat compression and a number of pain killers can help the pain.
Pain management is necessary, and he may even be prescribed opiod painkillers, or gabapentin that work well in such type of pains.
The decision of not getting the nerve burn should be discussed with the doctor who would tell you the need of it, he will explain the advantage and the risks, after that you may better decide.
If he is in pain, I would suggest he can at the moment, go to the ER, or his GP who would assess him, and would prescribe drugs for his pain accordingly . He may also arrange an appointment with your doctor.
Hope it help you understand your problem. Please feel free to ask any further question.
Good luck.

Above answer was peer-reviewed by : Dr. Nagamani Ng
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