advertisement
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.

This includes any analysis, interpretation, or advice based on any diagnostic test

See the Veritas Health sites: Spine-health.com, Arthritis-health.com, Sports-health.com, Pain-health.com for medical articles and videos.
advertisement

Micro-laminotomy and discectomy for L4 root decompression.

Hi!  I'm a 56 year old
guy.  I had a micro-laminotomy and
discectomy at L3-L4 last Thursday, January 3rd, 2019.

In 2016 after a number of pinched nerve events in my neck, I
had an MRI and was diagnosed with "Severe multilevel degenerative disease
and stenosis including complete effacement of the subarachnoid space at
C3-C4,C4-C5 and with disc causing focal anterior cord compression at C5-C6, and
to the left borderline cord compression at C6-C7." I chose to treat this
with a program of active denial.  I started
working out -- a lot.  I also changed my
diet, quit smoking, addressed some other health concerns and basically became a
fitness nut who tracks his heart rate and weighs all his food, etc..

I've had nagging back issues most of my life, all of which have
been treatable with chiropractic, stretching, etc., until now.  In 2017 I suffered a weight lifting injury
that never really recovered, and throughout 2018 I had some numbness and
tingling over most of my left leg, and some radiating sciatica pain on my right
side radiating from my right buttock to the outer hip down to the inside of the
knee and lower leg.  The sciatica was
intermittent and usually only after standing still for too long.  I had already stopped doing anything that put
heavy compressive load on my spine such as squats, deadlifts, and leg presses,
but I was otherwise able to walk, travel, exercise, etc.. As 2018 wore on, the
symptoms started to get a bit worse, with the numbness working its way up my
left leg, presenting some numbness in the "saddle" region, which was
concerning.  I had an MRI which showed in
part:

"At L3-L4, there is a large diffuse disc bulge
extending both posteriorly and laterally impinging on the ventral aspect of the
thecal sac and the bilateral L3 and L4 nerve roots. There is severe spinal
canal narrowing. There is severe bilateral neuroforaminal narrowing at this
level. There is impingement of nerve roots within the thecal sac. 

At L4-L5, there is diffuse posterior disc bulge impinging on
the ventral aspect of the thecal sac causing severe spinal canal narrowing. The
disc bulge displaces the bilateral L4 nerve roots in the neuroforamen. There is
severe bilateral neuroforaminal narrowing at this level."

During the MRI I was in a position that wasn't too bad when
it started, but grew more and more painful, and aggravated my sciatica
significantly.  After the MRI, I was fine
sitting in a recliner or at my desk, but I would get the radiating pain
whenever I would stand, walk, or lie flat. 
Within a few minutes I'd get the numbness and heat sensations shooting
around my right leg, and a significant limp until I could sit down.

I saw a pain management doc who put me on Gabopentin, and
did two epidural steroid injections, none of which had any noticeable benefit.

I saw the surgeon on Dec 26th, and she recommended a very
conservative minimalist approach -- A micro-laminotomy and discectomy to
decompress the L4 nerve root on the right side. 
The goal was to relieve only the right-side radiculopathy that she was
confident was coming from the L4 nerve root, with as little impact and recovery
time as possible, removing only a small portion of the lamina and leaving the
spinous process, facet, and as many ligaments as possible intact.  The surgery was scheduled for January 21st.
but moved up to January 3rd due to a cancellation.

After the surgery, when I woke up in the recovery room, I didn't
immediately realize that I had actually had the surgery until I reached around
and felt the bandage.  I wasn't in any
pain and the surgery site was only barely tender.  When I stood up and walked for the first
time, I didn't feel any sciatica pain at all.

Sleeping the night of surgery was pretty good.  The sciatica pain had subsided a bit in the
evening, and this persisted the next morning. 
In the hospital, my surgeon had chuckled at the suggestion that I might
work the next day, but I felt pretty good in the morning, so I was at my desk
pretty close to the normal time. My incision was more tender, but there was
still very little pain.

Friday there was still a good bit of sciatica pain and
numbness when standing and walking, and my understanding is that I'm not
supposed to walk or exercise while experiencing the sciatica pain, etc.

Saturday was the 2nd day after surgery, and the incision was
very tender.  For the first time I had to
be careful and get into and out of chairs very gingerly.  This was the first time it felt like I had
"real" surgery.  By Saturday
afternoon, the sciatica symptoms were much improved, so I went to the gym.  A PA in my surgeon's office had given me
approval to use an elliptical or recumbent bike in addition to walking.  It felt great to be out and about and in the
gym, especially two days after surgery! 
I did a leisurely 5 miles on the recumbent bike, and after a brief rest,
another mile and a half or so on the AMT elliptical. 

Sunday, day 3, I woke up less sore, but somewhat stiff.  Sciatica symptoms seemed about the same as
the day before.  Went to the gym again in
the afternoon and did another similar 5 miles on the bike.  The sciatica was a bit worse, so I didn't do
the elliptical.  Surgical site
significantly less sore and tender.  I
got into and out of cars and chairs much more normally.  Both Saturday and Sunday nights, there was no
noticeable sciatica pain while sleeping.

Monday, day 4, I was very stiff in the morning, and the
sciatica pain had got worse as well. 
Sciatica pain remained throughout the day, so no exercise other than
walking around the house.

Tuesday, day 5. Less stiff in the morning, bit no
improvement in the sciatica, which now seemed exactly the same as before
surgery.  I attempted to get a massage in
the evening, but I was unable to get comfortable on the table due to the
sciatica pain on either my back or stomach.

Wednesday, day 6, and now today, Thursday, day 7, there is
no change.  Except for the bandaged
slightly sore area on my back, nothing feels any different than before surgery.

I was very concerned the night of surgery, then encouraged
by the reduction in symptoms on Saturday and Sunday, and now very concerned
again.  I realize I may have overdone it
at the gym, but it didn't feel like it, and it seems the pain and effort others
have gone through during recovery were far more stressful than my fairly easy
time on the bike and the elliptical.

Is it not expected for there to be improvement in symptoms
from nerve compression pretty quickly? 
Or is it unreasonable for me to be concerned about the lack of
improvement at this stage? 

I do realize that my experience with surgery and recovery so
far has been embarrassingly easy when compared to many.  And, aside from my concerns about whether or
not the surgery was successful, I've been extremely fortunate. 

Since I still have 1 2/3 or so severely bulging discs, it
seems physical therapy might be a good idea. If so, How soon should that start ideally?

With bulging vs herniated discs, is root decompression more
common at the upper or lower level? 
Would an L4 root decompression be more commonly done at L3-L4 or
L4-L5? 

Since a nerve root traverses one level before exiting at the
next level, is there a good way to determine which area of compression is
causing the symptoms?

Thank you,

--Bill

advertisement

Comments

  • challengercchallenger Posts: 1,236
    edited 07/10/2019 - 3:40 PM

    Bill- I have had several surgeries and after all of them was only allowed walking for exercise, driving only allowed after 2-4 weeks, no sitting for longer than 20 minutes for 4 weeks. The surgery you had may have been conservative but it was still spine surgery that requires recovery. Good luck and feel better soon 

    challenger
    Veritas-Health Moderator


  • wmmbwwmmb Posts: 2
    edited 01/13/2019 - 2:48 PM

    @challenger, thanks for the input.

    I haven't been using ice much because there is not a great deal of pain or swelling, but I'm planning to start icing more to see if it can help reduce symptoms in general. 

    I've seen very little change over the last several days.

    I'm holding out hope because I did see some improvement a week ago, but I'd sure like to see some change in my underlying symptoms -- like being able to walk for more than a minute or two without the radiating pain.

    I'd love to understand the underlying mechanisms considerably better.

    Again, I don't think nerve healing is a factor here because the nerve seems fine.  There are no symptoms when my spine is flexed.  When it is extended -- instant symptoms, like pressing a button or turning on a light.  So this indicates to me that it doesn't need to heal, it just needs to sop being pinched when I stand up.  Is there anything wrong with this logic?  Is there some other mechanism by which symptoms can be caused only in certain positions?

    It was determined that my symptoms were almost certainly coming from L4 root compression, and the surgery decompressed the L4 root as it traverses the L3-L4 disk.  The L4 nerve root is is also compressed by the L4-L5 disk.  Is it likely that the surgery to L3-L4 exacerbated the L4 root compression at L4-L5 making that temporarily symptomatic?

    I'd love to know more about the experiences of others who have had laminotomies and/or discectomies with respect to their primary symptoms and how long it took for them to be able to walk, see improvement, etc..


  • advertisement
  • challengercchallenger Posts: 1,236
    edited 07/10/2019 - 3:41 PM

    Bill- Nerves can be crazy to predict, I had laminectomy on T12-L1 in Feb. I woke up in worse pain than before surgery because nerves had been compressed and are now waking up, I am now 7 weeks out of surgery and things are finally starting to calm down, anytime nerves are compressed and then decompressed they can act weird, my case is I could lay down and be fine, walking and standing were extremely painful, it takes time and nobody can tell you how long. Most of the questions that you are asking can only be answered by your surgeon and I would suggest talking to them as soon as possible, since you were fine and now your not, better safe than sorry. Good luck and hope you feel better soon 

    challenger
    Veritas-Health Moderator


Sign In or Join Us to comment.