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Numbness, no pain, L4/L5 nerve root compression

First post, don't know my way around the forum well enough to do a proper search, so any links to other discussion are most welcome. About 4 months ago I blew my L4/L5 disc while crouching (not bending down, but crouching) to pick something up. The pain was excruciating, and I felt the tingling/burning shoot down my left leg into my foot instantly. From there the pain was low level when standing, horrible when sitting, moderate when lying down. That lasted for a couple weeks, then I went off all the pain meds because the pain was gone. The numbness in the outer calf and ankle and top of the foot did not go away, however, so I'm quite weak on the left side. I do not have pain when sitting or standing, and I can do pretty much anything that a 70yo needs to do day-to-day. But I'm 40 with two young kids, I have a very active lifestyle, and I actually enjoy certain types of outdoor exercise. So there are a lot of things I want to keep doing for a few more decades. 

I had the MRI about 4 weeks after the injury, and the image is very clear - "large paracentral disc extrusion measuring 23 x 11 mm compresses the descending L5 nerve root." The Ortho team took one look at the MRI and said let's get you a discectomy. The system being what it is, they figured it would take about three months to get me onto the books. Meanwhile, I've been seeing a physiotherapy team regularly, a chiropractor and an osteopath (don't judge me here, I'm doing whatever I can to avoid surgery! ;) My strength has improved considerably on the left side, I can now go up on my toes most of the way (not all the way), and I've been doing barefoot jogging in grass without incident for the past few weeks, a bit at a time. The numbness has not gone away at all. And I also cannot lift my toes against any pressure (with the foot planted flat on the floor, I cannot raise my toes more than a few mm off the floor, the toes of the other foot come up maybe 60º by comparison). I can flex the ankle up, but the toes won't come. They can resist barely any pressure. I'm finally on the docket for surgery on Halloween, L4/L5 discectomy, and I'm going in to see the surgeon very soon for a last "do I really really need this" pep talk. 

I realize a lot of people on here have real, serious pain and misery, and I'm complaining about numb toes and foot with a fair bit of weakness, but I'd love to know of any experiences where people have had numbness with no pain and they have decided to either 1) go conservative and wait more than 4 months and see how things develop or 2) go with the discectomy and hope for 100% recovery. I've had my share of major and minor operations (this is relatively minor, based on my past experience), and I know what can go wrong and really wrong and so on, so no need to tell me stories about doctors accidentally installing evil robotic implants into spines or anything like that. But personal experiences of progress or otherwise with and without surgery would be most welcome. And as I said at the outset, any internal forum links to relevant discussion would also be most welcome. Thanks for anything and everything!

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Comments

  • Welcome dosland we’re glad you’re here!

    While you’re waiting for a reply to your first post, please take a few moments to review the Code of Conduct and FAQ section, located under Forum Tools. There you will find important information about posting in the forum and helpful tips for new members.

    Have you visited the Neck and Back Surgery Health Center on Spine-health? It has a number of comprehensive neck and back surgery articles, including a Back and Neck Surgery OverviewHow to Prepare Psychologically for Back Surgery, and Rehabilitation After Spine Surgery. I hope you find these resources helpful.

    Numbness and weakness are the 2 thing's that usually get a surgeons attention, my surgeon does not worry too much about pain but he does about numbness and weakness, the longer nerves stay compressed the longer the healing time, you also have the chance of permanent nerve damage if the compression is not taken care of. I have had several spinal surgeries, I am one of the lucky one's because all of them have helped, some more than others, but all have helped.

    Again, welcome to the Veritas Health Forum.

    Chip 

    Veritas Health Forum Moderator

  • Thanks, Chip, I've been quite surprised by how little information I can collect through even things like medscape on numbness/weakness with lumber disc issues - everything deals with the much more common symptom of horrible pain, which I no longer have (and I'm one of the lucky ones, because those few weeks of pain that I had were simply intolerable).

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  • I waited too long after my first injury, I had numbness and weakness in my right foot and calf, that was 32 years ago, surgery fixed most of it but I still have numb spots on my right foot, luckily the weakness was fixed but it took several months of PT to get my strength back in that leg. I don't want you to think that I am trying to talk you into surgery, because I am not, just wanted you yo know my story.

    Here's a couple of links that may be helpful

    Lumbar Decompression Back Surgery Considerations

    40 questions to ask your surgeon

    Take care and keep us posted

    Chip

  • I got to ask the surgeon most of my questions today, some of the answers were about what I expected. Still hoping I get a sudden onset of feeling over the next few days, but I feel pretty comfortable with the surgeon who does about 95 of these discectomies a year, on top of the much more serious scoliosis jobs and all the rest of it! Guess now I just have to figure out how to avoid a hematoma...no exercises for that one.

  • I have had 4 discetomies, all went fine with no real problems, I am hoping the same for you.

    When you get your surgery date, be sure to join surgery buddies for that month, you can find it at the right of your screen on the forum home page.

    Take care and keep us posted

    Chip

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  • Four discectomies?! Good grief! How long did you wait for the first one? There's so little information in the medical research around numbness/weakness (as opposed to pain) that I really can't get any solid information about what may or may not work for me - or safe/realistic timelines. I'd probably have to wait a full year if I put this one off past mid-November for a while host of reasons outside my control.

  • I waited a little over a year the first time, that was 33 years ago, at that time there were no MRI's at least in my area, doctor kept doing ct scans which didn't show the problem, finally had a Myelogram which showed a ruptured disc, surgery was 2 weeks later.

    I was an auto mechanic, dummy me kept going back to the same job, doing the same thing's, I was also born with an extremely small spinal canal, it doesn't take much of a bulge or herniation to cause nerve contact because of the spinal canal.

    I did get most of the feeling back, it took time though, I have numb spots on the outside of my right foot and my little toe is numb, you do get used to it over time.

    Take care and keep us posted

    Chip

  • Just to complicate things a bit further for me, the slump test has stopped coming up obviously positive - now both legs feel about the same, and the tension isn't obviously transferred below the knee on either side. All that 'flossing' seems to have helped. But if there's no other obvious test to see whether the nerve is still compressed, what's the discectomy supposed to do? I'm starting to think it would be easier to decide what to do if I had more serious symptoms! What a dumb thing.

  • Numbness/tingling has always meant nerve compression for me, I almost called my last surgery off, 2 weeks before the surgery I started feeling pretty good, talked to the doctor who said this will not get better on it's own, he was right, 2 days before surgery I could hardly walk.

    The decision to have or not to have surgery is very personal, doubts are expected, for me, I make the decision and stick to it, according to the doctor I need another surgery now, I have chosen to hold off for the time being, I do not have any numbness or tingling, just pain that is somewhat controlled.

    Take care and keep us posted

    Chip

  • Just a little update: I had my discectomy about five hours ago, and I'm coasting along pretty well on some low level pain meds. Procedure went fine according to the surgeon. I managed to get up to the bathroom already, and did a bit of walking in the hallway, but pretty lightheaded. Don't notice any obvious difference in numbness/weakness, but nothing is worse either. Glad I had so much advice around patience and patience and more patience, with a healthy dose of taking it light and easy! Thanks to the forum for the advice and support

  • Glad everything went well, you may have already read this, if not here's with some very good information.

    Practical Advice for Recovering from Back Surgery

    Take care and keep us posted

    Chip

  • doslandddosland Posts: 42
    edited 10/31/2019 - 3:54 AM

    Funny I just reread that one to remind myself about the sleep setup - nearing 11pm on the 31st here in New Zealand and my mind is finally letting me settle enough to try to sleep. Thank you, again, for all the support.

  • Glad it helped, patience is the key to a successful recovery, in my opinion it's the hardest part.

    Take care and keep us posted

    Chip   

  • Just spoke with my surgeon, he said they did have to pull out a pretty big bit of protruding disc, and it was harder material than expected so almost impossible for it to have receded or be resorbed on its own. He said the disc material overall is still "juicy" so pretty healthy and likely to recover really well now that it has a chance to close up and heal. A bit of a relief knowing it was unlikely to resolve without surgery, given how unsettled I was going into that decision.

  • Back home after surgery to decompress the l5 nerve (l4/l5 discectomy), spent two nights in the hospital as expected and everything seems to be going very well. My pain level is quite low, I've been taking it very easy but still getting a fair bit of sleep and steady walking in. Feeling a bit silly to be this well and still very weak and reasonably useless, but patience and long term perspective are at the forefront of my mind, so I'm going to stick to the plan. Hoping I remember that in a week when everything has really settled down and I'm feeling mostly normal!

  • I'm on day 7 now, getting some decent very slow and steady walking in, reasonably comfortable (only paracetamol now) most of the time. No progress on my original symptoms, but now I get numbness in my hand a fair bit, I assume something like tennis elbow where I'm pinching a nerve when I rest my arms on things, as that's something I rarely did before surgery and now I'm doing it all day every day. Staying positive, also quite bored by now!

  • Unfortunately boredom is part of recovery, games, books, TV, whatever it takes to keep your mind occupied.

    Take care and keep us posted

    Chip

  • I'm about 10 days post-op now, things are apparently progressing as I'm now more comfortable moving around very carefully and slowly, with some level walking thrown in there every day. My original symptoms haven't changed, and a side effect of being relatively sedentary is that I've picked up a pinched nerve in one elbow (which can't possibly be related to the operation, right?).

    I'm now coming down with a bit of a cold, which in my experience is always preceded by lots of sneezing. So if sneezing can undo my operation, I'm pretty well sunk, because I've been sneezing a lot. Fortunately, I've been pain free with the sneezies, and I haven't picked up any new symptoms or issues. All in all, still bored, still hoping to make some real progress when I'm finally able to start getting more active.

  • You're doing all the right things, be as careful as possible when sneezing, I always try to brace myself if I know a sneeze is coming, but that's not always possible to do.

    Walking will be your best friend in the long run, wish I could help you with the boredom, but I get the same way.

    Take care and keep us posted

    Chip

  • doslandddosland Posts: 42
    edited 12/06/2019 - 1:12 PM

    Just passed 5 weeks post op for lumbar discectomy on the l4/l5 disc to hopefully address numbness and foot drop on the left side. I am up to about 5 km walking every day now, and I've been doing hydrotherapy with lots of aqua jogging and plenty of careful slow stretching. I actually swam a few lengths yesterday, nothing to report there. I have had some pain around the surgery site and a couple days some sharp muscle pain on either side of my spine, but it always settles quickly and none of it has affected sleep or daily activities. The foot/numbness issues haven't changed at all as far as I can tell. Occasional twitches and tingling in the general area, but I can't tell if that is in the area that is numb or in the muscles and tendons around the area that have to work extra hard to keep up. I'm still optimistic that the nerves will come back, but I know I have to be hideously patient for months and months on end. A friend's partner had exactly the same symptoms and procedure and was still numb at 12 months, but came fully back to normal by 18 months. Think I'll be walking in circles by then with all the muscle imbalance... ;)

  • Six weeks lumbar discectomy update. Saw the surgeon for my regularly scheduled follow up. I'm nearly up to regular activity now, pretty mobile, reasonably able to do most things around the house. Still not picking things up, bending, or lifting heavy things from any height, will avoid all that as long as I can. Flexibility is pretty good now, my physio pool swimming has become almost real swimming, but slow and very exhausting. Legs are both really stiff up the hamstrings, and I need to do a lot more stretching there. The surgeon says my nerve may already have started growing back, but not worth running a nerve conduction test until 6 months out and even then it's a purely academic investigation, as there's nothing to be done if the nerve hasn't been growing out. I've read studies that suggest nerve regrowth is more likely with surgery within 10 months of the injury than more than 10 months after the injury, but my surgeon says it's basically just hit or miss as to whether my l5 nerve will regrow or not. At 1mm growth per say, I've got 18 months or so to wait for full symptoms recovery, if it's going to happen at all. I've been cleared for regular physiotherapy, so I'll get back into the core strengthening regimen pretty quickly now. About time, I'm very restless after 6 weeks of just lying around, walking, and occasionally light swimming. 

  • Sounds like things are coming along pretty good, you're right about the nerves, don't give up on it, my surgeon says nerves can take as long as 2 years to heal.

    Take care and keep us posted

    Chip

  • I forgot to mention that I had numbness in my left hand - pinkie and ring finger - following my discectomy. I assumed this was due to constant bad neck positioning in the days following surgery, but when I talked with the surgeon at six weeks, he said this is common because of how they position the arms when they're doing the procedure, and the contact points around the elbow/inner arm can really irritate the nerve through the "funny bone" tunnels. He said it can take 8 weeks or longer for the nerve to settle down, so that's another thing to be patient about...

  • I'm at about 10 weeks post op now, and I have nothing much to report. I'm getting more and more active, flexibility of the litter back is improving, but overall I'm surprised how uncomfortable I still am with daily life - I'm certainly nowhere near being able to pick things up or bend comfortably. I'm being extremely patient with the whole process, I could probably push myself a lot harder than I have been but just don't want to risk doing anything dumb. My fingers are still a bit irregular from the position during surgery, but I notice gradual improvement there, I think. That's my update for now.

  • Patience is the key to a good recovery, and it sounds like you understand that, I know 10 weeks seems like a long time and it is when you are dealing with it, but stay the course and it gets better, look for the little improvements, they can be hard to see unless you are looking.

    Take care and keep us posted

    Chip

  • Dosland,

    Unfortunately I had posted several threads on my situation leading up to surgery and post surgery, but that was back in 2014 and it looks like those threads were archived....we have the same story.   I had exactly the same experience you did, however it was on my right side and was a 12mmx7mm disc extrusion.  I did conservative treatment for close to 4 months then had surgery (laminectomy / microdiscetomy).  Pain was unbearable but more importantly the numbness and weakness was not getting better.  I had my surgery on July 14, 2014, and in 3 weeks was back to work, no sciatic pain but still had numbness and weakness.  I have done a ton since then doing PT, massage therapy, chiropractic, swimming, yoga, etc. etc. but unfortunately still have numbness on the outside of my calf and top of my foot and my right leg is still weaker than left.  I am a very healthy, athletic man ready to turn 55, and continue to do research and try new things to improve the symptoms.  My advice is to stay positive and see what time will present, and you can in fact have a very rewarding life even if you have this as a longer term deficit.

    Tim

  • Thanks for your comment, Tim, I'm still learning how to do a lot of the little day to day things I used to take for granted, but I don't feel like my leg/foot numbness gets in the way much at all - some days I stand for very long stretches and start to notice a bit of an ache in my foot, but on the whole things are pretty regular. The back stiffness and weirdness from the surgery probably still causes more issues for me, as I don't bend or twist much at all and I'm still fairly sore at and around the site of the incision. I am doing a fair bit of exercise and physio, and I'm figuring out when I'll be able to start getting into a yoga routine (easing my way in) or something else to really strengthen up the core. I'm resigned to remaining about where I'm at with the numbness and weakness, so if I progress at all from here I'll be very pleased with that. If not, I'll get along fine, I'm too committed to staying active to let something like this control my life too much! I still think I'm pretty lucky given how serious back injuries are for a lot of people...

  • Just checking in as we approach the 15 week mark post-op to say that I'm getting more and more comfortable moving around (still going to physiotherapy and being pretty good about my exercises), and that I've started to develop just the hint of the old sciatic pain in my glute. I am taking this as a sign for cautious optimism, as up until now that nerve was thoroughly unresponsive, and now I'm getting a slight ache that I hope is a bit of the nerve regrowing itself out into its old path. I'm scheduled for a nerve conduction test in late March, but I don't expect to learn anything from that, nor do I plan to change any of my approach based on whatever the findings are - I plan to keep working like it's going to be like this forever so that I'm as strong as possible regardless of what the nerve manages to do or not do.

  • Keep that attitude, it will take you a long way.

    Chip

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