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Had Microdisectomy And Foraminotomy. Taking Neurontin For Pain. Reason For Constipation?

Posted on Mon, 28 Oct 2013

Question: I had microdisectomy and foraminotomy due to a sever L5S1 nerve route compression from a herniated disk. I was ok after surgery, had pain relief and went to pt. About 12 weeks out I told my PT I was having pain when I walked down my left leg, behind the knee and my thigh and down the outside portion of my calf and on the back of the heal. I was discharged from treatment because this was the amount prescribed. The pain got progressively worse to the point I couldn't sleep or walk 5 feet. The leg cramping is unbelievably painful. I bend over when I walk. I went back to the neurosurgeon who told me he didn't know why I had such pain. Gave me Neurontin and 600 mg. ibu and 500 Tylenol. It wears off after 2-4 hrs. A second MRI shows a L4-5 disc tear and bulging and the l5s1 still has small disk material and scar tissue. I went back to the PT, she did an in depth exam and she wrote down L4-5 compression. She did some traction and it felt great. Anyhow, I am concerned about the pain and the fact that since the onset of the pain a month ago, I have been severely constipated. This is unusual for me. Any suggestions related to the leg/disk pain and the constipation. Are they related?

Answered by Dr. K. Naga Ravi Prasad (34 minutes later)

Brief Answer:
Your symptoms could be due to L4-L5 lesion.

Detailed Answer:
Hi, thanks for writing to XXXXXXX

All your radicular pain in the left leg may be related to the disc bulge at L4-L5 level.

Its a common finding to see on an MRI scan, having a remnant of disc material and scar tissue (epidural fibrosis) at the operated level. This is also to let you know that removal of the entire disc at the level of compression is not necessary, and only that part of the disc that is exerting pressure over the nerve need to be removed, which is termed as Bumpectomy. So, naturally one can see the remaining disc at that level.

In case of multiple disc protrusions, It solely lies on the judgement on the operating surgeon whether to perform single level or multiple level discectomies (which will be based on clinical examination correlated by MRI findings).

I suggest you to follow conservative management recommendations and look for improvement in your symptoms -

* Avoid lifting heavy weights as it imparts more strain on your back
* Avoid forward bending activities as it will worsen the disc protrusion
* Use a lumbosacral back support to augment your spinal muscles
* Intermittent pelvic traction to cause a regression of disc
* Maintain optimum body weight,if you are obese
* Physiotherapy to strengthen your back muscles. Physiotherapy has to be done only after the acute pain has subsided.
* Use analgesics ,muscle relaxants as needed. You can take daily supplements of Vitamin B12 also, as it a neurotropic vitamin.

I personally think that constipation may not be related to your disc problem. Take a General physician consultation for the same.

Hope I have addressed your query.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (20 minutes later)

Thank you for your answer. Would you suggest I have a second opinion? and from what type of doctor. I feel like he is dismissing the l4-5 disk issue. He was suggesting more surgery to the same disk but the PT did not agree and after the lengthy examination she said it was the L4-L5 pathway. I am doing exercises and doing the traction every hour at home. Doing this always relieves the pain but only temporarily. Do you expect that with time it may put the disk back in the correct place. My PT says the body wants to help itself so give it time. What is an expected time frame to see improvement?

Answered by Dr. K. Naga Ravi Prasad (14 minutes later)

Brief Answer:
Second opinion will always be helpful.

Detailed Answer:
Hi, Nice to hear from you.

I personally think that there is nothing wrong in having a second opinion, if there exists a doubt. I suggest you to consult either an orthopedic surgeon (having experience in spinal surgeries) or a spine surgeon for the same.

Generally, no redo surgery is necessary at the same level within 3 months of the initial surgery. Also, the results of the revision surgery are always poorer than the first one (as it is technically demanding) and there is a possibility of a neurological injury that may lead to permanent damage. The complication rates are also higher in redo spinal surgeries.

There is a possibility of disc regression and improvement in your symptoms with the above mentioned recommendations being strictly followed. This may take anywhere around 6-8 weeks.

Hope I have justified your query. Good day

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar