Leg Pain after ADR

sharman · #1 (**permalink**) 12-09-2007, 10:18 PM

Dr Charles Rosen has an interesting study on the internet, 24 patients suffering from back and leg pain after ADR surgery. Among the interesting things in this paper, Rosen claims that the post-ADR leg pain in these patients is due to damage to the facet joints. Rosen did revision surgeries on 5 in the group, and claims to have successfully resolved the leg pain. His revision surgeries remove the symptomatic facets and fuse with the ADR in place, using a posterior approach.

I don't seem to be able to use the URL link feature on this forum, but here it is all spelled out:
ispub.com/ostia/index.php?xmlFilePath=journals/ijmist/vol1n2/failures.xml

You often read about leg pain following ADR, usually a transient sciatica that resolves in a few months and is thought to be caused by stretching of the nerve root when the disc space is distracted during surgery. But there are some reports of leg pain not resolving after months and years. If Rosen is correct, then it seems there are two different post-ADR leg pain syndromes, one that will resolve on its own, and one that is serious, and may need revision surgery. I wonder how one tells the difference, other than time?

robprodisc · #2 (**permalink**) 12-10-2007, 04:53 PM

Ok it isnt only me with the leg pain after ADR. My pain that was near my hip bone lessoned, however I now have pain in my calf muscles. The more distance or standing I put on my legs the worse it is. I put up with it during the day, most of the time. However at night it wakes me up. Loose about a hour of sleep before the "stuff" kicks in.
Thanks for the info, hopefully mine will go away.

e-gal · #3 (**permalink**) 01-03-2008, 10:38 PM

I have two types of leg pain. Both were there prior to surgery (3 level ProdiscL 10/06 with Dr B). The first is a all over aching, sometimes hot pain that gets worse with standing and walking, usually from lower thighs down. Prior to surgery I had several rounds of facet injections and that helped this leg pain, as well as the grinding pain. Have been told that this is probably due to nerve damage. In addition, recently I am having bouts of calf pain (sciatica like). I am more concerned about this pain because it has come back. Also had this before the surgery but it went away after about 3 months. My PT thinks that my facet might be stuck so I am going to see my chiropractor, (who has 5 patients now that have had ADR). he fixed this problem once before with a gentle adjustment. I am also worried about scar tissue. I have lots of it from microdiscetomy and IDET procedures, Dr B told me that it complicated my surgery. SO I would like to hear others thoughts.

sharman · #4 (**permalink**) 01-05-2008, 03:13 AM

E-Gal, thank you for the input.

Certainly seems that, if you had a positive response to facet injections, then the facets are causing some or all the leg pain. Did you read Rosen's article, and did those leg pain patients sound like you? (IIRC, all of the patients in Rosen's group had back pain, some had leg pain as well. If you are now suffering only from leg pain, then maybe Rosen's findings are not applicable to your case. Still, same pain as before surgery, when the injections helped...)

Is it bad enough to pursue another procedure? Some have had success relieving facet pain with cryotherapy.

Have you tried any injections or other diagnostics since the ADR?

sharman · #5 (**permalink**) 01-05-2008, 03:40 AM

Oh also, may I ask you a question, e-gal?

You said that scarring from a discectomy and IDET complicated your ADR surgery with Bertagnoli. Meaning, scarring of the annulus? I've heard that Bertagnoli likes to keep as much of the annulus intact as possible, was this an issue?

And more importantly, "complicated" as in, you made Bertagnoli work harder, or complicated as in, may have affected the result?

e-gal · #6 (**permalink**) 01-05-2008, 02:19 PM

Dr. B didn't specify how the scar tissue from previous procedure made the surgery more difficult. The surgery took almost five hours, I think that they only planned on three. yes, there is always the issue that the outcome may not be as good. However, L5/S1 was in really advanced stages and there was a question as to whether he was going to have to fuse that level. I told him not to fuse if at all possible and I would take the chance that later it might be necessary. The leg pain that I have it not severe enough to warrant another procedure at this point. If it gets worse over time, I would consider facet injections. I realize that the scar tissue may also require some attention. I did read the article on facet problems after ADR. Quite negative. I also noticed that most of the revsions were with Charite, which has always been the choice for people that have wanted the most movement. May too much movement is not a good thing. The two ProDlisc patients were from 2002, probably from the trials.
I still consider myself to be a successful outcome

but have realistic expectations for the future. I don't plan on playing golf or going skiing anytime soon.

robprodisc · #7 (**permalink**) 01-09-2008, 04:13 PM

In ref to new nerve pain after disc replacement I have also one other new nerve reaction that has happen in the past few months that I didnt have prior to the surgery. Just when its time to go to the "washroom/bathroom" just below my butt and at the top of the back of my legs, it gets warm, numb tingly feeling. Very strange but painless.

Anyone else have this after surgery?

5 months since surgery has past.

e-gal · #8 (**permalink**) 01-09-2008, 10:56 PM

I have a spot in the same place you describe but I have been told by my PT it is related to tight hamstrings (something about it being the insertion point to the bones of the hip). I have a chronic problem with my right hip and right SI joint not moving properly and so this spot is annoying. Do you see a PT. Tight muscles, tendons and ligaments can lean on the nerves and cause tingling. especially since it is in the back of the leg, you are putting pressure on it when sitting. thats all for now