Please forgive if what I am asking has long been covered here. Being new I thought to dive right in and search later.
In 2001 and again in 2002 I had discectomy/laminectomy at L4-L5. First surgery was to correct profound left foot drop as "accidently" discovered I couldn't heel walk on the left foot - following five months of increasing excrutiating pain localized at left lateral calf, outer ankle, top of left foot into big toe. Immediately after surgery, days after, presented with exact same pain in same area of calf. Lived with that, tried chiro, acupuncture, therapy, and saw different neurosurgeon who suggested he could help me and did the laminectomy. Immediately presented, days after, with same darn pain again. After only two post operative visits to him, guess he tired of me saying it still hurt, was sent to pain clinic where I still go monthly. That's now about four years on oxy 80 and oxy ir for breakthrough. I still work but find the pain unrelenting. The longer I am on my legs the weaker the left one gets, until I limp and must get off it before I fall down. How can the pain come through so clearly with that heavy medicine ? What would it be like without it ?
What I am hoping for here is some advice or suggestions as to what to do now - was told by a third neurosurgeon to have a fusion - I refused when he told me he could probably fix my back pain but not the leg pain - It's never one or the other, just depends what time of day and what activities to see which pain is in the lead.
BTW, my herniation was a far left lateral at L4-L5, a foraminal herniation. What I am told is that because of the initial injury, the surgeries and resulting scar tissue, that the exiting nerve root is now encased and trapped in the scar tissue and no surgeon will touch that area. How can that nerve root ever be free ? And will that make the leg pain cease ? I feel that the first operation happened too late, that even though the foot drop was relieved, the damage to the nerve root by waiting so long was already done and is permanent. I definitely know that leg is weaker, smaller by more than 4 cm, and with daily use, I can't finish the day on my leg.
So, if anyone has had similar experiences, similar problems, any advice or questions, I'd sure appreciate hearing it. I've about reached a place where I just don't see this getting any better. Maybe there are techniques out there I don't know about, that "good" doctors are using. My prior two surgeons sure gave me the boot when I kept telling them it still hurt. I mean, " failed back surgery syndrome " ???! What the heck is that ? Something to say when you just don't know what else to do ?
Thanks for reading, looking forward to replies. Because I work I usually don't get on this until the evening and then depending how I'm doing, not every evening at that, so don't get mad if I am not back as soon as you might think. If I couldn't work I don't know how we'd survive - isn't that terrible ?

Hi,

I am so sorry to hear about your case. And I don't know if it will be of much help since you are not in the LA area but my neurosurgeon that treats me for TOS deals with a lot of failed back surgeries. His name is Dr. Filler and his website is www.nervemed.com. He also wrote a book about back surgery and has the reputation of fixing other docs mistakes and failed surgeries.

I hope it gets better. Good luck
Shelley

Part of your lower leg pain may be from Myofascial trigger Points (knots in the muscles of thethe lower leg.
Muscles and fascia work together in functional groups. When a muscle in that group gets a trigger point it impacts the function of that group and causes postural dysfunction. Therefore, the whole functional groups of muscles and fascia have to be assessed. Many trigger points cause satellite trigger points in predictable patterns.

In your case trigger points in tibialis anterior muscle which attaches proximally to the lateral condile of the tibia (below and outside the knee cap, about 1 of your hand width and to the outside of her lower leg), the upper half or more of the lateral surface of the body of the tibia (shin bone), and to the surrounding fascial structures . The muscles tendon attaches distally (foot) and to the medial and plantar surfaces of the medial cuneiform bone and the base of the first metatarsal (big toe) in the foot.

The Functions of the tibialis anterior muscle during ambulation (walking) are to prevent foot slap at heel-strike and to help the toes clear the floor during the swing phase.....

The trigger point is a hyper-irritable focus (knot) within the muscle or fascia that causes taut bands and characteristic, predictable, referred pain like that seen in the leg muscles. Trigger point referred pain does not always follow typical dermatome patterns.

Trigger points cause the muscle to become shorter and tighter. This limits the function and mobility of the muscle which causes weakness, decreased circulation and pain. When injured, most tissues heal, but muscles learn, they learn to avoid pain. This muscle memory can produce unexpected pain years after an injury has occurred, especially during times of physical and emotional stress.

Your may have an active trigger point in your tibialis anterior muscle in he impacted leg. This muscle is innervated by the deep peronial nerve with fibers from the fourth and fifth lumbar and first sacral spinal nerves.

Did you have a clear nerve conduction test of the L4-5 to the lower leg?
If the nerve conduction test is mostly clear then a trigger point is more likley

I am a myofascial trigger point therapist and primarily use my hands to locate and treat trigger points. I am not sure trigger points are the cause of your problem but well worth investigating.

The tibialis anterior myofascial pain syndrome rarely presents alone as a single-muscle syndrome, but occurs in association with other TrPs in other leg muscles.

Your Dr.'s may want to palpate your tibialis anterior muscle for the presence of trigger point(s) and treat accordingly. Therefore, foot pain can be caused by satellite trigger points in predictable patterns.

Take a look at this web site : http://www.latrobe.edu.au/podiatry/myofasc/cover.html

Best wishes

I appreciate the well wishes, name and anatomy lesson - that was fascinating and I thank you Painfree, for taking the tme to do that.
I left out of my initial rant that I've had several emg tests - one prior to the first operation and two subsequently, the last just this past august ( because I insisted on it so there was some empirical data there ). There was/is chronic denervation in my left lateral calf though I don't have the results in front of me, I recall the peronial 'something' being mentioned.
I present with no other leg pain at all, not anywhere else in the left leg and nothing in my good one. It is very localized = if you put your middle finger on your outer ankle bump and stretched your thumb up your lateral calf, chances are you'd hit the spot. It's been rubbed, poked, needled, I've had multiple back injections under x ray to try and bathe the area in the solution they use, and I've done a trial with medtronics back stimulator. that was a nightmare, though maybe looking back now it was kind of funny in a warped way. Usually the procedure is not that long but I was on the table for four and half hours because they couldn't get the wire in the right space. Doc told me after when the lead to block the back pain was going in he kept hitting scar tissue and couldn't get it where it needed to be. And the lead for the leg pain was fun too as apparently my dermatones don't line up with the chart. He thought I'd feel the stimulation in my leg, but it was now in my other thigh !, okay how's this, no, that's buzzing now in my butt, and we went on like this for quite a while ! Needless to say, it didn't take.
Now I know because of where I live I may not be subject to the best medical care - top docs are not running to set up practice here.
The doctor in LA is not out of my reach entirely as my son is planning to move out there later this year and I'm sure I'll be helping him and visiting.
I will explore his website and thanks Shelley, for that info.
Other than the trigger point - which not to dismiss entirely but I don't think my problem here is as much muscle related that way as it is originating in my surgical area though I will ask the pain doc about it next week, do you know of anyone else on this site who has an issue related to mine, that sounds similar > if not, thanks again for your help and information and best of health in the new year.

The Peroneal Nerve can be entraped by trigger points in the the Peroneus longus (lat leg + calf) and , Extensor digitorum longus muscles (big toe).

Read more about this at: http://www.round-earth.com/Entrapment.html

"dermatones don't line up with the chart. He thought I'd feel the stimulation in my leg, but it was now in my..."

Pain referred from myofascial trigger points do not follow traditional dermatones. Pain from active trigger points can be as painful as a broken bone.

Your Dr. may want to research this peronial muscle and nerve pain and dysfunction, most Pain Dr.'s have these books in their medical library:

Travell & Simons’ Myofascial Pain and Dysfunction Trigger Point Manual Volume 1: Upper Half of the body and Volume 2: The Lower Extremities ISBN 0-683-08363-5 and ISBN 0683-08367-8. These volumes cover most muscles and associated pain patterns in the body including those which cause your pain. The muscles cause about 90% of all pain felt in the body.

Your pain is covered in volume 2 under peroneal longus.

Worth a Try:
Ask your pain Dr. to locate the trigger points in the peronial muscle and use the spray and stretch technique and or direct injections into these trigger points followed by stretch and a home stretch program. The same for the Extensor digitorum longus and tibialus anterior muscles This should give you some benefit.

Wow Painfree that was awesome. I learned so much thanks.

jonnyrocket the LA doc is an expert at nerve entrapments. I hear he also practices out in PA from time to time.

Let me know when your son is moving out here and I would be glad to help him out or show him around. What is he coming out here for?

Hop everything improves.
Happy and healthy New Year
Shelley

WOw Thanks painfree for the , well, everything. Very interesting. I have my monthly appt on the 15th and will definitely ask the pain doc about this. I really hope he knows what I'm talking about ! He's a good guy and all and head of anestheseology at the only hospital within forty miles of here, but to be honest, his clinic seems to me to be more of script writing house than a get better place. Its a very very busy practice and I'm sure there alot of folks like me now dependant on the narcotic pain meds that were not when we first got there. On the other hand, I'm also sure there are folks like me who benefit enormously from those meds, so its a two edged thing. I'm glad for it and they're careful but I wonder as I'm finally sure others wonder too.
Thanks for the information, it will be utilized.
Shelley thats interesting about the doctor coming to PA sometimes. I haven't gone to the website yet but will. Thanks.
My son goes to school in Albany NY and two of his first year roomates are in a band called the Hills with two other college friends of his also and they all went to LA last summer to make their fortune. Jared served as his best friend, the lead singer and heart of the band ( as lead singers often are ) best friend, adviser, devils advocate. He also is a budding writer, and I must say, a very good one -not fatherly pride as I vision myself a writer trapped in someone else's life - but objectively viewed. He wrote some of their song lyrics and they've performed at some large LA venues, but I couldn't name them ! The band is still out there but we asked Jared to come back and complete another year of school while they tried to establish a real living and establish a real, paying job for him with them. So they have a manager now, have cut a CD and are begging Jared to come back but he's aman of his word and is finishing his year. But he is going back in the summer, mostly because he loved it out there and who could blame him. Y'know, I recall what it was like to have dreams and goals, and though I never got the chance to act on them, thats no reason not to support his - I'm jealous of him but boy I hope he attains them. HOpefully he will finish out there in your fine university system though I took a break myself and it seven years before I went back.
We'll see, he writes screenplays and that seems to be the most logical place to float them. Your offer is extremely generous to someone you don't know at all but maybe by the time he is ready you and I will know each other better. You can email me as well or tell me when you're on here and I'll see if I can't be on here as well. Thank you again.
Until later or another day......hiho hiho, etc

Hello painfree - quick question - do you know who publishes Travell & Simons ?Is it a harcover or in a journal. I used to work for Marcel Dekker, an STM ( science, technology and medical publisher) and have retained contacts under their new ownership. Just curious...thank you again for your info.
Also if there are other factors I can tell you please ask. You're a wealth of info and the more you have, the narrower the focus. I'm in good shape otherwise, at correct bmi for my height, have or had been a disciplined exerciser for over twenty years daily, am now 47, trouble started at 41. I've had injections over the years since surgery but the leg pain never really abated. Again, it always hurts but the more I am on my legs, the longer the day and especially the more strenuous the activity, the worse it gets to the point that I'm noticeably limping and favoring the other one. I also get these night things - out of a sound sleep I wake up in sever pain due to that area of my lateral calf hardening like a rock ! My big toe goes up, and the metatarsals ( I think thats what they are, the lines you can follow on the top of your foot to each toe, know what I mean ? ) they about seem ready to bust out of my skin. You can't rub it out like a normal nighttime charley horse. I have to get out of bed and put all my weight on that foot and torque my foot ,, like twist my foot to the right while trying to move my calf area to the right. Best I can describe it is when it is over its like a light switch was flipped - i.e., there is no gradual abateing, no easing off until it's normal again. It simply releases. I usually exhale a sigh of relief at that point as it is that intense while in the throes of it, and that significant when it lets go. The do said its like that nerve is having a seizure. That while I am sleeping there is inappropriate activity to that nerve root and my lateral calf there has a seizure. I am on lyrica but I don't like the side effects, kind of an aidible buzzing feeling I get into the next day.
On the trigger point issue, I am under the impression the problem originates in my lumbar region, the site of my operations and scar tissue, where the nerve root controlling that area of my lateral calf is, not in the calf perse. Is that correct ? So trigger point therapy takes place in the point of origin ? Due to the prior operations and mess thats there now, how safe is it to have needles back there ? My previous injections were of course done with xray in the o.r. while mildly sedated but aware so I could tell them where I felt it. As many here can attest I am sure, its not an overly pleasant experience. How does a trigger point injection differ in application ?
Sorry to burden you with so much info - there's more but I don't want you to hate me ! - but you offerred so much material already I thought it'd be okay to pick your brain some more.
You and Shelley can email me at jlevine3@hvc.rr.com if you'd rather.....
Thanks again and again.

Take a look at amazon at this link (Publisher Lippincott Williams & Wilkins; 2nd, 2 Volume Set edition (January 1999) ):

http://www.amazon.com/Travell-Simons.../dp/0683307711

Every case is unique. The scar tissue at the L5-S1 is an influence and may be the root cause of your pain but you can trick and rest this dysfunctional loop of pain.

Trigger point injection directly into the tibialis anterior and peronial muscles may benefit your discomfort. There are many ways to release a myofascial trigger point, injections being one.

I use my hands (finger pressure) followed by Specific stretch and a home stretch program to facilitate the release.

You can also use a spray and stretch or ice release method. You can Google the spray and stretch technique.

"exerciser for over twenty years daily"
If you exercise or take the myotonic group(s) beyond their current range of motion before the trigger point(s) are released then you may be doing more damage then good.

A long muscle is a strong muscle! Get the muscle long then exercise.

"like twist my foot to the right while trying to move my calf area to the right. Best I can describe it is when it is over its like a light switch was flipped - i.e., there is no gradual abating, no easing off until it's normal again. It simply releases. I usually exhale a sigh of relief ..."

This is a stretch twisting to the right of the peronial muscle.

Individual muscle treatment is beneficial, but if you want lasting benefits the whole functional myotonic(muscle) group must be addressed along with the the associated fascial (connective tissue) must be addressed.

Take a look at Anatomy Trains -(Fascia Lines) by Tom Myers at this link:

http://www.amazon.com/Anatomy-Trains...e=UTF8&s=books.

I would also look at the whole body posture - is one leg longer then the other, hemi pelvis, compensatory scoliosis... to identify any perpetuating factors and suggest corrections.

I would also look at ergonomics work posture, sleeping position, type of bed, diet, what you eat drink, sups... and address those issues for lasting benefit.

All I can say is DAMN ! Your info is so beneficial you should charge for it !
Where do your practice again ? I looked at the links you gave me and indeed learned, which is always a good thing. I see the doc on monday and won't he be surprised when I start talking. Over the years he has realized I do my homework whenever he proposes a new injection or new med and we discuss it pretty thoroughly. He's one of the few docs I know who actually appreciates an informed and intelligent patient, so this will be a good visit.
Thank you greatly for taking all the time you have to answer my questions and provide such important and valuable information.