Nerve pain in foot after back surgery

Dear Dr. Roach: My husband had surgery two weeks ago to fuse his three lowest vertebrae due to degenerative disc disease. He had no issues with his legs or feet prior to surgery.

Since the surgery, his back pain is gone, but his legs are extremely weak — he can walk only with a walker, and his left foot has drop foot. My main concern for him is the drop foot issue, because I recognize that the leg strength is something that’s just going to have to heal, whereas the drop foot could be from nerve compression or nerve damage.

At his two-week post-op appointment with the surgeon yesterday, the surgeon basically said, “Well, it’ll get better or it won’t,” and wrote him a script for orthotics for his shoes. Of course, he’s doing physical therapy, as well.

Does his drop foot have a good chance of improving just from the physical therapy? Should he continue to just do physical therapy, or should we find a specialist to see him ASAP?

Everything I’m reading says that the quicker a drop foot is addressed (in terms of finding out the reason — a compressed or damaged nerve — and getting that dealt with medically), the better the chance it has to be 100 percent repaired. Time seems to be of the essence.

H.S.

Dear H.S.: “Foot drop” is a simple name for a complex issue. It almost always involves damage to a nerve.

The nerves to the muscles that hold up the foot come off the spinal column at L4/L5, travel down the sciatic nerve and then branch off as the peroneal nerve. Foot drop can result from damage at any of these places. Clearly, your husband’s is related to the surgery (but that doesn’t necessarily mean the surgeon did anything wrong). I think it’s most likely an issue at the nerve root on its way out of the spinal column.

One way to confirm would be with an EMG and nerve conduction velocity studies. Damage can occur during surgery to the sciatic and peroneal nerves, though this is more common in hip surgeries (at least, that’s where I have seen it most often).

You are right about getting treatment quickly. If foot drop is due to ongoing compression of a nerve, such as by a herniated disk, then relieving the compression sooner enhances the chances of complete recovery.

I am glad you saw the surgeon, as I would be extremely concerned. It sounds as though his surgeon is convinced there is not an ongoing anatomical problem. Assuming this, my reading indicates that foot drop after back surgery is not so uncommon, and usually it does resolve on its own. Physical therapy and an ankle-foot orthotic are indicated.

Dear Dr. Roach: Is there any information regarding the relationship between the frequency of ejaculation and prostate health, such as cancer, enlarged prostate or prostatitis, especially in regard to older men?

J.G.

Dear J.G.: There is very good information. The rate of prostate cancer is slightly lower in men who ejaculate more frequently, with the group who reported 21 or more times per month having the lowest risk of prostate cancer. It’s not a guarantee against prostate cancer, sadly.

There also is evidence that frequent ejaculation relieves some symptoms of prostate inflammation. I am cautious not to advise sexual intercourse as a treatment, however, as a partner’s desires need to be taken into account as well.

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During spinal surgery, the chance of nerve damage due to bruising or accidental scalpel cuts is high. Nerves can also be damaged if the tissues around them become inflamed. Sometimes, the damaged nerves can be repaired, but they can also be permanently damaged. Therefore, damage to nerves after spinal surgery can be a very serious problem. According to medical malpractice statistics in the United States, 250,000 people in the U.S. die every year from medical errors and negligence, which is why it’s important to have a Philadelphia medical malpractice lawyer on your side if you or a family member have been severely injured due to an error by a medical professional.

Nerve Injuries

Our nervous system is a critical component of our bodies – the two types of nerves are central and peripheral. Neurons form the network of nerves, which allows coordination of various physical activities and the regulation of bodily functions. Therefore, injuries to the nervous system are very problematic. Injuries to the nerves vary by their form, which makes it hard to group them by types. They were eventually categorized into three different kinds of nerve injuries in 1943 by Sir Herbert Seddon, neurotmesis, neurapraxia, and axonotmesis.

• Neurotmesis injuries – the worst type of nerve injury. It is identifiable by lacerations, contusions or stretches. With neurotmesis, the connectivity of the connective tissues and their axons is disrupted. The nerve’s sheath gets separated from the nerve. In other words, the nerve is snapped into two pieces. Partial recovery is all that can be hoped for with this type of injury.
• Neurapraxia injuries – do not alter the nerve’s structure but the injury interrupts impulse conduction. Neurapraxia normally is the result of minor external injuries, which cause loss of motor and sensory functions. That prevents coordination of some complex body movements. These injuries can be fully healed in about seven weeks. Neurapraxia injuries also disrupt blood supply and compress the nerves.
• xonotmesis injuries – the myelin sheath and neuronal axon are disrupted. The other nerve components are unaffected, including the endoneurium, epineurium, perineurium and Schwann cells. This type of injury paralyzes motor, sensory and autonomic nerves and is more serious than neurapraxia.

Nerve Damage Caused by Surgery

Nerve damage can be caused by other factors than the cuts and bruises that may result from mishandled surgical tools. For example, anesthesia can also cause nerve damage. The anesthetic medications or even the syringe used to give them might cause damage to the tissues of the nerves. The discomfort might be long-lasting or temporary. A spinal epidural, which is used in a spinal tap or during an infant’s delivery, can damage the nerves of the spinal cord if performed incorrectly.

Symptoms of Surgical Nerve Damage

There are several symptoms of nerve damage that can be present after surgery.

• You might experience numbness or a tingling sensation in the region of the damaged nerve. This is sometimes referred to as loss of innervation or “pins and needles.” The symptoms do not have to be in the area where the nerve was actually damaged due to the complex nature of the nervous system’s network structure. The symptoms could manifest far away from the injury.
• You could experience weakness in the ankles or feet if a nerve is damaged during knee surgery.
• Knee surgery can also cause a condition called “foot drop.”
• Damage to the spinal nerves can cause difficulty walking or a change in your regular walking pattern.
• Neuropathic pain, which burns severely, can be caused by an injury to the nerves of the spine or other areas during nerve surgery.
• Another injury that might be caused by knee surgery is dragging toe.

Contact Rosenbaum & Associates

Nerve damage is an unfortunate, unpleasant complication of back surgery. It causes pervasive pain that can sap the enjoyment from your life. If you or someone you love have suffered a nerve injury during spinal surgery, contact a Philadelphia surgical error attorney to discuss what steps you can take to receive compensation for your damages. Call our Philadelphia office at (215) 569-0200 for questions or to schedule a free consultation.

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