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L5 nerve root injury following a radiofrequency ablasion

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  • L5 nerve root injury following a radiofrequency ablasion

    In Nov. 2008 I had a stress fracture at L5 and subsequently had a spinal fusion with bone grafting, 4 screws, 2 rods and a interbody cage. After surgery I had continued having pain and radicular symptoms. But pain has been controlled with 3 or 4 vicodin a day, Ibuprofen and skelaxin for spasms. I had 2 epidurals and 12 sessions of acupuncture, which both caused an increase in symptoms. Physical therapy was the only thing that help the symptoms. I was unable to sit, stand or walk for extended periods of time but I was living my life.But I wanted to improve my quality of life, I had become depressed dealing with chronic pain and the inability to participate in all the activities I enjoyed and most importantly I wanted to return to nursing. On Oct. 5,2011 I had radiofrequency ablasion. This was an out patient procedure and the most common complication is more pain. All information about procedure states loss of function is not a possible complication of procedure because nerve branch that send signal to brain are the ones being cauterized. But when I stepped off table I was unable to move left leg and had no sensation. Initially it was believed to be a lidocaine leak but when it didn't wear off within a few hours it became clear something went wrong. I had 2 neg MRI. An EMG shows damage to L5 nerve root. I was started on IV steroids and movement and sensation returned at hip and partial at knee. I have decrease sensation and minimal motion at foot and require forearm crutches to ambulate. Within a week the temperature of leg was very cold and then I began having blood pooling in leg and veins were distended and leg became purple. On my first attempt at shopping I had a syncopal episode. 911 was called and they were unable to get pulse or BP. I had lost consciousness for a few seconds but was very lethargic and confused. I was put in trendelenburg position and woke right up. I was admitted to hospital and was diagnosed with RSD. The doctors seem to be at a loss to explain what happened. Or really what to do with me. On discharge I was told they couldn't keep me till I was better because I won't get better. So I was given compression thigh highs and told to take it easy. If after 2 weeks If I'm still dizzy they will try midodrine to maintain BP. Also they discussed starting Baclofen but I refused. I'm at a loss. if anyone has any suggestions for me. I have been seen by 2 neurologist and neither had a clue what happened. A pysiatrist did the procedure, should I see another to get 2nd opinion?? I also have clonus which is a upper motor neuron deficit which does nt fit with a L5 injury.
    Last edited by Christine1965; 11-13-2011, 07:03 PM. Reason: add info

  • #2
    Welcome to CareCure, Christine. I am so sorry about everything you have been/are going through, and I empathize because so often, neurologists and other specialists really have no idea what is causally related to what - this has been a hallmark of my experience with MS and concomitant neurological issues. I urge you to get a second, and even a third, medical opinion, and be guided by the weight of the evidence if there are wide differences between expert assessments. All best wishes to you, going forward!
    MS with cervical and thoracic cord lesions

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    • #3
      RSD diagnosis

      I have L5 nerve root damage from a radiofrequency ablation that I had done 10-5-2011. I now have minimal use and sensation of foot and partial use at knee. After a week or so after injury I noticed temperature change of leg followed by blood pooling in leg-veins distended and leg purple. On my first attempt at shopping 1 month later, I became dizzy and passed out. My blood pressure had bottomed out and heart rate dangerously high. I was readmitted to hospital and left with a diagnosis of RSD. I have pain but it's controllable and these are normal symptoms after a spinal cord or nerve root injury. I was given compression stockings and told to take it easy and if I continue to have issues, meds to maintain BP will be started. I don't know if I agree with diagnosis. I've been seen by 2 neurologist and the physiatrist who did the ablation. I'm going Monday for another opinion. No one will give me a prognosis or say much more then I'm sorry this happened. (My initial injury was Nov. 2008 I sustained a stress fracture that was repaired with bone grafting , rods, screws and a cage in Aug. 2010)

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      • #4
        Thank you so much!! I'm going to another Doc on Monday and hopefully will get the answers I'm looking for

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        • #5
          Hello Christine! I just read on your other post that you'll be getting another opinion on Monday, and that's great. Hope you come away from your appointment with an accurate diagnosis and workable treatment plan.

          If you do have RSD, more than likely you won't be given a prognosis because RSD is so unpredictable and strange. I have RSD in my left wrist and forearm, secondary to a botched ganglion cyst excision, and it did get better over time in terms of the character of pain and severity of temperature changes. It's not always easy to get an accurate diagnosis, especially since RSD can have atypical presentations. You might have to observe your symptoms closely for awhile and monitor any changes you see.

          Best wishes on your appointment - hope you like the doctor and that there will be good communication and easy rapport between you.
          Last edited by Bonnette; 11-13-2011, 11:28 AM. Reason: wording
          MS with cervical and thoracic cord lesions

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          • #6
            Christine, I have asked Dr. Young to respond to both of your posts (which I merged here) and the PM you sent me. He is very busy right now, but I am sure the will get back to you as soon as he can.

            (KLD)
            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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            • #7
              Thank you for responding and I'm sorry for the redundancy but I'm at a loss and getting very anxious. I'm in a holding pattern at the moment and I feel like it's lost time and I'm not getting stronger. I appreciate you forwarding to DR. Young
              Bonnette-thank you and I hope you are doing okay. I'll let you know what Doctor says.

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              • #8
                Christine,

                I am sorry to hear that you are having these problems. Reflex sympathetic dystrophy (RSD) is a terrible condition but I am not convinced by your description that you have RSD. Can you provide more details about the radiofrequency ablation treatment that you received? Was it a dorsal root entry zone (DREZ) procedure? I assume that, because it was an outpatient procedure, they were inserting the probe percutaneously (through the skin). Was the pain localizable to L5? I am puzzled by the procedure, as you described it.

                Wise.

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                • #9
                  Thank you Dr. Young for getting back to me. I don't agree with a diagnosis of RSD. I believe something went wrong during the ablation. Yes, It was done percutaneously and I don't know the entry zone. The procedure was done at L4-5. The doctor assured me that he checked the calibration of the machine and that there was nothing wrong but he still could not explain what happened. The global nature of my symptoms did not fit with the area the procedure was done. It's my understanding that during a neurotomy the medial nerve branch is what's cauterized and in no way could cause loss of function. Why would I have clonus?
                  I had 2 epidurals and a facet block after my fusion surgery. I had low back pain with burning through the hips and glutes. I had numbness and tingling after increase in activity and shooting pain down left leg. I never had weakness or any other symptoms until after ablation.
                  It's my understanding that the symptoms I have are normal autonomic nerve symptom response for nerve root or spinal cord injury. The treatment would be the same regardless of the cause but I would like some answers. I'd appreciate any input.

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                  • #10
                    Seen by a 3rd. neurologist today and still no answers. He wants me to go back and have further cardiology testing. I was admitted onto a cardiac care unit when I had the the syncopal episode and had a very thorough cardiac workup. I was on cardiac monitor for 3 days, had echo cardiogram, Doppler of leg and carotids and cardiac enzymes and a CT scan of brain. Neurologist believes my syncopal episode was a vasovagal response but doesn't understand why I continued to have tachycardia and dizzy spells unless I wear compression stockings. I have not become hypotensive since then but I also have not been up for any period of time since then either. The doctor does believe that I have RSD. I also have a slight tremor of hands, due to this and having clonus he is sending me for a MRI of neck and believes I should repeat the EMG. He gave me a prescription to get AFO and restart PT. I don't know what to do next, I am at a complete and total loss!!!

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                    • #11
                      One of the worst things about SCI is that it doesn't indemnify us against other conditions - yet it tends to put a period to the sentence for many doctors, and when that happens, they don't look elsewhere for answers. In that sense, it's good that the new neurologist wants to know more about your cardiac, c-spine and nerve conduction status. He might be able to spot something subtle in the test results, and put together a meaningful picture (or at least rule some issues out, definitively). So the best approach might be to have the tests the new neurologist is recommending, and go from there.

                      The possibility exists - and many of us here have experienced this, myself included - that a satisfactory explanation for specific symptoms might prove elusive (even in the face of a correct overall diagnosis), in which case you will need to deal with symptoms in a piecemeal manner, on the basis of self-observation, trial and error. It is maddening, but I find that it helps to take things one step at a time, and then one day at a time, without anticipating either the best or the worst. Easier said than done, I know!
                      MS with cervical and thoracic cord lesions

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                      • #12
                        I don't know why it's so important to me to know what exactly happened and why it did. Perhaps I'm focusing on the wrong thing. But at least I now have a go ahead to restart therapy and will be given a AFO brace so I can start gait training and possibly walk with a cane in the near future. Thanks for all the support

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                        • #13
                          I understand why it's important to you to know what happened, and why. It's a big part of getting your mind around things so that you can move forward with confidence. If it's possible to arrive at those answers, you certainly deserve to know what they are! And if it isn't...well, at least you'll have tried.

                          Therapy and early gait training are so important. I'm very glad that you'll be getting an AFO, that will be a huge help.
                          MS with cervical and thoracic cord lesions

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                          • #14
                            L5 nerve root damage following a radiofrequency ablation

                            Going for a MRI of C Spine tomorrow.

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                            • #15
                              Good. If anything is amiss there, I hope that it will be clearly visualized...also, that you won't have long to wait for the results.
                              MS with cervical and thoracic cord lesions

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