Leg weakness after microdiscectomy

For people with sciatica, conservative treatments such as physical therapy, chiropractic care, and non-surgical decompression are usually sufficient. Minimally invasive microdiscectomy is a common surgical procedure performed for those whose pain has not been relieved by other means, or for those who have severe conservative symptoms, such as incontinence, that require immediate intervention.

A common cause of sciatica is a herniated disc in the lumbar spine. As the outer rim of the disc weakens, fluid in the center of the disc begins to leak out and irritate the nerves leading out of the spine. The roots of the sciatic nerve exit the spine from vertebrae L4 to S3. Nerve irritation causes sharp pain radiating from the lower back to the legs, muscle weakness, and numbness.

Microdiscectomy involves removal of the small piece of disc material responsible for compressing the nerve. Many who have had the surgery find that although pain levels improve, strength does not return to the affected leg muscles.

Surgeons report that success rates for microdiscectomy and other spinal surgeries are around 95%. However, these rates often reflect that the surgeon was successful in removing a piece of the disc or that the bones were fused together in a spinal fusion procedure. The actual relief of patients is not always included in the definition of the success of a procedure.

A study of 91 patients with herniated disc and leg paresis (paralysis/mild weakness) who underwent microdiscectomy showed that success rates, in terms of regaining strength, were far from 95%. Only 75% of the study patients had regained strength in the affected leg one year after surgery. While this represents a majority, a quarter of the participants did not regain their strength; this is a remarkable percentage. See an abstract of the study at http://www.ncbi.nlm.nih.gov/pubmed/22193841.

Microdiscectomy is often successful in relieving pain, but it cannot reverse nerve damage that was already done before the procedure. If the sciatic nerve sustained damage that interfered with its ability to send motor and sensory impulses down the leg, it will not heal on its own after surgery. This means that if you have severe muscle weakness, microdiscectomy may not be a better option than conservative treatments to relieve nerve impingement. Decompression, traction, and exercise therapies should be followed rigorously before surgery is considered.

Nerve Regeneration

Nerve damage is usually permanent; There is no standard treatment to regenerate the sciatic nerve once the damage has occurred. Experimental treatments such as stem cell therapy and growth factor therapy are promising options, but access to them is limited. Your best option for these treatments is to seek trial studies to participate in or to travel outside the country for treatment.

Consuming omega-3 fatty acids, either from food or supplements, can stimulate nerve repair soon after injury. See http://www.sciencedaily.com/releases/2012/01/120111103856.htm for more information on this.

Electrical stimulation of the nerves can also help them repair themselves and grow back. This method has been tested on severe sciatic nerves in rats and was shown to promote regeneration. Check with local physical therapists, chiropractors, and other health professionals about the availability of functional electrical stimulation in your area.

Treatment with microdiscectomy is not likely to relieve severe leg weakness, as this is often caused by nerve damage. While it is important to resolve the cause of the sciatic nerve impingement, a surgical procedure may not be the best option due to cost, recovery time, and risks. Although severe nerve damage is usually permanent, new methods of nerve regeneration are being explored.