Please excuse any use of medical terminology that is grossly out of place. I can only post what I understand based on what I’ve read and been told.
I know that it takes a long time for nerves to repair themselves on those occasions where repair is even possible. But just how does it work? If a portion of of major nerve is “stretched” (causing axonal damage that is not beyond repair) during back surgery, I can understand why it would effect an entire leg. It would then seem that once the stretched portion of nerve repairs itself – albeit very slowly because the axons take a relatively long time to reassemble and reconnect, the leg would return to its normal state, provided there was no unrepairable damage at the site of the original problem. But it seems that even though only a small amount of nerve was directly damaged, the nerves running the entire section of the leg to the foot must also undergo some sort of repair before things get back to normal.
So. instead of it taking just a couple of months at a rate of 1-5 mm per day, it could take up to two years, even though the nerves in the leg and foot weren’t directly involved. Why is this?
Maybe I’m posting in the wrong place, but I’m looking for information on why it takes so long for nerve function to return to a limb when the damage was to only a relativeley small portion of the nerve itself. I know this is a complex issue, but it has always puzzled me. I have had three back surgeries and the latest had some unexpected post-op complications. I’m not looking for legal info or for medical information using my specific numbers. I’m simply wondering why if there was a small area nerve outside the L5 nerve root stretched during surgery, why would it take at leat one and possibly two years to heal the effects.
For example, I have a mild to moderate foot drop in my left leg that I didn’t have prior to surgery. It is a result of minor nerve stretching or soft-tissue compression that occurred during the surgery. These things happen – it’s a risk of spinal surgery. However, I have two doctors saying 6 months or so (my surgeon and pain managemet doctor) and another 18-24 months (neurologist I was sent to by my surgeon for a second opinion).
The neurologist says the entire series of connected nerves must rheal (something to be with axonal damage – I’ve looked it up, but it doesn’t seem to address this specific issue). My pain management doctor says that once the section of nerve heals, it will reconnect with the remaining sections and everything will be fine within about 6 months. I haven’t spoken with my neurosurgeon yet (I see him tomorrow – Monday morning), but my pain doctor has spoken to him over the phone about my latest test results and that conversation led to the 6 month conclusion.
Based on the way nerves with several centimeters of repairable axonal damage heal, who is right? Any answer with some science behind it will go a long way toward helping my anxiety level. There’s a big difference betwen 6 months and 24 months worth of foot drop. AS far as I’m concerned, 24 months worth of recover borders on the “we’re not certain it will ever heal” prognosis.
I am nowhere near a doctor and this information is based on a google search. It’s possible that it depends on the person, obviously with injuries resulting in paralysis for example some people are able to overcome their injuries and regain movement and others aren’t.
Anyway, according to this wikipedia article: http://en.wikipedia.org/wiki/Nerve_injury there are three different types of nerve injuries, all of which presumably (the article doesn’t go into too much detail) have different prognoses.
And perhaps the doctor saying 24 months is just being conservative in his guess because he knows it depends on the person/injury and doesn’t want you to be discouraged if it’s not healed sooner rather than later? I would bring up the time discrepancies with all of your doctors, they can answer this a lot better than us.
Thanks for responding, CatherineZeta, I appreciate it. In my hunt to understand the doctorese, I came upon that same wiki article. My injury is in the second category, axonotmesis. My doctor’s have said that the majority of my problem involves axonal damage. I have been told that virtually none of them, if any, are in the third and most severe category.
Most places that address axonal damage give a healing rate of anywhere from 1-5 mm per day. They also say that complete recovery is quite often the result, with distance being the main factor in how long it takes to achieve that recovery.
My questions is: Distance from what? The distance from where the injury starts to where it ends? In my case, that’s only a few centimeters. For sake of discussion, let’s say 10 cm, which works out to 100 mm. At a very conservative recovery rate of 1 mm per day, that’s about 3 months. And let’s add on another two or three months for getting the whole system up running again. That would be the 3 to 6 month time frame. Given that, you’d think that soon I’d start noticing some recovery.
So where does the one to two year talk come from? Is there something more to this than I realize? If part of a nerve is damaged, does the whole nerve have to be replaced? If so, how can you discover at what point the recovery is?
Anecdote only. A family member had her throat operated on for thyroid about 2 years ago. In the process they “stretched” a nerve associated with her vocal cords. Sounds much like what you are talking about.
Her post-op voice was a whisper, then after some weeks improved to a good imitation of Minnie Mouse. The doctors told her they were cautiously optimistic it would come back to normal. Today, about two years later, she has roughly a normal voice (you probably wouldn’t notice a problem, maybe a huskiness), but it is not the same voice she took into the O.R. and I’ve commented to her that her voice is not the same as I knew it all the years before surgery. I’d guess (emphasis) about an 80% recovery in her case. She tells me that’s as good as it will get, her doctor says.
As you say, this stuff happens; it’s one of the risks of any surgery. You might be luckier. Don’t give serious weight to anecdotal tales told online, it’s one snapshot. Listen to your doctors–they went to school for this.