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Answer to your Health Question

Question (11/11/2012):

Title: Rare polyphasic potentials to the anterior tibialis .

My husband was cleaning out a wheat bin and his partner forgot to tie him off outside and he fell about 25-30 ft and landed on his butt and lower back because of the slope inside.

On May a neurosurgeon preformed a microdiscectomy for L5-S1 radiculopathy.

He was still having persistent/recurrent pain so the last week of October the Dr redid a MRI of the L & S spine.

The impression was enhancing epidural fibrosis partially encasing S1 nerve root an L5-S1 annular disc bulge and moderate foraminal disc protrusion with compression of L5 nerve root.

Then he had a EMG/NCS the impression said abnormal EMG/NCS with rare polyphasic potentials to the anterior tibialis, peroneus longus extensor hallucis longous,posterior tibialis an medial hamstring.

Rare positive sharp waves in the posterior tibialis muscle as well.

Does this mean he will probably need more surgery or that the nerve damage is permanent?

What do test results mean?

Answer:

Epidural fibrosis (EF) is a major cause of failed back surgery syndrome (FBSS), which induces disabling radiculopathy for which no effective medical treatment exists.

A foraminal disc protrusion is an important entity to recognize for a number of reasons.

First of all it is relatively easy to overlook as it does not impinge upon the spinal canal. Secondly as it does not narrow the subarticular recess it compresses the exiting nerve root only, thus clinically mimicking a posterolateral disc at the level above.

As posterolateral discs are common as is multilevel disease, missing a foraminal nerve root compression leading to only one level surgical decompression is a cause of failed back surgery.

Failed back surgery syndrome (also called FBSS, or failed back syndrome) is a misnomer, as it is not actually a syndrome - it is a much generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery and have experienced continued pain after surgery.

Despite advances in surgical technology, the rates of failed back surgery have not declined.

Treatment for failed back surgery syndrome may include physical therapy, nerve blocks, medications, injections or a chronic pain management program.


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