Re: conitnued back pain post fusion

Posted By CCF Neurology MD - AY on January 07, 1999 at 17:38:23:

In Reply to: conitnued back pain post fusion posted by Marni on January 07, 1999 at 15:26:45:






I am a 28 year old female who is 17 months post op from an anterior interbody BAK fusion with iliac crest bone graft.  I was diagnosed with degenerative disc at L5-S1 with a central and left annular tear.  3 months after surgery I underwent 6 months worth of physiotherapy - with an extremely dissatisfactory outcome to the point that my therapist told me I was wasting my money.  At present I experience constant back pain across my entire lower back (never less than 3/5 with 5 being excrutiating) and radiating around into my hips as well as extremely limited range of motion. Oftentimes I experience pain in my anterior and lateral thighs which continues from time to time into my posterior calf, though the severe leg pain I had prior to surgery is improved, it is not eliminated.  I have had a post op MRI which was negative, as well as 2 rounds of L4-5/L5-1 facet injections bi-laterally which did nothing but cause me more pain at the lower level.  I have had a CT scan of my hips, pelvis and SI joints which was unremarkable.  My most recent flexion/extension x-ays showed a difference in the spacing between L4-L5 which was (as my doctor put it) not grossly abnormal, but still they did not expect to see it.  I have never had a CT reconstruction of my entire lumbar spine, CT myelogram, EMG (what is it?)  nor a discogram (neither pre or post surgery).  Do you think any of these tests are necessary?  Also, I have been told by a family friend that 1 out of 30 people undergo back surgery ending up with unfavorable results and that this may well be my life now.  I cannot accept this as an answer.  I was not a typical back pain sufferer.  My problem came on suddenly and progressed rapidly, but prior to this episode (which has been going on for 2.5 years in total), I never had serious back problems - certainly nothing for which I would seek treatment or medical advice.  Is this my life?  Is there anything more that I can do - or at least hope for?  How could one tell if there was microscopic movement in my cages?  Could this cause so much pain.




Thanks for your question.  The electromyogram (EMG) is an electrodiagnostic
test that records the electric activity of peripheral nerves and the muscles
innervated by those nerves.  It can help in the evaluation of both spinal
cord, nerve roots, and peripheral nerve injuries because each one of such
injuries will display a specific pattern of alterations in the electric
activity of the studied nerves and muscles.  For instance, an active process
of denervation will result in the presence of fasciculations during the
Needle electromyographic exam (NEE) of the EMG test.  The different scenarios
are too lengthy to described in their full extent.  One of the possible
complications of any surgical intervention on the spine is the formation
of excessive scar tissue that results in the compression of the originally
affected structures.  Another possibility to consider is an instability
of the bony structures due to improper healing/consolidation process.
Please discuss these different possibilities with your surgeon, since he/she
would be in the best position to evaluate possible complications from the
initial surgical intervention.
I hope this information is helpful.  Best of luck.
This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.