Pain developed 5-6 months after Lumbar Fusion (L5-S1)

[Krash48]

Long story so please bear with me....was in a car accident in 2008.  I suffered a torn rotator cuff in my left shoulder and a broken bone in my hand, along with neck pain and general body aches.  Everything was dismissed by the clinic I had to go to for workman's comp except for my shoulder and hand.  I returned to work and suffered chronic neck pain, migraines, and low back pain shooting down my legs.  I had a cervical MRI which was misdiagnosed as clear in April 2009.  I waited 3 months to see the head of orthopaedic spinal surgery in Troy, MI at Troy Beaumont Hospital (Dr Richard Easton).  He immediately diagnosed 2 ruptured discs in my neck at C4-C6 and I had a double anterior fusion done in December 2009.  I was also diagnosed with a severely ruptured disc at L5-St which had developed  scar tissue on my sciatic nerves on both sides so I was suffering extreme pain and numbness/tingling from disc fluid pressure and scar tissue pressure.  I had a laminectomy in March of 2010 and underwent a month of physical therapy and then an extra month of aquatic therapy.  During the aquatic therapy, I was pushed too hard and re-ruptured the repaired disc.  I had a Lumbar Fusion L5-S1 in January 2011.  The surgery went great, I recovered well and followed all instructions for the 3 months of rest, then began physical therapy and had very little if any pain.  I finished my 1 month and started going to the gym on my own walking on the treadmill and doing the exercises I was doing in physical therapy.  I used the elliptical machine a few times but I started having low back pain going across my waistline, down into my butt/hip, and down my left leg.  It has gotten progressively worse over time and I was told by my doctor to cease activity.  I still do stretches and walk but the only thing I've done at the gym is use the pool to try to keep things loosened up.  It feels like the muscles around the left side of my pelvis are very tight and I spend a lot of time trying to loosen them to help relieve the pain but it doesn't last long.  I am on Norco 7.2/325 (2 every 6 hours, max 6/day), Percocet 7.5/325  1 every 8 hours, Motrin 600 1 every 8 hours, Neurontin 400mg 1 every 8 hours, Tinazidine 1 as needed, Robaxin 750mg 1 every 8 hours, and Elavil 100mg 1 per night,   It's amazing that all that just doesn't provide relief.  It barely takes the edge off and allows me to function.  With the pain returning so long after my fusion I cannot figure out if there's scar tissue in there again or if a facet joint is blocked/affected.  I'm going in for my 2nd caudal epidural steroid injection tomorrow morning and am hoping for some relief, but the first one didn't offer much relief and I'm headed back in within a month.  I will have to look in to a selective nerve root block maybe.  I don't want to live on narcotics and my pain management doctor doesn't wan to resort to the either so I'm trying everything.  The pain is the same type of pain I had while waiting for the fusion surgery I had in January - it's just on the other side.  If it progresses to tingling and numbness I will definitely be concerned.  I'm trying to go back to work full duty, not go under the knife again.  The pain in my hips from laying down so much has skyrocketed and I've had bursitis in both hips and had injections done in both.  I feel that my current off-brand memory foam bed is insufficient, so I just bought a Tempurpedic Cloud Luxe and cannot wait for it's delivery so I can see if I don't wake up in pain because of pressure points or sleeping in the dent in the middle of my bed. I do leg, hamstring, calf, and pelvis exercises daily to try to keep things loose and equal.  I sleep with a pillow between my knees as well,  but my left side is KILLING me.   I feel that the Neurontin is not helping me at all and is just giving me side affects (making me angry, causing memory lapses, sometimes searching for words when talking...)  I'm EXHAUSTED all day every day.  No matter how long I stay in bed, I wake up every hour or two and am up for a while even though my room is dark.  I take Xanax and Restoril for sleep but my mind wins the battle.  Well, that's my story.  Thanks for anyone who took the time to listen.  I'm open to any advice.

[Shazam2008]

I have the exact same problems. Same operation same pains..everything !! Operation was January 2014 and Now July with pain getting worse. Once I am up and walking awhile the pain seems to ease up. I have a desk job and sitting to long makes my back pain worse. Go back for x-rays and visit with my surgeon at the end of the month. I know I won't agree to surgery again as I ended up catching Sepsis in the hospital and almost died. I've heard there are some Lazar options available out there and will look into that before ever agreeing to another surgery.    

[S. Kaul, MD]

Hi there!

Well, you may probably need to change you bed, or add a broad plank (wooden/ iron) for centre support. Aside the nerves, narrowing of the spinal canal may give a constricting type of pain around the waist. With your current symptoms I would strongly suggest a re-evaluation as well; based on which we could decide which way to go for management, either conservative or interventional.
Hope this is useful.

Take care!

[Krash48]

Thank you for the very professional and helpful advice.  I tested beds in the store, but you really can't get a great feel for one until you sleep on it for a while, so I purchased the one I liked best, and I have a 90 night home trial to send it back and exchange it for a different model if I feel the one I have is too soft.  I believe I located the problem with my current bed - I have a box style steel bed frame but there is no center support bar so over time the sag in the middle has developed and the lack of solid support to my surgically repaired area HAS to be causing me problems.

As for my severe symptoms in general, I had a CT/Myelogram in June and was told there was still swelling and healing at the surgical site, particularly on the left aide (where my pain is the worst) but that there was no sign of scar tissue or nerve impingement.  I've since had the 2 caudal ESI injections with no relief and began physical therapy yesterday.  I spoke with my surgeons head nurse and she documented where/what type of pain I'm having and I should be getting the doctors opinion next week.  The nurse believes he'll immediately want an MRI with contrast.  The CT had shown one of the pedicle screws "poked through into the anterior cortex" on the left side of my fusion which 9 months pater is still healing.  The screw is not loose, it just went through.  I was reassured by the surgical nurse that the doctor placed the screw where/how it is and how tight it had to be and that it's common for them to go through.  The screw is not touching any tissue or nerves.

As you mentioned,  I would like to try a selective nerve block to see if we can find which one is being so affected.  The pain goes right across my waistline, down my backside, down my leg and into my foot, which is near exact the type of pain I had before the surgery.   I had an injury - The disc at L5-S1 was completely ruptured, with no sign of degeneration on any surrounding discs.

[S. Kaul, MD]

Hi there!

Well, without a clinical evaluation with probably a detailed imaging study such as the MRI, it would be difficult to determine the cause of your discomfort. It could be further degeneration, development of scar tissue or related issues. As for the current situation, I would suggest considering a re-evaluation by an orthopedician to identify the cause and if an ‘orthopedic’ management plan (conservative, interventional or surgical) would be advisable at this stage. If your orthopedician believe that pain management would be an appropriate option at this time, nerve root block may be a potential option for chronic pain relief along with others. Also for the mattress, I would always advise using a firm one (neither too hard nor too soft) and test one before purchasing it. Select control mattresses with adjustable firmness for different sleep numbers may be an option worth considering if you develop issues again. It would be inappropriate to comment further without the relevant details. I would suggest discussing the current situation in detail with your orthopedician, so that a further management plan can be worked out.
Hope this helps.

Take care!