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Post surgery fluid buildup near L-5 causing pain?
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Post surgery fluid buildup near L-5 causing pain?

I had back surgery last month to fix a bulge on L-5 which was pinning the sciatic nerve. The procedure involved removing the ruptured material in order to give the nerve the space it would have under normal circumstances.. Two weeks after surgery I started having a repeat flairup of the pain I was experiencing prior to surgery which in the past week has come back with a vengence. Last Weds I had a followup MRI done to see if it could reveal what was going on. In talking with the surgeon's nurse today, she says that the MRI revealed a fluid buildup taking place..That my surgeon is on vacation this week and next, but he did get a chance to review the MRI and left his thoughts with her. That if she heard from me indicating that the switch from Gabapentin to Lyrica was not giving me any appreciable relief, that a " nerve root block injection ?" would be the next step to see if that can get this pain under control.

Has anybody in here ever found themselve's in the position that I find myself at the moment? Are you familar with this "injection" approach that he is asking me to consider? What exactly is this this substance and how would this help?

Any feedback would be most appreciated..I'm in unfamilar territory here and looking for any information that you all could share on this....David
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82861_tn?1333457511
Hi David and welcome to the forum.  :-)  

There aren't any doctors here but many members have had the same surgery that you did.  I can't imagine the disappointment of having the same pain return after surgery.  The fluid could POSSIBLY be a result of normal healing and response to inflammation.  Did your doctor happen to explain it's presence to you through his nurse?

I had two cervical surgeries myself, and found that ice really helped a lot in the first 6 weeks post-op.  A few times a day for no more than 20 minutes at a time made me so much more comfortable.

As for the injections, try not to panic.  You'll be knocked out with twilight anesthesia and a local so you won't even feel it.  Your doctor will inject a corticosteroid solution in the area that bathes the affected nerve roots.  It calms down the pain signal as well as treats localized inflammation at the site.  

Many people have a strongly positive response to the injections, but some feel no improvement at all.  If it's going to help, you'll know it quickly.  Given a choice between the injection and lyrica or neurontin, I personally would jump at the injection.  Risk of side effects or adverse reactions is quite a bit less with the injections.  Have a talk with your doctor before you make your decision.  Injections are a great option, particularly since the nerve meds aren't helping you.  Hope you feel better very soon!  :-)
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547368_tn?1332173665
Hello David,

Welcome to the Pain Management Forum. I am glad that you found us but so sorry to hear about the side effects from your surgery. It's so disappointing when we undergo a painful procedure to "fix" an anatomical problem only to develop problems from the fix. Don't despair this is most likely temporary.

When our body heals one of it's normal functions is to send healing fluid to the area of injury. Your body views the surgical correction as an injury or insult. For reasons unknown this fluid can come in an over abundance or fail to be absorbed. Sometimes the body continues to view this as an irritation therefore the fluid continues to develop. There are any number of reasons for this. So without going into a detailed medical explanation let me say that to my knowledge this fluid is usually harmless and occurs normally to some extent but unfortunately pain can accompany it.

I am not certain as to the exact procedure your surgeon is referring to when he said, "nerve root block injection." These words can mean any number of similar procedures. As Jaybay indicated the success of these procedures vary from individual to individual. It's not super painful. Depending on the procedure will determine the type of anesthesia used from twilight anesthesia to local freezing. Discuss the procedure with your surgeon and request adequate pain control during it. I encourage you to continue to take the approach you are and learn about your condition and the procedure available. Educate yourself before you make any decisions.

It is also true that sometimes this fluid will absorb in time and the body ceases to manufacture it. Everyone is a bit different. It seems now that the goal is pain management until your surgeon returns from vacation. Why is it they always seem to go on vacation when we need them? :)

Please let us know how you are doing. We will be interested to learn you outcome. Also feel free to ask additional questions. We are here to offer support and information based on our personal experiences and backgrounds. I wish you the very best and look forward to your updates.

Take Care,
~Tuck
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1283286_tn?1312915566
Thankyou Jay and Tuck..Both your comments have helped me immensily in sorting this out. Yes, Jay, this info was relayed to me thru his nurse without any real detail as to what this consists of. Therefore, I told her let me dwell on this some and I would get back with her. I would have liked to have discussed this with him but he's on his annual 2 week vacation with this week being the beginning. So in asking about this over in the substance abuse forum, one of the members there suggested this forum as a good place to possibly get a better picture of what this is. I'm seeking another opinion thru my primary doctor as well as he has the MRI film that he can look at to give me his impression of what he see's as a second opinion. I haven't heard back from him yet though so its a waiting game right now..I'll say this much though,,I had pain before surgery which was pretty bad but what I have now exceeds that. Something I definitely have to get addressed as this virtually has got me shutdown workwise..I never know when this is going to flair to the point I have to get off my feet so I've been real hesitant to take on some work thats available. I don't want to get caught up in a situation where I can't complete a job..Misc survey work is what I pick up from time to time so it involves a fair amount of walking....

Anyway thanks for the info..Very helpful :) David
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Avatar_f_tn
My husband is in a similar line of work, he's a contracted inspector for a railroad.  He has to walk out jobs and supervise job sites of directional drilling.  One thing I know he would say is "Don't stop moving".  He was hit by a drunk driver and was revivived on the scene.  He had a vertbra pushed out of the spine, held on only by the spinal cord.  He had to have a fusion and rods, and we joke that he's a cyborg.  His biggest advice he gives anyone in the contruction industry is "Don't stop because of the pain".  He swears by it and he's been off narcotic pain relievers for over 3 years now.  

When I had the nerve block they put me under completely.  I think they used fentanyl.  I think the major differences are epidural injections and facet injections.  I think the actual nerve block is more like the facet.  Sometimes the doctor's office has informational sheets on the procedures to give you an idea, and the surgeon should be able to show you on a model what he is going to do during the injection.  I have heard that in some people they are wonderful and take care of pain for 6 months to a year.  Some people have a less-favorable reaction.  
I hope that you are able to get back to your life soon.  I know how frustrating it is when pain interferes with what you need to do.
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Avatar_n_tn
Hello David,

I had surgery on my lower back (L3-L4) for a disk herniation back in March. I just found out this past wednesday July 28th when I went to go see a pain therpist that I also have a fluid buildup on my spine where I had the surgery. This has been there since I had the surgery back in March. I also had a slight low grade fever at the time of appointment of 99.1 so the pain therapist wouldn't do the epidural injection. He told me if the fluid stays in there long enough, it will become infected. So just an FYI you might not be able to get the injection like me because of the fluid buildup on your spine. I hope your pain recovers as I do myine recovers too, I am on Neurontin right now but just like you still have pain. I also have degenerative disk disease also! Hope you can get your pain handled!

~Tarra~
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1283286_tn?1312915566
Hi girls, I did go for the block injection this past Tuesday. Never did get a chance to discuss this with the surgeon but will tommorrow. It was a case where the pain got to be too much to handle middle of last week so I called his nurse and told her to line it up..Ok, a description:

Numbed it up with that good "bee sting" type numbing stuff..She then shot some dye in there and then followed that with a mix of a numbing med and some sort of steriod..She indicated it might take a couple days for the steriod to work. That by Friday (tommorrow) the full extent of the effectiveness should be known...Well, I'm not super optimistic here. I am living with a new flavor of pain..A constant ache inbetween a 4 and 5,,vs extreme spells 5 to 10 times a day with a break inbetween were there would be no pain.

So, it a toss up..It doesn't seem like I gained any ground here..I will say this though..I threw the pain meds out 9 days ago and am fighting through this setback without them..I flat got tired of them ruling my every thought..They had to go..
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547368_tn?1332173665
Hi Dave,

Thanks for the update. I am sorry it wasn't better news.

But don't be discouraged....your constant dull ache my begin to ease over the next few days and you may feel better. I've heard others describe their pain following an injection just as you have...and in a few days they noted improvement. I certainly hope that the same will be true for you.

Please let us know how you are doing.

~Tuck
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1283286_tn?1312915566
Thankyou Tuck, I'm skeptical but still being hopeful at the same time. I will get to finally sit down with my surgeon later this morning and see whats going on in there from the MRI we had done just over three weeks ago..About time! (darn rascal and his 2 week vacations! :)
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547368_tn?1332173665
I don't think physicians should be allowed to go on vacation without our approval. After all don't we employ them? :) :)

How did your appointment go today?

My Best,
~Tuck
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1283286_tn?1312915566
What a rat!  Sneaky surgeon I have Tuck! He's one of the formost surgeons in the field of inovations in regard to advances in back procedures. Well, he's been playing around with a new approach to handle post op internal bleeding in and around the disk site..It appears "I am" on the road to recovery is the positive I got from the appointment. MRI actually looked great at the surgery site which exception to some future problems in other area if not careful.

What happened was he had been using some sort of substance to kinda "seal" or paste the area where he craved the bulge off of the nerve cutting it back to the disk to try to help seal any residual bleeding that would persist post op until it scar tissued itself (scabbed over) or clotted up ....

Anyway, the stuff he used to keep the bleeding to a minimum aggrevated the surrounding area.. as it caused some inflammation in there as my body tried to combat it as a foreign material which led to some swelling and inflammation..Hence , pressure back on the nerve. He tells me the material used will dissolve in time but really couldn't tell me how long, but it will. Which once dissolved, would free up the whole channel in there removing the pressure issue I got from the swelling...So thats good news for me..I got copy's of the MRI as well so I can see for myself whats going on. I need to be careful though. I have 3 other disks I could see that are 30% to 50% bulged but not into the nerve..So I need to stay aware of that fact when doing any physical work...

Today actually " is " better pain wise..It has settled alot. Still doing waves of pain but not to extremes. He really didn't say how long it would take for this material to eventually be totally gone but at least I see light at the end of the tunnel..This little idea of his kinda threw the MRI people as to them ,it looked like excessive fluid buildup when actually it was this paste of whatever he had placed in there as he removed the tube he performed the procedure thru.It remined me of old indian remedies were they would take mud mixed with herbs or whatever to paste on an infection to help heal the area in question.

.What a rat though! He could have at least filled me in on this little experiment before he left on vacation as the past two weeks I was in depair thinking I was going to have problems the rest of my days..He has not done this added extra alot, but did indicate to me that he probably won't be doing much more of this as the dozen of so patients that this pasting method was used to cake the edge of the **** to "band-aid it" has created similar situations with the other patients..He said it was a plus/minus equation and he feels now that the pluses aren't quite enough to continue it as a few individuals encountered a some mild infections as well which took a little bit of work to get under control.  Thing is,,the rascal knew all along what was going on..Thats why the block shot instructions were left with his nurse..He's a good egg he is, but I said,,"ok, Hanley..no more surprises..ok you rascal!..You had me thinking I was looking at disability..To which He responded "well, as active as you are,,I figured I'd discuss this with you later to keep you pinned down so you won't go out a chainsaw trees down like you famous for in your survey work..

Yeah, ok Doc,,that humor,,I recognize that! ( You rascal!)..

Still have level 4 to 6 pain waving,,but tolerable..The tear bringing spikes are go..But like I said above, I have 3 more disks pushing 50% on bulging so from here on out I have to stay vigilant on the approaches I take when my work gets into the physical range.Especially bending over as I have a long back and am prone to compression..I'm 6'-6" without the shoes..Its like this: "In regard to my height ?? "Dad told me to grow up when I was a teen and I got confused"  "chuckles)  :).

Good news Tuck. I'm not out of the woods, but have sushine out on the horizon.Might be a month or so before it finally stabilizes.

.Btw, His name is Dr Edward Hanley,,Chief surgeon of Carolina Medical Center Ortho division in Charlotte. He's been a maverick in new procedures over the years and written a number of papers for the medical society..

So the appointment was a huge relief Tuck. Took a huge uncertainty off my mind (still feel like I could string him up though! :)  :) David
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1283286_tn?1312915566
Tuck,,why would they block out the word "disks" above? I just noticed that..Weird..Thats what was written where the stars are above. I used the word in several other place in this post. Some sort of computer default if some words are in proximity of another?..Its like over in the addiction forum I had a similar problem. Everytime I used the words "drug treatment" in a sentence as a recommendation to a poster asking for advice,, they would be removed..None of the senior girls in the forum over there could understand that..

Hope your day is starting well. I did get some measured sleep last night and only night sweated one t-shirt, so thats a change :) The mental burden of uncertainty is huge though. Its amazing how information such as what I gathered can roar right thru the depession I've been fighting with..Better results that any medication I could have been given..The mind certainly is a powerful influence when provided with the right type of stimulus..I feel a hint of peace now in my soul which has been long overdue..I have reclaimed hope for the future..Thats a very good thing..
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Avatar_f_tn
Dav, I have heard of the "bone wax" being used in Artificial Disc Replacements between the vertebra and the artificial disc to prevent scar tissue forming and causing mobility problems while healing.  It's good to know about the complications your surgeon has seen with it, though.  When I reviewed the surgery video and break down of the procedure it really looked like a good idea as I know scar tissue and adhesions can also cause pain.  They said on the website for the surgeon that the bone wax is relatively new.  Very good to hear someone's experience with it, though.
Sometimes MH blocks out some of the words I use.  I don't know why.  I have generally figured out which words it blocks out.  Like the word cr@p.  For some reason it always blocks that one out and in the context one generally uses it, it looks like a different bad word when blocked out.  One idea is that you might have made a typo in that particular use of the word and the computer assumed it was a typo of a different word.  I have seen that happen.
I'm glad to hear your surgeon finally explained what was going on.  I do understand him tricking you into taking it easy.  They would have to do that with my husband for sure.  He was back out pulling manhole lids and working days after his various surgeries.  Thank God he has a mostly desk and overseeing job now.
You're right about the mind being very powerful.  I have found that when my anxiety is high, so are my pain levels.  I also try to trick myself into believing I'm not in pain as a way to cope with it.  It doesn't really work, though.  I keep trying, though.  Distraction is a great tool.
I hope you are getting the rest you need and will just keep feeling better and better.  Thanks for keeping us updated and giving us all the good information about your experience.
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547368_tn?1332173665
Sorry David...I am tardy in my response. I'm the rascal now! :)

Great news!!  Just great news!! And what an interesting post...full of good information. Your surgeon sounds like he's top notch. However you got to be a guinea pig and didn't even know it.  :)  You must have been relieved to know that this is just a passing issue. You're right, he is a rascal!

Your case proves that radiologists can't always determine exactly what they are seeing on imaging. Of course that would be especially true because your surgeon kind of "snuck" that seal in.

I'm not sure if what you surgeon used is the same as the "bone wax" Jaded is referring to... as it has a different purpose than sealing....and is more widely used. Our surgeons at the leading spine center in our state are using it in certain situations. It would be interesting to know if they were the same.

Yes you must remember to be cautious. My dad was 6'5" and prone to spine issues till his passing a few months ago. He experienced compression and pathological fractures. His neurosurgeon said in part, it was due to his height. If that is true it also puts you at greater risk.

MedHelp blocks out words that look similar to undesirable words. Obviously it is computer driven program and often doesn't make sense. Why it chose to block disk (let's see if it's blocked) is puzzling. Could you have struck a wrong key and changed the letters/spelling and not have know it?  I think you meant to spell it d-i-s-c.

Again thank you for the update. I hope that you will continue to improve every day. A pain level of 4-6 is tolerable for awhile. We'll look forward to hearing from you soon.

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1283286_tn?1312915566
Morning all..Yes,,your right on target on "d-i-s-c"  vs  "d-i-s-k " Tuck...Dummy me!...I was wondering why the word looked funny to me?? !! (I am known for some "duh" moments in my life) :). And don't worry about the delayed response. I pretty much gave the computer and this site a rest over the weekend..Tried to stay busy canning cucumbers with a pickling mix along with par boiling or short steaming some other veggies I picked Saturday(pole beans lima's and corn to freeze in an effort to try to pre-occupy my mind and try to block out the nerve inflammation..

All this fun wasn't without consequence though....Lower back is tight,,slightly achy along with the nerve hovering at a consistant 4 at the moment in my butt and lower calf muscle.:( . I really am trying hard to get by with the neurontin and advil at present, but don't know how much longer I can keep this up as this lack of relief is wearing me down.

On your comment Jade about the type of sealant?,, I don't think this patch or whatever is this " bone wax" you mention... Sounded like a concoction(sp) he personally put together which as best as I could grasp the definition,,sounded more like a cross inbetween clear silicone and styrofoam type mix of materials...The way he worded it made me think of that "can" spray insulation one can buy to seal around window sills etc that expands after you spray it.

I really need to call him today though and try to pin him down as to a more specific time frame on this material to dissolve...I'm still not clear on how long this might take . I imagine the vague answer I have gotten so far is due to the possibility that he hasn't actually studied this with followup MRI's to track a more specific timeline. Might have to do with the experimental nature of this and the expense.

Had a few heavy duty flairups this weekend...Not the crippling extreme type like I had prior to the shot,, but enough to keep me headachy and in a less than favorable mood....Turns on and turns off on its own. No one particular movement triggers it nor can I find a sweet spot move that can get it to lighten up....It comes and goes as it please's...Sometimes lasts 5 to 10 minutes, sometimes an hour or more at times where I have to lay down or sit in my recliner and wait...I imagine its small shifts in maybe twisting my back that might possibly be just enough to create a shift in the mass of the patch pressuring the nerve.

I've heard something about what you describe Jaded in regard to artificial disc replacement but not a heck of alot. What I did see about it though struck me as a replacement material that would have the texture of a clear silicone after it cured..Not rigid, but not too soft.. So as to absorb any "shocking" or jarring one might experience like a person would experience if running for example..

There was a fellow I knew of a couple years ago that was considering this replacement procedure,, but when I caught up with him after hearing the rumor, I came to find out he decided against it..Not sure why but his age may have been a factor...He was in his 70's..

It would be real nice if we could find someone who has had it done though to hear any pro's or con's they may have about it. Hope everyone's week is starting well. Talk to you all later :)
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547368_tn?1332173665
I'll bet your right that your surgeon doesn't have a time stamp on the absorption rate of his "creation."  Add to that the fact that all our bodies are different and any time frame he gives you will most likely be a guess. :)

There is some information on various artificial disc replacement on the internet. A goggle should help you search through them.

I hope this week will be better for you as you continue to heal and improve.

~Tuck
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Avatar_f_tn
That is definetly an interesting "creation".  I've never heard of it before and it sound interesting.  Please let us know how it goes.  
I have read a lot on the subject of Artificial Disc Replacement, but haven't met anyone who's had it done.  My MIL has a close friend that had a double level ADR, and she is very satisfied with it, but she also had a fusion at the same time, so isn't too sure which feelings are the ADR and which are the fusion.  Altogether she is happy with the results.
My husband speculates that one reason we don't have many on the forum who've had an ADR is that they aren't in PM anymore, they're out living without the constant chronic pain.  I'm thinking it may be a combination of ADRs being less common and them working well.
I hope that you will continue to heal and improve as well.  It's great to hear stories of surgical success.
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1283286_tn?1312915566
Ok, me and my shortcomings on abbreviations this morning..Guess I need more coffee!..

Jade? MIL?? Mother in law ??  Btw, I did put a call into the surgeon's nurse yesterday ..Asking her to touch on the subject of this inhibitor paste or coating with Dr Hanley again..To tell him I am still not clear as to "how long" it may take for this material to "dissolve"..That I am uncomfortable here with this nerve acting up and really would like a better idea than the vague answer of,,,: "it will dissolve" in time! :) ..A month? Less?,,More?,,,, 2 months?,,
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Avatar_m_tn
Hi Dave, I just had my spine fused from S1 to L2, and was doing great. Then bam! It hurt so much I didn't see stars, I heard them. The hospital stay was less painfull. I can't do anything without horrible pain, except stay still, then it mellows out, but move even an inch, and the stars are back.
MRI with dye has shown fluid build up on my spine, they did a ton of tests to make sure infection wasn't in there, and thank goodness there was no infection.
I am now prisoner of my pain. I see my surgeon tomorrow, and I have been very happy with him. I just hope there is a way to remove the pressure and pain. I don't think I can take months of intense pain like this. I still have my morphine pills, and even they won't touch the pain.
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