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Psoas Muscle - EXCRUTIATING PAIN post XLIF

AnonymousUserAAnonymousUser Posts: 51,489
Greetings all,
I had an XLIF at L3-4 (on 12/30/08) with full disc removal and implementation of full instrumentation, and fusion. Actually, they had to remove instrumentation from an L4-5 XLIF fusion that was performed in April of this year, then re-install all hardware from L3-S1 to make for a smooth transition.

I have all the normal post-op pain...blah blah blah, but I am experiencing something I've never felt before- EXCRUTIATING pain and burning in my upper left leg and thigh. Honest to goodness, the only pain I've felt that could be called worse than this was the pain I felt during my discography.

My physician said the pain is a Psoas muscle response to the surgery, and that it should go away. He didn't seem too concerned about it, nor did he say that the pain would be just about enough to make me want to jump off my roof.

Has anybody experienced this in a post-op capacity, and if so, what did you do?

I am currently taking the following meds:

- 75 microgram Fentanyl patch (72 hours)
- 5mg Oxycodone ER (max. 60mg/day)
- 10mg Valium (2/day)
- Lyrica
- Prednisone

The Lyrica and Prednisone I just started yesterday, as a result of the this pain. Any advice would be great! The doctors don't want to hear it, and I my next step will involve very loud and uncomfortable verbiage in the middle of the spinal clinic.

Happy new year.
mike
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1345

Comments

  • Hi Mike, it sounds like your doc is taking this serious, with the lyrica and prednisone. That is exactly what I would have suggested you check in to. Hopefully you will see some improvement soon. If not, keep being the squeaky wheel, as we know who gets the oil :) I personally did not experience anything like you describe. I would say I felt like I had a giant muscle spasm from my shoulders to my knees on both sides. Hang in there, Cali-Sue
  • Hi Mike. I didn't really have psoas muscle issues right after surgery so I cant really relate. However, the Lyrica and prednisone should help this pain, but it will take a few days to start feeling the effects of both. As your doctor may have told you too, both these medications can have significant side effects but if you can bear with them you should get relief.
    Keep positive!

    Bruce

    ...an old timer here and ex-moderator

  • Mike, I've had several physiotherapy treatments where they "released" the psoas; I didn't find that any drug made a difference, it had to be manual therapy. It's probably a little early for you because of your surgery, but if it persists, it would be worth trying.

    Take care, and hope you heal quickly.

    Tracy
  • I had/have this pain still 6 weeks after surgery. It was so bad in the hospital after surgery that I could not even have my gown touching my skin on the right side. Gabapentin (generic Lyrica) has made is slightly more tolerable, but I think I need to up the dosage. My doc says that this is nerve irritation and that it should heal in time. My aunt had cervical fusion about 8 years ago and she described almost exact symptoms as me after surgery. She still has them...

    One Love,

    Stephanie
  • Hello Mike ~

    I can certainly empathize with you. I developed pain in my right thigh, on the front side, about 12 hours after surgery, when the PT started working with me. I have never had anything hurt so badly. I was still hooked up to an IV line with a morphine drip, so the nurse added something to it in an attempt to calm me down. I'll spare you all the details, but it made my recovery very difficult.

    My surgeon's assistant told me that I was laid out on my stomach for several hours during the surgery -- that the body gets put into peculiar positions while they are working on the patient, and even though they use padding and are careful, sometimes a patient will end up with pain from a nerve or soft tissue being crimped during the surgery. In my case, she thought it was the femoral nerve that runs right along that area.

    Several months later when I began physical therapy,in a clinic that only deals with spinal patients, my PT thought it was a psoas issue. We concentrated much of our time on that. I'll never know for sure what was causing the pain, but luckily it has gone away, a year later.

    I too was given Lyrica and took it for 6 months. It didn't help that much, and there was concern that it was damaging my kidneys, so I stopped taking it.

    I think the best they can do is guess at what might be causing your pain. It is a real mystery though how we come in with one set of problems and wake up from surgery with a whole new pain.

    Good luck. I hope your pain is temporary and will resolve as you heal.
  • balou2 said:
    Greetings all,
    I had an XLIF at L3-4 (on 12/30/08) with full disc removal and implementation of full instrumentation, and fusion. Actually, they had to remove instrumentation from an L4-5 XLIF fusion that was performed in April of this year, then re-install all hardware from L3-S1 to make for a smooth transition.

    I have all the normal post-op pain...blah blah blah, but I am experiencing something I've never felt before- EXCRUTIATING pain and burning in my upper left leg and thigh. Honest to goodness, the only pain I've felt that could be called worse than this was the pain I felt during my discography.

    My physician said the pain is a Psoas muscle response to the surgery, and that it should go away. He didn't seem too concerned about it, nor did he say that the pain would be just about enough to make me want to jump off my roof.

    Has anybody experienced this in a post-op capacity, and if so, what did you do?

    I am currently taking the following meds:

    - 75 microgram Fentanyl patch (72 hours)
    - 5mg Oxycodone ER (max. 60mg/day)
    - 10mg Valium (2/day)
    - Lyrica
    - Prednisone

    The Lyrica and Prednisone I just started yesterday, as a result of the this pain. Any advice would be great! The doctors don't want to hear it, and I my next step will involve very loud and uncomfortable verbiage in the middle of the spinal clinic.

    Happy new year.
    mike
  • Howdy folks,
    Well, I'm about 7 weeks post XLIF, and the leg pain has gotten incrementally worse. Originally, I thought it was caused by the psoas muscle, but it appears the cause is lateral femoral neuropathy. I have continued with the Lyrica, and am at the maximum daily dosage, as well as adding a prescription patch called Flector, that adheres to the affected area.

    I am truly at my wits end, as it is detracting from healing from the fusion, which seems to be doing o.k., thus far.

    Any new folks out there, who can add your experiences with this? I did some reading on femoral nerve damage and found that it can take longer and be more painful to heal from than the fusion.

    Best,
    mike
  • Hi Mike,
    Sorry to hear about your struggles. I perform Neuromonitoring in spine/brain surgeries for a living. I have CNIM and R.EEG,T. certifications and have been practicing since 2003. We monitor the pathways of the nervous system during the length of the procedure and keep the surgeon informed of any Neurophysiological changes that might lead to post operative deficits. I routinely run into this NuVasive company in the OR, often with X-lifs. From my personal experience and the general consensus is that their monitoring equipment is unreliable. It also might have to do with the fact that the NuVasive sales representatives run the monitoring machine during the case. Their whole monitoring system was developed as a 'Trojan Horse' to sell more instrumentation, not necessarily for pt care. I could not be more opposed to this in a professional or personal matter. I am sorry that you are still suffering. I hope that your surgeon made clear the possible complications beforehand, especially the for the genitofemoral and femoral nerves that run through the Psoas. Don’t get me wrong, the X-lif procedure can do wonderful things for the patient if it is monitored correctly. Some advice I can give you is to find out what kind of monitoring you had, if a monitoring record exists and if there was other types of monitoring available that were not performed. You are not alone, complications with the psoas are more common that surgeons or Nuvasive want to admit. I have attached an article that might be of interest to you. Good luck

    Herb


    http://www.spine.org/Pages/Publications/SpineLine/CurveSurvey/Archives/cc_sle08mayjun.aspx
  • This is a real eye opener for me. I had a PLIF in Jan. of 2008. The second day while working with the PT I developed instant, excruciating pain the in front of my right thigh. It is not as bad now, but I still have it and have been trying to figure out for 15 months what's going on.

    At first the surgeon's PA suggested that it might be something to do with the femoral nerve and explained that I was in some stressful positions during the nearly 4 hour surgery...and sometimes patients ended up with some temporary problems with the femoral nerve....

    I will follow this post with interest.
  • Oops -- I see I posted on this topic previously!!

    Sorry -- guess the meds are affecting my brain cells. @)
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