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Psoas Muscle - EXCRUTIATING PAIN post XLIF

AnonymousUserAAnonymousUser Posts: 51,465
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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1

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. @)
  • Any further news from anyone who had thigh pain after fusion surgery??

    Has anyone had a diagnosis for their pain?
  • Are you feeling any better yet?
    I had an x-lif with fusion at L3-L4 in April 2007 and another x-lif from the other side attempting fusion at L4-L5, but they were unable to access the disc. That was in August 2007. I have pain in both legs so bad that I am unable to sit for any length of time. My doctors and I have been assuming that the pain was from nerve compression. I went to an acupuncturist yesterday who tested me and felt that the problem was related to the psoas muscle. He feels that with acupuncture and physical therapy I should be able to return to work. I'll post back when I know the results.
    By the way,in the past two years I have taken massive doses of narcotics to no avail. I'm also on 4000mg of neurontin.
  • Has anybody had nerve block for continuing thigh pain? I am now 15 weeks post op and my surgeon has prescribed nerve block at L2 . I need to get off Neurotonin, I can't stand how it makes me feel. I am scheduled for Friday.
  • Had nerve block L2 on May 16. Had 2 separate non- consecutive days without pain but it didn't last. I also discontinued Neurontin but was put back on it yesterday, too much pain without. Now scheduled for L3 injection on June 3. Both my surgeon and the "needle guy" feel pain is coming from nerve that is stretched during surgery and it takes awhile for the nerve to get back to normal. I will be 4 months post op June 2.
  • Not to be a downer, but both my surgeons have decided that my nerve is responsible for my pain -- it is not compressed and nothing can be done surgically.

    I had fusion at L4-5 in Jan of '08 and then a smaller surgery this past Jan at L5-S1, all in an attempt to solve my radiculopathy. I have had many ESIs, nerve blocks, SI joint injections, etc. and I now feel just like I did prior to any of this medical intervention.

    The doctors seem to agree that the nerve itself is scarred (not that scar tissue is pressing on the nerve)and that is the source of my pain now. Previously it was compressed. Now it is like a frayed electrical cord and just sends out various wacky signals that keep me with chronic pain.

    So I have parted ways with my surgeons, at least for now, and am going to two people who are acupuncturists and have master's degrees in Chinese medicine and herbs. Not sure where this will lead....but I'm not ready to give up entirely!!

    xx Gwennie
  • Diagnosed with advanced arhritis and severe degenerative disc disease 2007. Tried PT, accupuncture and epidurals.I finally had XLIF L2-L3 & L3 - L4 with insertion of 2 rods and 6 screws Feb. 2, 2009. My surgeon was part of the team that developed the procedure. Awoke from anesthesia with excrusiating pain in right thigh, initially treated with IV steroids and Neurontin, which helped somewhat. My whole thigh was numb for 7-8 weeks. It still hurts to have leg in bent position for any length of time, sitting is miserable. I am currently taking Vicodin and Neurontin and have completed another series of PT. I walk daily. My surgeon sent me for a second opinion to determine cause of pain and that ortho is thinking of doing a mylogram (had CT scan one week post surgery because of severe leg pain, it was normal). Has anyone definitively found cause of leg pain? Has anyone gotten over the leg pain? I'm so tired of painful procedures, don't want anymore!
  • 2 weeks ago I had my second spinal injection post surgery and I have finally had relief from the continuous thigh pain. I can sit for long periods without pain, put on my socks, etc. I am still on neurontin, but at 600 mg per day. My biggest problem now is back pain where all the hardware is in my back. That started Memorial Day weekend. Has anybody else had that problem? My "needle doc" says that could be because my body is trying to get used to it. If it continues until next week, I'm calling the surgeon back. My back didn't hurt the last time I saw him. By the way I'm still on Vicodin also. I am now 4 1/2 months post op.
  • Anyone ever had XLIF move and not stay in place and have to have second XLIF procedure and have it yet move again.

    HELP ME
  • I had an incident at night when I got up that felt like something moved, 10 plus pain , basically passed out on bed. Next morning, pain level 5 at 5 months post-op. Surgeon took an x-ray and said everything ok, but something must have shifted temporarily. Did you have rods put in to anchor the cage? I had 2 rods with 2 cages.
  • I agree, go in for a manual release of the psoas, works wonders! I am going to do the same as I am sure mine is tight now too and is causing some of my post op pain issues.
  • I too am still experiencing nerve pain after XLIF on 12/15/09. I am still taking Neurontin and using Lidoderm patches quite alot. I am still wondering when it will end also, I am so... tired of it.
    gigi
  • Hello Mike,

    I'm a new-be to this site as of 10 minutes ago. WOW! It's refreshing to find out I'm not alone with all of this pain.

    The psosas release is a simple stretch that can be done several ways.
    1. To stretch the side of involvement, mine being the left, place your right knee on the floor directly under your hip. Place your left foot out in front of your left hip to where the knee is at an angle slightly greater than 90 degrees. Making sure to keep your hips and shoulders square, gentley lean forward making sure to keep your back straight and your head directly over your shoulders looking forward. This is important:
    NEVER hold a stretch longer than 2 seconds. By doing this you will fool the protective stretch reflex located in all muscles.
    I hope this helps, if anyone would like to know any other ways to release the psoas, just ask.

    In my case, the back pain started just over a year ago. My left lower back and left psoas are involved. MRI shows mild DDD with some arthropy and signifiant buldging from L2 thru S1. I rate the pain at a 22 most of the time. I swear you could cook eggs on the bottoms of my feet. Tuesday I received 4 levels of the facet block. So far, no change.

    Does anyone out there relate to my situation? Would love to hear from you.

    I use the name of max the kook because my speciality is getting rid of pain. Now that I'm in the terrific system of our healthcare system, the doc's think it's all in my head--the pain. Being in the field of healthcare seems to make matters worse.

    Jeff
  • I had a microdisectomy in Aug 2008, then on Dec 11, 2008 I had the X-Lif...I had to learn to walk again. My pain was in the right leg, but my left leg became the weaker leg. I am still doing physical therapy with pilates 2x a week and working only 4 hrs/day. My left leg is still week and it appears to be almost frozen, adhesive capulitis. The pain when moved in different directions is horrible. I don't take pain meds but I do take xanex to sleep because there is no comfortable way to position myself. Are we just be experimented on?
  • I have a xlif surgery,Since i had that done i had to learn to work,Its been 8 months The pain in my leg is terrible.weakness in the upper leg and numminess in calf, plus my knee buckleing out.Please someone help me Thank you, Tom
  • My mother (67 years old) just had the XLIF surgery. First part was on Thursday 5/20. The second part was on Tuesday, 5/25. Prior to surgery, she was mostly independent. She could walk with a walker or a cane most of the time, but with some weakness in both legs. For long distances, she required a wheelchair. Since the second part of the XLIF surgery, she has had truly excruciating pain (to the point of screaming) coming from the back of her right hip. At times she can't even sit up. It seems that putting any pressure on her right side - even just sitting - aggravates whatever it is that's causing the pain. She can't walk at all unless she has had a heavy dose of pain medication. When she tries to walk the pain is so bad she starts to collapse after just a couple of steps. PT hasn't been able to work with her much at all. So, she is almost bedridden now, which means she has to rely on other people to do almost everything for her, including bringing her a bed pan, which she absolutely hates. She has consistently complained of pain along the outside of both thighs. I so wish I had researched XLIF before she had it. Her surgeon is a highly regarded neurosurgeon. We assumed he knew what he was doing. Both he and another surgeon (resident?) said the pain was probably coming from her "bursa". The surgeon contacted my mother's pain management doctor, and that doctor gave my mother an injection in the hip. It seemed to relieve the pain for about 1 day. No one ever mentioned anything about a "psoas" muscle. Various medical professionals (doctors, nurses, PTs) have told her the standard things about how she just needs to give her body time to heal after surgery, about inflammation, etc. While that may be true, it seems something serious with long-term implications may have happened.

    My mother was transferred from the hospital to a skilled nursing facility this past Thursday. She does not tolerate pain well at all. She gets very agitated. In the hospital, they had to start her on on Zyprexa to keep her calm. Now that she is in the SNF, she is getting less pain medication than she was getting in the hospital. So far, they are not managing her pain well at all. Prior to surgery, she was taking about eight 10-325 Percocet daily, plus ibuprofen in between the doses of Percocet. They've now cut her dose of Percocet, and she can't have any ibuprofen because it would interfere with the healing of the fusion.

    She is getting very depressed and angry about the whole situation, especially since she seems to be in worse condition now than she was before the surgery. At least prior to surgery she could walk most of the time and be independent. Now she has to be moved in a wheelchair, and even that is painful. We have been hoping her pain would subside in a few days, but after having read these posts, I am very concerned she could end up having a long-term debilitation. Today is Sunday. I intend to call the neurosurgeon's office on Monday to ask some serious questions about my mother's prognosis.

    I would really like to hear an update from those of you who wrote about your post-XLIF problems. How are you now? Did the pain ever subside? If so, what worked? Did you require additional surgery?

    By the way... if you go into a hospital for a procedure and stay for any length of time, I strongly recommend you review your medication orders with your nurse to ensure no one accidentally transcribed your medications or dosages incorrectly. In my mother's case, someone did not correctly record her Effexor dose. She was supposed to be taking 75 mg twice a day, but they were only giving it to her once a day. We didn't discover the mistake until she had been there about 10 days.

    *****************************************************
    *****************************************************
    8/22/2010 FOLLOW-UP:
    My mother's hip pain did eventually go away and she got better. She can walk now, and she lives independently again. However, she is "bent over" at the waist. That is, she can't stand up straight. She had that problem before the XLIF. Whenever she was in terrible pain she became "bent over". We had hoped the surgery would allow her to stand up straight. She has multiple levels fused now. At least three. I'm not sure. She does physical therapy in a swimming pool. Her physical therapist told her it will take time for her to build enough strength to be able to stand up straight.

    When I originally posted this I was very worried my mother had some sort of permanent damage from the surgery. She seems to be making progress now, though. I just wanted to post this update for anyone who is concerned about about the hip pain after surgery.

    PS. It wasn't my intention to "hijack" Anonymous's original post. I just had a lot to say.
  • Here is my XLIF, 2 years post-op:

    http://i52.tinypic.com/2sg2s.jpg

    My pain has been excruciating. I don't think there is anything holding me together.

    My hip gets RED HOT, my legs get muscle spasms, my back is always spasm'd.....

    Those metal pins are floating there and it doesn't look like any bone has fused!!!!

    HURTS LIKE HECK!!! Somebody HELP!!!
  • I do not think those metal pins are floating there, I believe they are cages that were put in. check with your MD.
  • 3 weeks ago tomorrow... i have also in the past had the ALIF/PLIF twice- and i was shocked by my pain levels i experienced with this XLIF/PLIF- and it was primarily the leg/ thigh pain i had from the XLIF... i am also STILL swollen up like a balloon through my middle- to the point that shirts and tops that are normally GIANT on me are almost tight!!! for those who had the thigh pain how long does/ did it last? this is HORRIBLE!!!!!! help!
    i also have a big hump in my back under the skin that WAS NOT there before- i am starting to feel ruined
  • sharyn51 said:
    I do not think those metal pins are floating there, I believe they are cages that were put in. check with your MD.
    Sharyn51,

    They are using PEEK plastic spacers to put in the disc space. The FDA approval letter for them says the titanium pins inside them are only there so surgeons can see orientation when putting them in. They do NOT protrude from the plastic spacer.

    The FDA Approval Letter says FIXATION was supposed to be used with those PEEK spacer implants. They used NO fixation on me. They just went in thru the side and took out the disc, hammered in the PEEK spacer, closed me up. You can find the FDA approval letter on the FDA Medical Devices website.

    Now when the doctors hammer my knees for reflex tests my legs don't move anymore. Femoral nerve is damaged. I am now 2 years post op, can't get into a position to sleep. Legs bother me too much. Hips get red hot. Also on the lower part of my back there's a bulge there now. In my Xray's you can see the whole area around the implant is bulging, pinching off nerves. More pain now than before the surgery.
  • Also for the XLIF procedure they hammer in the PEEK plastic disc spacer.

    image

    Look at Vertebrae L3, see the "gouge" on the backside of it?

    Looks like they broke the back half off of L4 and it's been grinding into L3.

    L4/L5 is the "fused" area. Notice the massive bulge in the front? That's got to be effecting the nerves/blood veins transversing that area.

    XLIF=bad.
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