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Almost 5 weeks post ALIF w/pedicle screws and in MAJOR PAIN

AnonymousUserAAnonymousUser Posts: 49,670
edited 06/11/2012 - 8:40 AM in Pain Management
So, December 1st, 2009 I underwent an ALIF with pedicle screw placement to repair a pars defect and slipped disk at the L5-S1 level. The surgery took about 3 and a half hours and I'm told it went perfectly. For the first 10 hrs or so I was medicated with subcutaneous morphine which worked fairly well. The next day I was discharged home on percocet 5/325 strength with instructions to take ONE every 6 hrs as needed. Well, that lasted a little over a week. Then, when I was still having pain, they gave me vicodin 5/500 (and a BIG attitude because how dare I still be in pain). That lasted about 3 weeks and I was feeling pretty good but then suddenly developed extreme right leg sciatic pain. When I called the doctor they put me on a steroid taper for "nerve inflammation". When it did not touch the pain they decided they would see me in the office. So, December 30th I was seen by the surgeon. They took x-rays and because the hardware had not shifted and "looked excellent" I was told basically to suck it up and deal with the pain (taking motrin 800-1200 mg every 6 hrs and tylenol in between is doing NOTHING-except killing my kidneys and liver perhaps?).
So, that being said, I need some feedback. Is it unrealistic to still be in pain? Could I have nerve damage going on? I am at my wits end with this pain. I cannot function. I cannot do my rehab stretches because it makes it so bad that I cry and then my husband gets pissed and tells me to go lay down (which I do but then get stiffer).
Prior to having the procedure I went a long time having some good days, and some bad....but NEVER was on narcotics for the pain. So why is he treating me like I am lying about all the pain I am having in order to just get pain meds (I would MUCH RATHER be pain free w/o meds and back at my job!)
Oh and I now have "bladder control issues" since the surgery.



  • You should insist that the surgeon do a new MRI or Ctscan. It's possible that a piece of the disc that was removed was left in there and pressing on a nerve. In my opinion, you shouldn't be in that much pain 5wks after ALIF L5/S1. I had the same surgery with pedicle screws, cage and plate with BMP.

    The fact that you are having bladder control issues is reason in itself to be concerned and talk to your surgeon asap. Did you mention the bladder issues to him? This is not something to take lightly.

    Please contact your surgeon asap and if he doesn't listen then go to the emergency room or contact your primary doctor. Given the bladder issue this could be something serious. I don't mean to scare you.

    I felt pretty good 4-6 wks after my fusion. I didn't start having issues until 3 months post op after I had a fall and now have 2 broken screws and possible failed fusion.
  • Perhaps it is your surgeon's ego that is preventing him from admitting that you are still in pain....If it helps to ease your mind, many people are still in pain at the five week mark after lumbar fusion.

    I had a PLIF at L4-5 two years ago. I was in the hospital for three nights, which is standard for my city for an open lumbar fusion. Fortunately my surgeon believes in drugs and I was not subjected to these silly notions that you should be pain-free in a matter of days, and if you are not, something is wrong with you. I don't remember the dosages, but I was given oxycodone, vicadin and Lyrica from the day I was discharged...and I took them for the first eight weeks. I set an alarm and woke up to take my night-time dosage because that's what the doctor told me to do.

    Finally after eight weeks, it occurred to me that I probably could do OK without, so I just stopped, but continued to take the Lyrica.

    Of course each body heals differently and at a different pace. If you have had an X-ray, it will only show if the hardware is still in place. You will need a MRI to show anything else that might be going on. Doctors do not like to order them so early in the healing process, but I had one at 3 weeks because I was having terrible pain that I had never had prior to surgery. You may have to be insistent with your surgeon...let him know, in an unemotional way as possible, that you are in more pain than you can handle...and then be prepared to give him specifics -- not just "I can't stand it...type thing."

    When you suddenly develop pain after feeling like you are slowly getting better it is often not a good sign. It can be that scar tissue is attaching to a nerve and pressing on it, for example.

    It could be that a pedicle screw is too close to the nerve, or it is possible that your body is not going to accept the implants, for whatever reason. There ARE factual reasons why you are experiencing an increase in pain after surgery. Do not let the surgeon convince you it is all in your head.

    It may be appropriate for you to be on a medication for nerve pain, such as Lyrica, or neurontin (gabapentin). Sometimes cymbalta is also given.

    If your surgeon is reluctant to do this, you may have to seek out the services of an interventional pain management doctor who will prescribe meds for you. But your surgeon should be following through to find out why your pain came on suddenly three weeks after surgery when you had been doing better.

    It may be that your nerve was just compressed sufficiently long that it is damaged and it will take time to regenerate. Perhaps the surgeon had to tug around on it to free it up during the surgery. This type of pain usually is present right after surgery and very, very gradually gets better as the weeks and months progress. You usually do not feel better for a period of time and then get worse. You can read about scar tissue here:


    Good luck in tracking down the source of your pain. You may have to stand up for yourself and be firm. Some surgeons are not keen to deal with someone who continues to have pain after surgery, regardless of the reason.


  • Gwennie just reminded me that it may be a good idea to keep a pain journal as detailed as possible so that you can give your surgeon more accurate info such as pain levels and what you were doing at the time and such.

    I also forgot to mention that when I was discharged, the surgeon sent me home with 10/325 hydrocodone and I had to take 2 every 4-6hrs for the 2-3wks afterwards and then I slowly started tapering down. I was also already on cymbalta for depression but knew that it helped with nerve pain as well.

    My biggest concern with what you mentioned was the bladder control issue. Please keep us posted and be persistent with your surgeon.
  • Oh wait!! I totally missed your last sentence about bladder control issues. This is the one potential sign of a back issue that is considered a medical emergency. Anyone with lower lumbar problems who develops bladder or bowel issues should immediately contact his or her physician or go to the emergency room, if the doctor is unavailable. It can be a sign of cauda equina syndrome and can quickly result in permanent nerve damage.

    Anyone with lumbar issues needs to be aware of the symptoms of CES. Please read about it here:

  • wow! Thanks for all the feedback everyone. Very much appreciated. I have a call out to the surgeon since 10 am this morning. I got a call back from the medical assistant who said she would "run it by the doctor" and see what he said, because I have now started using flector patches (which I had laying around due to my stupid knee issues) because thats how desperate I am for pain relief. Like I told them on the phone today, I DID NOT appreciate that it had been implied that it was in my head and/or I was just looking for pain meds. I still woke up in pain this morning despite a middle of the night motrin dose of 800 mg and wearing the patch all night.

    I'm forgot to mention the bladder issue to them, but when they call me I will. It seems to maybe be getting better as I'm only incontinent when I sneeze or cough (but this used to not happen pre-op).

    I was thinking about what y'all said about an MRI, I had though of asking for one the other day but was afraid he would again treat me arrogantly. But, I will definitely press the issue now. I feel like I know my body well enough that SOMETHING is not right. Maybe its a screw irritating the nerve or any of the other possible causes you guys suggested.

    I thank you very much for your help...I will keep you posted!
  • I have been suffering from what I beleive if a failed back surgery. It was a fusion of L5/S1 and it is pretty obvious to me that mistakes were made. The surgery was September 08 and I am still in a great deal of pain, levels 5-9. After a nerve test (which you may want to look into), my PM doc scheduled a myleogram which is supposed to provide a greater level of detail that is normally not acheived in an MRI or X-Ray.

    Supposedly, it shows up the disc fragments that were mentioned by another person on this thread. I just warn you, if you get the myleogram to make sure you do not get up too quickly following the procedure. I was told to get up by my nurse far too early after the procedure and aparently had the dye used in the myleogram go up my spinal column and into my brain....it was the worst pain I ever experienced inside my head. They had to perform a blood patch procedure which instantly took away the head pain.

    I dont want to take up too much room here, but if you need an L5/S1 buddy to converse with, I can share my experiences with you. At this point, I am done with my local neuro-surgeons (Tampa area) and have been registered at the Univ Of Penn Hospital for a neuro-surgical review for FBS. I am also trying to see if I have enough finances to get myself into the Mayo clinic as my insurance does not cover Mayo...:(

    I truly wish you the best of luck and my heart goes out to you and all the others here.

  • Did you get a hold of the surgeon and were you able to mention the bladder control issue? I was just thinking of you this morning. Please keep us posted.
  • I also had the L5-S1 ALIF back in march of 2009. I believe that it was a success on the basis that I'm in less pain as before and I can stand up straight, but I still walk with a slight limp. My surgeon was great and he told me that in no shape or form will this completely cure me of all my pain. He gave me a 70% success ratio. For all of those non-believers of us that say we shouldn't have any pain, why don't you go under the knife for 4 hours. The surgeons went through my stomach instead of going through the back. I have a scar about where a woman would have a C-section. I was in the hospital for 3 days after surgery, on a very potent IV drip, and was on meds for weeks afterwards. I was up walking the day of surgery, after I completely woke up from being put under. I did have a problem with the cath though. My cath got stuck on the way out and become lodged in the tip of my penis. It was extremely painful and took almost 20 minutes to remove. I still have bladder problems and find myself having to sit down and urinate most of the time. I don't know why it makes a difference standing compared sitting, but it does. Its been almost a year now, and I'm starting to have more pain now, and had all the tests done again, and come to find out, I have yet another disc that needs to be removed. I worked from the time I turned 16, and now I'm 30. I've been told that I would probably never work again. I worked in heating and air, all commercial/industrial. I put units in the size of doublewide trailers and and ductwork big enough to drive a car through. I don't see myself doing this line of work again, and I can't even pick up my child. I think this has affected me more mentally than anything now. I've tried physical therapy, and boy does it hurt, but I keep going to try and make my back stronger. This is something that is very hard to deal with, but I do. It hasn't killed me so I guess it has made me stronger. I just dread going back through all of it again, but if it can get rid of the pain and there is a possibility I will be better, then bring it on. I welcome it then. I haven't worked now for almost 2 years, filed for social security, and trying to figure out my next step. As you all know, you can't sit, stand, or do about anything else for a long period of time. Sleeping seems to be the worst. I guess I'm an aggressive sleeper, cause I wake up alot in pain. If anyone has any tips or suggestions please let me know. I haven't talked to anyone else who has had the same thing done. But in a sense my case is a little more different cause I'm going be be cut again. This time I guess I will be having the L4-L5 ALIF. Thanks for taking the time to read this, and I welcome any input I can get.
  • I had lumbar decompression & fusion Jan 25. after 10 weeks, a screw broke causing severe pain. I had 3 screws - 1 in L-3, L-4, & L-5. The one in L-3 sheared off flush with the vertebra. The rod & screw holder are causing severe pain when I move. Does the loose hardware need to be removed? Will this all scar over & heal? I still can't do anything except sit on ice & take pain & anti infamitory meds.
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