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Well, 6months later.

thenadetthenade Posts: 137
edited 06/11/2012 - 8:43 AM in Back Surgery and Neck Surgery
Hi, I've been around but just not posting much. Sorry this is a long one. I had a minimally invasive TLIF of the L4/L5 oct 26/2009. Recovery has been up and down. The actual surgery went well, home within 2 days, no complications. Off opiates within 1 week. Started physio at 7 weeks but was not able to continue. Developed pain in my left leg and continued having pain in my right leg. Physio just was not sure what was wrong with me and wanted me to see the surgeon. Had a ct scan in emergency on Jan 01. Nothing of any real interest could be found. My own family doctor prescribed, gabapentin, cymbalta. Both did not help with the nerve pain and had a lot of side effects for me. I was finally able to see my neurosurgeon in early Feb and he went over ct scan, said everything looks great. But he was puzzled about my continued leg pain and ordered an mri to check out all lower lumbar levels. He said the usual, nerves can take 1 year to regenerate, sometimes they only come back 60%, sometimes they get a memory etc etc. In the mean time he prescribed a dose of amitriptyline at bedtime to help me sleep and break the cycle of pain & depression(it was starting). I was able to sleep a bit better, sitting became easier and I was not awoken by pain. At around 5 months I started going to acupuncture and I think that has helped a bit. I have seen improvement in my condition with this surgery. But I am still suffering right buttock & leg pain. It ranges from just annoying to burning painful. I am not taking any meds consistently for it. Yesterday I saw the neurosurgeon regarding my MRI. His words were "The Mri does not show any pressure on the nerves on either side at all. The site of surgery looks excellent. I am at a loss as to explain your symptoms. I do not see any need for more surgery." Indeed the Mri did not show problems at any other levels, he said I did not have a lot of scar tissue and internally I had healed very well. I asked him about pressure on nerves when standing. He said that I would have some pathology to indicate that is happening and I did not have it. I then asked him about fusion. He didn't really explain if I had any or if I did, how much. He said one does not see fusion till about a year and some of the new info out there was that in patients 60 to 70 and older it is not as important to see a solid fusion. I asked him if the screws can break, he said they can but he said you're pretty little and that should not happen. I could tell he was done with me. I gathered he would not actively be following my fusion or fusing. I don't know who will be. He agreed to refer me to a neurologist for an EMG to see just what is happening with the nerve. One if his comments was that sometimes these things just go on for awhile and then just finally burn out. He hoped things settle down over time. I don't know how I feel. In Canada we are so short of neurosurgeons that perhaps they don't follow their patients till they fuse. Any Canadians out there who can comment on their experience. What can I hope to learn from an EMG? Has anyone had continued improvement after 6 months? How long did it take? Thanks in advance for your comments.


  • Any thoughts anyone? Especially about the EMG? What will it determine? How many have seen continued improvement after 6 months or is that as good as it gets? I know everyone is different but it would encourage all of us who are struggling if anyone one could share their continuing success stories after the 6 month mark. Has anyone had epidural injections this long AFTER their fusion with any success?
  • No thoughts for you, but I am very interested in what you're going through. I'm in the U.S. so my experience with the neurosurgeon is probably different. I'm coming up on 6 months post of L5S1 PLIF. For the most part I'm better compared with pre-op. However, I still can't lift anything remotely heavy, sit in a straight chair for any length of time and I have a very hard time riding in a car. I don't know if this will ever get better and I have a difficult time getting information out of my doctor too. I won't be able to go back to work like this, but he can't really give me any guidance past "sometimes it takes a while to fuse." I really feel that he's non-helpful in that regard.

    I wish you the best and I'm going to be watching to see what happens to ya. Sorry I have no words of wisdom for you though.

  • I'm sorry nobody has gotten back to you yet. Kind of surprising, really, but here I am. I'm sure others will be along to share their opinions and experiences. (By the way, I'm in the US, not Canada.)

    I didn't have any continuing nerve pain after my TLIF, so I can't relate to you there. But I know there are a lot of people that do. I think an EMG is a good idea and I've included link that explains more about the procedure and what it does.


    I'm concerned about your doctor not talking to you about how much you're fused and I don't believe that you won't know about fusion for a year. My surgeon already saw fusion at three months out with my L4/5 and said I'm ahead of schedule so I'm in PT. And why is it not important to not see fusion in patients over 60? I don't understand that reasoning - fusion is fusion and that means stability. It does kind of sound like he wants to be done with the situation, but I'm glad he's at least sending you to a neurologist.

    I know that nerves can take a very long time to heal sometimes. I also know that scar tissue can grow and press on a nerve or nerves as well. There could be so much happening and I hope the EMG will be a first step in finding out what's going on. I also know there are some that have injections done after surgery when there are additional nerve problems.

    Good luck and please keep us posted. Do you have your EMG scheduled yet?

  • I live in Canada but haven't had fusion. I have had an EMG though and it shows how the nerve is doing and the Neurologist will let you know how you're doing. But really the Drs give it a year to see the progress of your fusion. I've heard people have had a Pain Management Dr. to help after surgery if you need injections for pain.

    Do you have a bone growth stimulator? Many people get that to help them fuse after surgery. Best wishes and hope you heal completely. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN

  • I'm in US and had a MI TLIF on 12/3/09. Surgery went
    great and I had no pain when I awoke for the first time in over 1 year. Leg pain started at 7 weeks and
    has progressed to almost constantly. I am still much better following surgery. But the left thigh pain goes from burning, numb to stabbing that is excruciating and I can not walk. It started in one
    spot and now has spread from hip to knee. Prior to surgery, the sciatica went to ankle. So I don not know if this is sciatica.

    I have been put off with same kind of comments you were told until i phoned surgeon this week. I had cat scan today. I will find out results next Friday.

    I also found out today that my insurance co. changed
    "networks" without my knowledge or consent. I had a
    network that was accepted by everywhere. my surgeon
    and the practice does not accept this new network.
    My deductible in network is 6, 000 and out on network it DOUBLES to 12, 000, And I pay over 700 a
    month for this. So my followup, exrays etc. for the
    fusion that was covered by insurance will not be covered.

    Do I have any alternatives? Can I file an appeal or
    complaint or do something to get my other network back. both my husband and I are self-employed and I
    know I can not easily switch with just having spine surgery.

    I'm no help to you, I know, but I also would like to
    know if people have had improvement after 6months or if problems that appeared get steadily worse over time.
  • Did you all survive the Olympics? If you remember, I scheduled my fusion for immediately after the Olympics closed as I didn't want to miss anything. How ironic...one day before surgery, I was notified that my insurance company was denying authorization....I am in the process of appealing and have my review on Wed.

    I imagine you will have a nerve conduction velocity test along with the EMG. These are given to determine if and where you may have nerve damage. Once you know which nerve is potentially insured, the doctor can look further for some kind of mechanical problem that is compressing the nerve.

    I had PLIF at L4-5 over two years ago, and continue to have nerve pain primarily in my right leg. On occasion I also have it in my left leg. I began at about six months to figure out what was causing it. I had my first post-surgery MRI at 3 weeks to see if hardware was in place. I had an EMG at 9 months and another MRI. The EMG showed S1 chronic radiculopathy.

    The problem with the EMG is that it can only tell if a nerve is damaged, not WHY. And in realty, it seems to me, doctors don't really know all that much about nerves other than to say it is damaged. They have no way to predict if the nerve will recover.

    There is a relatively new form of MRI that scans the nerve. It was invited by a doctor who practices in southern California and he is just beginning to license the machines. They have recently opened new imaging centers in several places on the east coast and I think there is one in Seattle. He calls it neurography.

    Anyway, I'm off topic. Sorry.

    What I wanted to tell you is that my MRIs did not show anything that would be compressing the nerve. I went to another city to have a positional MRI to see if that would show something. They did it standing and sitting because my pain is worse when I am on my feet. In my case what's happening is that with the fusion, that area of my spine presses down and causes greater force on L5-S1. I have some instability there that does not show up on a prone MRI. But when I am standing, the angle of the L5 and S1 vertebrae is much greater. On the posterior side they come together and almost touch. This cuts off the foramina, which results in the nerve compression. But this is not clearly visible on a MRI unless one is looking very closely. It is clearer on the positional MRI but still not blatantly obvious to the casual observer.

    I mention all this by way of telling you that there are situations that result in a great deal of pain that are not obvious on standard MRIs.

    There are various things that can happen to the nerve that also cause pain. There can be scar tissue that has attached to the nerve. The nerve itself can become scarred. When this happens it is a bit like a frayed electrical cord. It makes a connection but not a reliable one, so you end up with chronic pain. I was told there is not really any treatment for this .

    And, as everyone repeats, nerves are very sensitive and surgery is a traumatic event. It can take up to a year for them to calm down after surgery...and, personally, I don't think there is anything magical about that year mark. My symptoms continued changing after a year. If the nerve is not dead, why shouldn't it still have a possibility of getting better? The Chinese medicine people think they can continue to regenerate...and I choose to following this line of thinking.

    I had a MRI at 3 weeks, which is not usually done. Even the technician kept questioning why I was doing it.... It showed a bit of fusion already at that point and I was fully fused by six months. It does take a year for the bone to set up and become strong. ..but most people have fused before a year. I can't quote you statistics, but not fusing till a year would be considered slow.

    You might want to check to see if you have any more spondylolisthesis. That could be a pain generator. You could have a hardware block to see the condition of your hardware, whether something is out of place...(that would be visible in MRI scanning). The block would indicate if a screw is loose.

    Let me know if I can be of further help. I know from personal experience that you can continue to heal from nerve pain for long after six months. Please post with the results of your EMG and any other diagnoses you may be given.

    xx Gwennie
  • I am sorry to hear of your mess with the insurance company. I would suggest you call your state's insurance commissioner's office, tell them what has happened and see what the deal is for you. Maybe SpineAZ could shed some light also. She has worked in the field for many years and may be familiar with your situation.

    Whenever I see a post such as yours, I tend to think "scar tissue," epidural fibrosis as a possible cause of your pain. Often when a patient has an immediate reduction in pain after surgery, and then it comes back from about 6 to 12 weeks, scar tissue is often the culprit. The main time of formation for scar tissue is in that time frame. If the pain suddenly started at 20 weeks, chances are it is not caused by scar tissue.

    I'm sure you are eager to get the results of your scan. Hopefully you just need more time to heal.

    Good luck.
  • Thanks everyone! I'll try and comment on everyone's post. This may turn into a book.

    B52- Sitting does get easier. Hang in there. I find sitting in a straightback chair more comfortable. I need that support. In the car I use a stiff lumbar support to keep me straight. I don't really try and lift too much. If I carry something like a bag of groceries I hold it close to my body. Something physio taught me. Do you have continuing leg or back pain?

    Cath111- Thanks for the link. Yes the fusion part is concerning me but I guess I'll ask my family doctor to follow my progress. At this point I've had enough radiation for awhile. Within the last year I've had the xrays during surgery, 2 sets of mammograms,&a ct scan. I think I glow in the dark!! Maybe he thinks that at 60 or 70 people aren't as active and the solid fusion is not as critical. I know many active seniors who want to be even more active after their surgeries. I don't have my appt with the neurologist yet. It will most likely be a couple of months.

    Charry- Yes I hope to find out what is happening with the nerve. I believe that it is the L5 nerve. The compression on it was quite severe prior to surgery. I asked him about the bone growth stimulator when we were first discussing surgery. His comment was that there are studies that show that they do not work very well. I don't know where he comes up with these studies. But he is a clinical prof at the university, head of neurosurgery at one of the large hospitals, fellowship trained at McGill and UWO and has trained in the US for Minimally invasive surgery.That's why I had put my trust in him. He also said that if I wanted he would order the injections for me. He said they may help with the pain but left it entirely up to me. I think I'll wait till after I have the EMG to decide.

    Laughnsmile- Yes I'll be interested to hear what your CT showed. I don't regret having my surgery because I had the instability on bending and things would have just become worse. But at this point I am hoping for a better result.

    Gwennie-Yes, the Olympics were wonderful. The energy in the city was unbelievable during those weeks. I wish you all the best on Wednesday. How quickly will you find out if things are a go again?
    So is the pain that you are having now different than the pain presurgery? It's coming from a different level now, right? Thanks for all the info re the MRIs and the nerves. I hope to find out if mine is damaged and where I go from there I am not sure. I am going for acupuncture with a doctor that also practises Chinese medicine. She was trained as a neurologist in Beijing. She thinks that nerves can regenerate. I am also very interested in body movement. Many years ago I had a fall on my right knee and my pelvis never felt balanced after that. I went to chiro's, physio etc. I learned to live with it for over 20 years but I feel that imbalance is what degenerated the L4-L5 level in my back. I think the psoas muscle may have been part of the problem. I still feel that imbalance but I don't know if it is caused by the L5 nerve or if the muscles are playing a big part. Or is the way I walk and move causing more pressure on the nerve. So in the new few weeks I'm going to go to a recommended kinesiologist and see what he says. I hope to have him set up a stretching and exercise program for me. So many questions, so few answers!
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