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Extreme Pain 7 months post Discectomy - Scar Tissue?

Background - 38 yo Male, Pretty good overall health. L5/S1 Disc ruptured, with extruded fragment pressing on S1 Nerve in march 2011. Did not have any back pain, but had pain shooting down right leg to foot. Discectomy performed Dec 2 2011 to remove herniation and decompress nerve. Surgoen stated that nerve was very red and irritated. He said he wrapped nerve with a strip of fat soaked in Steroids, and relieved the bone slightly so the nerve had some room.

Recovery - December there was a lot of recovery type pain. By the end of the month I was not using the Percocet, Vicadin or any of the prescription drugs. By the end of January I was not using anything at all, with just a little soreness and stiffness. Leg pain was getting better each week from January to May. During this time I was pretty functional, could sit and stand and walk for miles without severe discomfort.

The change - Late June / early July noticed some increase in back pain. Took some Ibuprofen as needed (after not using any for months). Each day seemed worse. Within two weeks I was in excruciating pain, and was losing the ability to walk, sit and stand. I had a very sudden increase in pain one morning, and I had noticed what looked like a bruise or hickey (purple discoloration deep under the skin) about an inch to the right of my incision. There was also a swollen lump next to the incision to the right. The pain was very sharp just to the right of the incision, and my whole right leg was in flaming pain as well. Could not walk upright, could not straighten my right leg.

Communicated with surgeons office. They did not have an explanation for the swelling / bruise. They suggested to give it a few weeks to settle down, as it was possible I just really irritated the nerve.
Spent the next 4 weeks with a lot of ice packs, ibuprofen every 4 hours and trying to rest and avoid movement. Could hardly walk to the car, and could not sit in my desk at work for more than a few minutes at a time. I got through the days using the max dose of ibuprofen and some Vicadin during the day. Could not sleep at night through the pain some nights without the percocet.

At the end of August I got an MRI of the lower spine down, and it showed that the disc was not re-herniated at all, maybe a little reduced in height from the original. It did say there was some epidural fibrosis near the S1 nerve. When talking with the surgoens office they said that could be part of the issue, and suggested that as the reason for the swelling and bruising.

Treatments - I tried ice and heat to the swollen area to the right of the incision. Ice makes the pain decrease and heat makes it worse, so probably not directly a muscle issue, and more of an inflammation issue

I tried Aleve with no noticeable help.
I tried Nabumetone (Relafen) 2x a day, it helps reduce the leg pain some, about the same as Ibuprofen
I tried Gabepentin for 3 weeks, did not notice much help, but made me feel very goofy and strange, don't want to do that again!

I have now recieved 3 Steroid injections: First one was a Caudal, did not help back pain much, and leg pain slightly reduced. Second one was transforaminal into right S1. Much more dramatic difference. First 3 hours was great! Leg pain returned with a small reduction. Noticed swelling to the right of incision reduced. Third one was a repeat of #2, just a few days ago. Swelling on right side reducing more and I can now sit and walk some. Still have sharp leg/foot pain and still dependent on Relafen and Ibuprofen.

Questions: Does this sound like a scar tissue development or something else? What should I do to get a solid diagnosis?

What else to try? I have not done any PT, as my surgeon advised against it several times, though I am wondering if it would not help. My hamstring and everything on the right side is very tight. While lying down I can lift my left leg straighted to about 45 degrees, and my right leg I can hardly straighten. Stretching seems to make pain a little worse, though I am wondering if I should not be doing some stretching now that the inflammation is calming down.

Is the tightness on the right side some kind of response to the real issue?

7 months seems to be a long time for scar tissue, most other I have seen when researching the issue seem to have it develop sooner. What is the next thing to try after the steroid injections?

The last 4 months have been awful, and I have not been able to function well at work, or at home with the kids. I am determined to get to a point where I can again sit in a chair or walk a few miles.

Thanks for reading and any help you can give!


  • After l5/S1 discectomy, I had 2 nerve root injections like you. And like you, I had immediate relief for a few hours. So that confirms the location.

    My surgeon recommended building up core strength and riding bike machine. Went to hydrotherapy as well what he wanted.

    Went to another consulting surgeon who recommended swimming to soften scar tissue.

    So, I am not suggesting you do what I did. What i would suggest is that you discuss the situation with your surgeon and also engage a physiatrist to help you get the best conservative treatment possible.

    I now have an excellent PT, whose directions I have followed post fusion and it is working out reasonably well for me.

    All the best.
  • Thanks for the reply.

    Is there a way to diagnose if scar tissue is the issue? Is scar tissue able to cause this much pain? I am in so much more pain now than I ever was before the surgery, even after the 3 shots.

    Does the swelling and pain to the right of the incision offer any clues?

    Also, since my right side is so tight that I can hardly straighten my leg, is there any diagnosos from that? Should i try to stretch that out out despite the pain?

    Thanks everyone!
  • youputz74yyouputz74 Posts: 3
    edited 01/03/2013 - 8:37 AM
    Well after a couple of months of the Doctor's assistant telling me that it was the epidural fibrosis, I now have a complete opposite diagnosis. I finally got into the Surgoen and he looked at the MRI and said no way it's the scar tissue (even though there is a little), and he pointed out a small bulge in the disc that was very focused and pressing on the nerve. He also pointed out that the disc height is half of what it was. He says the only way to get better from here is Fusion. He says the PT and the steroid inections are just a waste of time.

    I have been going to a few sessions of PT and it did seem to help a lot with the pain. I have been trying to do the Flexion excercises at home with minimal results. My hamstrings are very tight. My right leg I can hardly straighten and raise off the floor.

    There are a lot of people that say tight hamstrings can cause back pain. However, can the tight hamstrings be caused by the compressed nerve? Is it worth trying to keep stretching it out, or will the nerve problem keep causing it to be tight?

  • Another tool available is neurography. It's like an MRI, but for nerves.
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • Paul: neurography, Very interesting.
  • Most more than I have had to deal with so far, thankfully. But one thing that I relate to very well is the hamstring issue. Both pre & post op, that is one of my lingering problems. Is it the chicken or the egg? For me the hamstring reacts to the nerve problem. Whenever I have swelling or inflammation that damn hammie tightens up bad, the calf too. I stretch evryday, sometimes up to 20-30 times. Just a few minutes with the leg straight, toes in, head down. hold, release, repeat. I hold & release about 5-10 seconds each. 5-10 x per stretching session. I use about 5 different stretches, but that one is the easiest to do & explain.

    I dont think it helps to "fix" anything. But it loosens the muscles at least!
    L5S1 REMOVED herniation. Years of pain & compression. Microdiscectomy complete!! Trying to be super smart & safe with recovery!
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