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!