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My XLIF Surgery

drakemargiottaddrakemargiotta Posts: 4
edited 08/03/2015 - 1:32 PM in Back Surgery and Neck Surgery
I am going to post a blog about my recovery from L4L5 XLIF surgery and try to give details for people looking into this type of surgery.

My back pain started when I was young due to skiing, football, basketball, and degenerative disc disease.
This is my 3rd surgery on the L4/L5 disc along with removing material from my spinal canal for spinal stenosis.

Surgery #1 (July2011) was a microdisectomy and removal of spinal tissue for spinal stenosis. Pain was more in my back vs. leg and getting up from sitting was the biggest issue
Surgery #2 (July 2013) was a microdisectomy on L4/L5 to remove a 5 mm diameter piece of my disc that was lodged int the sciatic nerve. I could reduce some of the pain by leaning over on a cane. Surgery reduced pain but did not alleviate it completely. I have 3 damaged discs so exactly where all the pain was radiating from could have been also coming from L3/L4 and L5/S1.

Surgery #3 (July 27 2015) L4/L5 disc herniated again so after 3 herniations we are going to remove it. I originally wanted an artificial disc inserted however my insurance would not cover that surgery.
My surgeon decided to do a XLIF procedure going thru my right side along with titanium rods and screws for stability which is less invasive than the other approaches.

7/27/2015: Surgery lasted 4 hours and went as planned. I have incision in my right side which is where he inserted to plastic cage with infuse vs. using my own bone and incisions in my back to insert the screws.
Pain after surgery was about a 7 on a 10 scale however with no movement the pain went down to a 2 or 3. The biggest problem was moving my body to position it on the bed. Pain would shoot up to 7/8 with movement and when pressure was put on the lower back where the screws were located pain was severe. Was on a morphine pump the entire day which made the pain bearable. The act of moving in bed was very difficult I did however get out of bed to sit in a chair but no more than that.

7/28/2015: I continued on the morphine for half of the day and was moved to hydromorphone 4mg oral vs. IV. The goal was to get off of the IV to prepare to go home. At this point I needed assistance for everything from the nurses and my wife. You will not be able to do much and you will need assistance for everything. Mid afternoon I was able to get out of bed and walk around with a walker for 5 to 10 minutes. The pain was down to a 4 when I was walking but getting up or down or moving in bed was difficult and pain about 7. I walked around the hospital floor a few times to get blood moving and also you will need a brace which helps keep you from moving too much. Pain sitting for a while brought the pain down to a 2/3.

7/29/15: The goal today was to leave the hospital on only Hydromophone and muscle relaxers. Pain was still high when moving in bed but when sitting it went down to a 2/3. Surgeon did release me and my wife got us home. The goal is to only be on the main floor of the house so I don't have to go up and down stairs. I have not tried but I don't think you will be going up and down stairs yet. Getting in and out of bed is still difficult and pain around 6/7 when moving. I walked around the outside of the house a few times for 5 to 10 minutes. My right leg tingles and is numb which I have been told is from the surgeon moving the muscles on my right hip to get to the spine. Supposed to be common. I do not have any lower leg pain that I had presurgery so it seems it worked and now healing is going to take some time.

7/30/2105: Today the thigh numbness seems to be getting a little better in that it does not seem to be completely numb. The area around my hip where the surgeon went into the spine and the back where he inserted the screws is swollen. As the swelling in my back overall has gone down the area under the bandages seems to be more swollen. Having issues with constipation and will try a suppository today. I was able to walk quite a bit today with no real issues with balance or major pain. The pain is definitely being masked by the narcotics as I can tell when they are starting to wear off and the pain level starts going up pretty quickly. The main challenge is getting up/down from a chair and my bed. I have very little strength in my right leg from where the surgeon went in for surgery. It is very difficult to get it to move and I need to use my hands to get it to move any distance. I am going to try and do some of my very beginning PT exercises I had learned my last surgery tomorrow. I want to keep it slow and not strain anything too much. The pain level is still about the same in that it goes down to 3/4 when I am sitting but goes up if I sit too long. I get more shooting type of pain in my back and upper right leg with movement that goes up to 7 or so but it is manageable.

8/2/2015: The last couple days have been about the same. The pain has went from more of a shooting pain in my side and lower back to more of a pain like you would have if you had a very deep bruise. Walking has become easier and I can walk further. What has improved only modestly is the pain from getting up from sitting in a chair or bed. The numbness in my thigh has improved quite a bit. It is still weak and I can't lift my left leg up on it own without the help of my hand. I hope to start PT this week to see what kind of mobility I have and start to work at it to improve my range of motion.

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  • Ice manIIce man Posts: 123
    edited 08/01/2015 - 1:54 PM
    Good luck with your recovery. I am almost 4 weeks post op ALIF L3-L4, L4-L5 PLIF fusion so I understand what your going through. Take your time and hang in there.
  • trishdownunderttrishdownunder Posts: 971
    edited 08/08/2015 - 9:31 PM
    Hope you continue to recover well, but as you know it's a slow process. I'm interested in your experience because I'll be having a 2 level XLIF on the 20th.


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • 8/3/15 to 8/6/15: The pain in my right thigh has been improving along with the strength in being able to move it without the help of my hands. Getting up and down from a chair is still painful but does seem to ease a bit everyday. The incision points on back and hip have started to less sensitive and the swelling has come down quite a bit. The in house nurse came by and redid the bandages since I made part of the one on my back come off from sliding off the bed when I did not have my brace on. She thought the wounds were healing nicely and seemed normal. I still am unable to put my socks and shoes on without help but I likely should not be doing that anyway since bending is a no no at this stage.

    8/6/15 to 8/8/15 The physical therapist came today and as it turned out I would not recommend having one come by until a bit later. For some reason I thought she was going to give me some exercises for increasing the strength in my core and legs but she thought it was way to early for that. She said I should not be doing anything like that until after 6 weeks or longer. She said I need to get more guidance from my surgeon on activity level. She gave me some very basic stretching and small movement exercises and I likely was doing to much before she came. Today also I have started to get some of the shooting pain come back that went from my lower thigh to the front of my calf and down to my foot. This is the location of the pain after the herniation of my disc. The pain is no where near the amount or type of pain before surgery but that pain had completely gone away right after surgery and just came back. It worries me now that I may have been moving too much but we'll see how that goes. I am getting up out of a chair much easier now and there is some pain but nothing like it had been. The swelling at the incision points has gone down dramatically but it is still a little swollen. I can walk quite bit now but it does cause some of the leg pain but again more like a level 2/3 pain and it seems to come on more when I arch my back backwards.
  • Sounds like you're doing well . Just keep to gentle stretching and what walking you can do at this stage, with lots of rest.


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • Ice manIIce man Posts: 123
    edited 08/13/2015 - 2:55 AM
    Drake are you walking everyday? I walked everyday for the first 30 days after my surgery and it helped so much. I am at 5 weeks post op and feel good.

    Trish, good luck with your surgery and please keep us posted.
  • Thanks Iceman and keep healing as well as you have so far. I'm posting in Surgery Buddies August/September.


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • I bet it was so good being out on the trails after being cooped up. Keep getting well and I hope I do as well as you.


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • 8/11/15: Today was my 2 week follow-up with my surgeon. We reviewed the new Xray and he showed me the hardware he put in my back and explained how he did it. I have 4 screws that really look big when you look at the Xray. they attach to 2 rods. The surgeon said the wounds were healing nicely and took off the coverings. They are still pretty swollen right at the incision points but the areas around the incision are starting to shrink so it looks now as it the incision area is more swollen than it seemed before. He said to leave the covering off the wounds and to not submerge yet in a bathtub or pool. I really want to get in a pool since for my previous 2 surgeries it was great relief to take the pressure off the back and legs and you can still get some exercise that my body needs.
    I thought I would be starting PT after this visit but absolutely not. He only wanted me to walk and now I should be able to hike up hills. I had only been staying on flat surfaces since I live in the mountains and the hiking paths are very steep. In my previous surgery I had overdone it and put to much stress on the wounds before they were healed. I don't want to do that again so taking it very easy. Surgeon said for the next 4 weeks only stretch lightly and do "passive" type of exercises. From my pervious surgeries I went thru a technique that focused on reengaging your inner core muscles that control the small muscles that control your spine movement. From all of my sports and injuries my body had lost those muscles and they never worked correctly. I can however do some of these very simple exercises that have you flat on your back and pushing down like you are going to urinate to engage these muscles. the better these muscles are working the better you have control of your spine and body movements at least that is what the theory is and I did feel completely different after I went thru the program including how my body walked. I had a "hitch" or limp that was compensating my right leg and oddly enough I never noticed it until after going thru this PT. Afterwords my movements were much smother and my lower back would no longer get tired after walking which is how it should be. Dr. says I can get into a pool on 8/15 but I'll keep looking at the wounds to make sure they are healed before I make that decision. I am walking each day I would say about 1/2 mile again on flat surfaces.

    8/12/15: Today I decided to walk the trails for the first time in about 3 months. After I herniated my disc I had really not been able to walk for 3 1/2 weeks and after that it took almost a month before I could walk more than 50 steps so my body is in pretty bad shape as far as movement. I am still having pain in my right shin that seems to come more when I sit too long. Dr. think that is normal and it could be the nerve memory from being inflamed for so long. I feel better that he is not concerned about it at all at this point.
    I hiked about 1 mile and it was a little difficult to get my right leg moving. I am not walking normally still due to the pain in my hip from surgery but at this point I can walk pretty far however I have not tried to push it.

    8/13/15: I am pretty sore from the hike yesterday. I likely pushed a little too hard since at nighttime I had more pain in my incision points than I had in about a week. I had also decided to move from Hydromorphone to Tramadol since it is a lot less potent of a narcotic and I have been trying to use the least amount of drugs possible. I woke up around 4 AM with more pain than I had in a while so I decided to take the Hydromophone again. It worked and felt better later in the morning. I am going to ease back on the hiking at this point so as not to push it. The one observation is I really need to watch how much I sit without getting up to walk. There is a direct correlation from the amount of sitting to the amount of leg pain I have been having. I am a CEO of a tech start-up and I am trying to still run it while recovering so I lose track of time when I am on calls or writing emails. I need to put the recovery before the work but it is a challenge.

    8/14/15: Not hiking yesterday seemed to keep the pain down some today. I am also now using Tramadol in the daytime and using Hydromorphone before bed and that seems to keep the pain well under control during the night. It had been that I could not get thru a whole night without waking up and taking another pain medication. Walked a bit less today than normal and pain seems to have gone down.

    8/15/15 to 8/21: The pain has been pretty stable at this point. Pain around the incisions is still there along with the hip. The pain in my shin/calf does come back when sitting but I can get it to go away with walking. I am down to Tramadol 3 times a day along with Tylenol. I am now also in the pool almost everyday and that also has seemed to help get movement in my legs without putting pressure on the back.

    8/22/15: I moved a little too much last night without my brace and pain has increased. I do think this was due to my twisting a little too much and will see how long it takes to hopefully go away.

    10/5/2015: I have not posted an update in quite a while mostly since there has not be a major change in my recovery. For the last few weeks I have been pretty active hiking over a mile each day and being around the house without my brace with little pain. I started PT last week and now that I am doing controlled stretching and movements to see where I am there is definitely pain in the lower back where the surgery occurred. My hip is pretty healed up and have gained most of the strength back. Mostly the PT is going to focus on trying to work the scar tissue around the lower back and try to slowly get the pain to dissipate. Movement has caused some pain but it is relatively mild and am told it is completely normal and just a matter of healing. No real set backs or new pain. The other challenge has been getting my hamstrings to stretch since they have been so tight after not being used for so long. Just a little everyday on that front and I think that will also help with the lower back pain as I get more flexible.
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