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360 ALIF Post Operative Conditions

EMS GuyEEMS Guy Posts: 1,606
edited 06/11/2012 - 8:26 AM in Back Surgery and Neck Surgery
I had a 2 level (L4-S1) 360 ALIF performed right at two years ago. The pain I had pre-op was eliminated with surgery. The problem is that 2 yrs afterwards, I'm having a bunch of new pain that my PM and I think is muscle related.

If I stand for longer than 45 minutes my back begins to tighten up. After that happens, I usually sit down and try to bend over to strech the muscle out and that helps some. If I drive for a while, it begins to hurt as well. Usually once I move positions, lay on a heating pad or take medication, I feel better. Not to mention, when the weather changes, things aren't good. But, there are times that the muscles get really pissed off and hurt for days on end. It seems like this is happening more and more.

Is there anyone else out there who had this procedure done who is going through the same thing? I've searched the Internet and can't find any good articles about post operative pain studies after this procedure is done. Isn't it strange that a person can find porn in .0001 milliseconds on the Internet, but you can't ever find what you are looking for?

Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2


  • Well Keith, as an old internet friend, I think I can say to you-quit searching for porn so much and maybe you'll find the back solutions!!! }:)

    Seriously, tho, I know you wore a bone growth stimulator but are you fused? Non-fusion can cause pain. On the other hand, hardware can cause pain so if you are fused, you don't need it anymore(I'm sure work comp would love to approve another surgery for you.) Other than seeing a broken or loose piece of hardware on scans, no way to tell if the hardware is the source of the pain without taking it out. Some people get "hardware blocks" but I've had several physicians tell me they really don't tell anything. Essentially they just are squirting lidocaine around hardware but the stuff drips all over and it doesn't necessarily stay right on the hardware so if your pain goes away, doesn't mean the hardware is the problem.

    When was your last CT scan? Has it been since your symptoms increased?
  • I've never been able to stand for 45 minutes. I had a 360 fusion 2 months ago, but I couldn't stand for 45 minutes before that or after. I naturally have a crappy spine, so maybe that's it, but I have never in my life been able to stand for 45 minutes without pain. I generally switch positions all throughout the day. Sorry I don't have anything helpful to offer.
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  • Usually surgeons say you have a "golden window" of about 10 years until the disc above the fusion site goes bad. Could it possibly be the disc above the fusion site???? Your PM could inject that disc to see if you feel better which could be diagnostic as well as therapeutic. Don't know which is cheaper, injection or MRI.

    Could it be an SI joint problem from stress of the fusion???? Your PM should be able to inject and see if that gives you relief or maybe a good physical therapist can assist in that diagnosis.
  • That's a good one, Angie! Actually, my 9 year old son was typing in a site they use at school to practice math and he obviously had one letter wrong. Before I could say Holy Crap, he was asking me what "THAT" was. I'm not prepared to educate my 9 year old what an orgy is! I told him it was a form of Twister! Gives a whole new meaning to "left hand, green".

    My CT is clean, normal X-rays show solid fusion and a new MRI only shows some scar tissue which is normal. L3 is still looking fine. That was actually one of my first concerns. If that level goes out, I'm screwed. I have no intention of going through the fusion process again unless I'm down right disabled. I specifically asked the Radiologist and PM to look for any hardware issues or anything that would be causing this problem. So far, nothing is showing up. I also had trigger point injections done with no relief. I've had a couple rounds of steriods both injected and oral which help a little bit, but then I go right back to the same old crap. And, yes I did have a bone growth stimulator.

    I asked the PM if it is possible that the muscles are just not forming to the structure of my new spine or if he thought the hardware was rubbing on them in a bad way. He is leaning towards the muscles not forming to my new structure very well. Every time I go in to his office, he can palpate the area around my surgical incisions and feel the muscles all balled up. He did say the hardware could be a contributing factor, but WC is going to want a more definitive diagonsis than that before approving another procedure to take it out. I was doing pretty well, but then a damn hurricane hit Louisville (Ike) with 80 mph winds for a couple hours which took down some of my trees. After cutting them up, I was down for a couple of weeks. I'm glad my doctor used a minimally invasive procedure for placing the hardware. Removal is pretty simple and I could go home the same day.

    I did change PM's about a year ago. The first guy was a frigging moron. After seeing him for a year, he didn't know who I was, didn't know I had a 2 level fusion and his answer to my pain was to walk circles in a swimming pool and take ultram. The new PM has been very open to anything I want to try and has given me different drug therapies which helps. I now am using Voltarin Gel 2 times a day, have Skelaxin to take (although it gives me a headache), and have both Darvacet and Lortab to use for breakthrough pain.

    If they ever do decide that hardware is the problem, once they remove it I'm going to put it in a ziploc bag and throw it into the faces of the people who have told me it can't hurt that bad!

    Angie - I've read some of your posts about your on-going issues. Are you going to have another procedure done? Are you still trying to work, or are you off now?

    Lo - I hope that you heal correctly and can have some of your spine issues solved. I'm sure the cold weather up north isn't helping matters any.
    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • Keith,
    My two year anniversary for my 5 level, 360 fusion is coming up in a few months. All my hardware is in place and I am fully fused but I too have trouble standing. I can walk for 90 straight minutes but struggle to stand still for 90 seconds, let alone 45 minutes. My back will spasm out and if I bend forward and stretch it out, the spasms weaken. When I was going to PT, my therapist told me that your core muscles allow you to stand straight without pain and because of the 360 fusion and all the muscles that were cut, standing comfortably will probably take the longest to recover.


    As for "Twister", thats how I hurt my back in the first place.
    Emergency surgery in March of 2006 for spinal infection of L 2 and L 3. During surgery, discovered I had Cauda Equina Syndrome. Spine became unstable after surgery and had 360 fusion with 10 pedicle screws, plates and rods in April of 2007.
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  • you guys crack me up! Good luck to you all!! I'm awaiting phone calls currently...

    GOOD LUCK!!!
  • Don't want to hijack your thread, but no, I am not working and yes, I'm having surgery again in January(more cleanup from the original fusion.) Intend to post an update after surgery(maybe from my hospital room again when I'm on all the drugs!!!) That way I can say what all he did and found.

    Hardware removal is pretty easy. It was just an overnight stay for me(for one side.) I hurt kind of bad for the first week then felt pretty darn good. It was nothing like getting the stuff put in.

    I've got my right sided hardware in a cup. Wicked looking stuff. Shuts people right up when I show them and say that the left side is still in there and poking into my pelvis. When I win the lottery, I'm going to get liquored up, get naked, stroll into work, start singing "Take This Job and Shove It" and start tossing pieces of hardware everywhere.

    Good luck. Hope someone else here has something more constructive to offer other than lottery and Jack Daniels fantasies!
  • That's funny! When you win the lottery, just keep us little people in mind.

    When they took out your hardware, did they go through the same incisions they used for the initial surgery?

    Since they used the Sextant System on me, I don't know how they get the rods out short of making a longer incision on both sides.

    I have acouple more questions, but I'll e-mail you if you don't mind about those?

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • Yes, he went through the right sided incision to take out the right sided hardware. He plans this time to go through the left side incision. I'd really like him to go right down the middle and lay the whole darn thing open so he can inspect it all! But then again, that's why he's getting paid the big bucks, he knows better.

    One thing I did not know(remember I've always been an ER nurse, never a surgical nurse) is that when they go through an existing incision, you will have a LOT more serous(clear) drainage then normal. Like, I had to lay on a beach towel this first few days cuz of drainage.

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