I am two weeks post-op for 4 herniated discs. I have 8 separate incisions including one in my right side for XLIF. I now have right groin and leg pain that is so intense I cannot sleep. My leg is also weak to the point that I have to lift it in and out of the car, bed, etc. I've been prescribed Lyrica 75 mg x4 and Percocet 2 every 6 hours. This does not control the pain but only provides minimal relief. The doctor's assistant has said it's caused by a swelled nerve and is only temporary but I have not been able to speak with the doctor and there is no improvement in the condition. Can anyone advise me or provide a positive outlook?
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Cymrudenver (09-12-2011),t39467b (12-25-2011)
Welcome to the board. I'm afraid what you are describing is one of the unwanted side effects of the XLIF procedure.
I'm not quite sure what you had done -- the XLIF is a fusion procedure...but I don't think they do it for multiple levels. Did they do discectomies on several levels and then the XLIF on the L5-S1 segment?
In any case, when the XLIF is performed, they go in through the side and the psoas muscle is often affected. This results in leg weakness, particularly in the quad. muscle. It usually goes away with time, but I have heard patients complain that it can take quite a long time before it goes away.
Thank you so much. Had the possibility been described to me in detail I would have never chosen XLIF. As far as I know the doctor only fused one disc and I believe it was the S1. He only decided to go in from the back the day before due to the extreme pain down the left side. I was astounded to find the 8 incisions and I still don't know exactly what they represent. My follow-up is Sep 21 and I plan to have a detailed discussion with him them. In the meantime, do you know of anything I can do to relieve the pain? It is all-consuming and right now my quality of life is zero. Thanks!
I would suggest you request the operating room notes from the hospital where you had the surgery. Call the medical records office at the hospital and ask what their procedure is for obtaining them. Then keep an ongoing file pertaining to your back.
The eight little incisions are from whatever minimally invasive procedure was done...perhaps discectomies?
XLIF is always sold to the patient as being less invasive because they don't have to go in and cut through the big back muscles as they do with a PLIF, or go through the front and move all the major arteries and organs, as in ALIF...but it is not without consequences. There are a bunch of nerves in that area that have to be moved, and the psoas muscle and several others have to be retracted, moved out of the way...I have heard other patients say their leg was so sore afterward ....I found this....on the North American Spine Society website (http://www.spine.org/Pages/Publications/SpineLine/CurveSurvey/Archives/cc_sle08mayjun.aspx)
"The XLIF approach requires blunt dissection through the psoas muscle and the traversing lumbar plexus. The use of appropriate nerve root stimulation and monitoring is required to safely approach the disc space. Occasionally, the disc space cannot be accessed using an XLIF technique and a back-up procedure should be available and discussed with the patient preoperatively. Furthermore, a traction neuropraxia can occur because of pressure on the lumbar plexus by the expandable cannulas used to perform an XLIF. These patients may complain of postoperative numbness in the thigh or groin because of injury to the genitofemoral nerve. In one study, 30% of patients developed postoperative numbness, and in two-thirds of these patients the numbness lasted longer than one month."
Some patients have been prescribed lyrica in combination with prednisone for this nerve pain. I would suggest you call your surgeon tomorrow and let him know how much pain you are in.
I'm right there with you, I'm sorry to say. I'm 7 weeks post op from a similar surgery (I had non-invasive 4 level lumbar fusion). I have lost the use of my right leg as a result, which I'm told is temporary, but could take 9-12 months or longer to heal. I understand the pain thing as mine is exactly the same as yours.. no amount of medicine is helping. Do you find yours is worse when you lie down? I see you had said it affects your sleep and I am only getting maybe 3 hours a night because of the pain. I am taking the max dose of neurontin (had taken Lyrica for fibromyalgia last year and that didn't go so well), long acting morophine 3xday and percocet every 6 hours.
welcome to the board.. I am new here, but have read a lot of useful information and everyone is awesome!
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Cymrudenver (09-12-2011),ej1948 (09-11-2011)
I find mine is worse at night when I'm trying to sleep and everything is calm. If I get up and walk around it lessons but doesn't go away. In addition, the pain travels down my leg to my knee and is equally as bad. Lyrica has provided minimal relief as has Percocet. I'm very angry that this complication was not discussed with me and that it isn't more prominent on the XLIF websites. I was told "it's a piece of cake" and "non-invasive so no big deal" but that was the extent of the discussions with my doctor. It seems like every day it gets worse rather than better. I'm so scared that this may be permanent because it will affect my job, life, and even my car since it's a manual transmission and my leg feels too weak to try to drive. At this point I'm thinking lawsuit and I never thought I'd say that.
If you look online for XLIF complications, you will find quite a bit of information.
You are still early in your recovery, so if it is muscular, it will probably eventually go away. Same if it is a nerve injury, but it will most likely take considerably longer.
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Mine is worse at night as well and like you it does not hurt as bad, but is always present during the day when I am moving around. I think it's like arthritis.... that once the muscles and nerves are "warmed up" the pain decreases. Unfortunately there is no pain medication for nerve pain...they say meds like Lyrica and Neurontin are supposed to, but it's not happened yet for me and I have been taking Neurontin for a long time (and am now on the max dose). I was given the same story about how great this procedure was and that the recovery time was very minimal compared to other the other types of procedures. It really makes me mad to hear that these doctors can do this to their patients and not give them the choice after showing them accurate facts and allowing them to decide if it's worth the risk!
I am so sorry you are having such a hard time with everything. I pray your injuries involve only the muscle and not the nerves as the nerve damage in my right leg certainly are not fun at all!!! Are you finding yourself dozing off no matter what you are doing? I actually just woke myself after taking a quick little 30 second nap. It drives me crazy!!!
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Thank you so much for your advice. I thought I had thoroughly researched XLIF before agreeing to the proceduire but never once thought to research compllications. I should have been more diligant. I will definitely be informed by the time I go for my follow-up.
I just thought of something which may help you.. I know it sure has helped with my nerve pain!!! I have found that wearing stretch leggings desensitize the nerves considerably... so much that I bought enough pairs so that I could wear them daily. I suppose anything like tights, or panty hose would work as well.
So who knowingly chooses this kind of pain? At least I could get occasional relief from the back pain. This groin and leg pain is so encompassing that I can only focus on what it's doing to me. Here's another night and after multiple pain pills and a sleeping pill that is supposed to be 100% effective I'm walking the floor, crying, and wishing I could simply go back 3 weeks before this whole procedure was performed and deal with what I knew. My only hope is that this will lessen with time. But I do want to thank all of you who providing encouraging words or additional information. At least I'm better informed going forward.
Please remember that you are still very early in your recovery. Things are probably as sensitive as they are going to get, and will improve as you go forward.
Be sure that you are doing your walking. It is important that you walk as it keeps the spinal nerves stretched out, and most importantly, it keeps scar tissue from attaching to those nerves as it forms after the surgery. Short walks several times each day are much better than one longer walk.
Be sure you are well hydrated.
You might want to look into getting one of the CDs on how to deal with pain...usually people don't look into this resource unless they have chronic pain, but I would think it could be beneficial to you at this stage in your recovery, too. If this idea interests you and you need some suggestions, just send me a message.
Pain is almost always worse when we are trying to go to sleep. Our minds are free to focus completely on how we are feeling without the distractions of things going on around us. Then without sleep, we are less able to cope with pain, and the pain increases.
After my first fusion, I had terrible new pain on the front side of my thigh. The only thing that provided even temporary relief was using ice or a cold gel pack. Normally you'd put the cold on the area where the spinal nerve is located in the lower lumbar spine...but I would put the ice on my thigh...and it would help, at least for a bit.
Just keep reminding yourself that it does you no good to look backward and wish that you had made a different choice. Try your best to keep a positive attitude that this is a temporary situation....take it one day at a time. You are probably going through the most difficult time right now. Things will get better in the days ahead...we just don't know exactly when.
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I wanted to provide you an update. Just as tetonteri66 said, the pain has gotten better. I had my post-op follow up with my surgeon yesterday and we discussed the pain more in detail. He apologized that it had been so severe because he said the psoas muscle appeared to be minimally disturbed during the procedure but it was possible it had bled internally and there had been some tearing or other damage. More importantly, the pain has gone away. I can't tell you exactly when but one day I noticed the groin pain wasn't there. I still have problems with my knee but now I'm not so certain that it isn't arthritis and was simply generated thru the surgery. My leg is still numb and extremely weak but I can see definite improvement. The first time I could cross it I knew I was on the road to recovery!! My doctor checked my leg reactions and, while they were diminished compared to my left, he could still see that the leg was reacting and said it would just take a few weeks longer for the feeling to return. He did not clear me to drive since I cannot feel the pedals but that's a minor issue compared to the pain. He also cautioned me that when the feeling begins to return there may be some additional pain as it will be the same feeling as when our leg or arm "goes to sleep" and we have the ensuing feeling when it is waking up - something like hitting our elbow and getting the electrical shock sensation.
This is far too long but I did want others to know that there is actually a light at the end of the tunnel and just when you think the pain will overwhelm you, it will begin to go away.
Yippee! That sounds like a great appointment with your surgeon. I am so happy the groin pain is gone and that you are getting feeling back in your leg.
Just remember...slow and steady wins the race. Learn to listen to your body and don't push yourself. You want to grow stronger without causing inflammation...and remember that regardless of how the surgeon accessed the spine, it takes the new bone a good twelve months to set up strong and hard.
So, here I am back on the board. I was so optomistic just a few days ago...then yesterday I felt some groin pain twinges and last night the pain returned. It wasn't as intense but still there. I took more pain pills (seems that's all I do) and finally got to sleep early this a.m. My leg numbness hasn't changed and I don't see any improvement. In fact I believe it may be getting worse. I rubbed my leg several times hoping it would generate something. Nothing. I'm 5 weeks post op and wondering when/if this is going to change. I'm supposed to return to work in a couple of weeks but I cannot drive. I honestly don't know what I'm going to do and as I research this more, I'm scared to death that there is nerve damage as opposed to nerve swelling and I may be facing a year or more before there's any change. And now I find out that test results show I'm diabetic and my family practice doctor needs to see me to start a diet regimen and prescribe more meds. Wish me luck as I try to figure out how to get to her office.