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Old 03-09-2011, 06:41 PM   #1
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6 month check up after lumbar fusion - help

My husband had a lumbar fusion on October 4th and he is returning for his 6 month check up in a few weeks. I must stay that his recovery has not gone well and he is still in a lot of pain. Because of complications that he has had he as been admitted to the hospital of 4 different occasions. His xrays have indicated that everything looks fine but he has worse back pain now than before the surgery and his nerve pain seems to be random but still very painful. He is still taking oxicodone 4 times per day and Lyrica twice a day. He also takes muscle relaxers occasionally. Is this level of medication normal 6 months after surgery? Without the medication he is in tears and can not function at all. With the medication he can tolerate the pain but is definately not leading a normal life. Is anyone else still on this this amount of medication this long after surgery? Could someone give us some advice on what we should ask the doctor when we go for the 6 month follow up? thanks

 
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Old 03-09-2011, 08:16 PM   #2
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Re: 6 month check up after lumbar fusion - help

Welcome to the board. I am very sorry to hear your husband is still in so much pain. Could you provide a bit more information about your husband's surgery? Do you know what levels were fused? What type of complications did he have after surgery?

Your husband needs to request a new MRI. An x-ray will only be able to tell that any hardware that was used in the surgery is still in the right position, and will show any bone growth, but will not show soft tissue, nerves, etc.

I am assuming they put in a cage and pedicle screws, or rods and screws. If so, the physician will most likely order the MRI "with contrast." This is a procedure that uses a type of dye that is injected into a vein in the arm during the MRI that makes the contrast in the images stronger. After fusion, the hardware can cast off a reflexion of sorts, called "artifact." Contrast allows the doctors a more accurate view than a plain MRI.

At six months, most people are not in the amount of pain you describe, unless scar tissue has developed, hardware has slipped or a screw has broken, or there are other issues...such as the the wrong level was operated on or one level was done and there are still issues at adjoining levels, etc. Obviously, I cannot guess what might be wrong...but it is not common to still need a full dosage of pain pills at six months post surgery.

You need to be prepared to specifically tell the surgeon the type of pain your husband is experiencing, if it is brought on by certain activities, or is constant; what makes it better or worse. Don't just indicate he's still in pain...the more specific you can be, the better.

I would suggest you contact the hospital and request the operating room notes for the surgery. There is usually a form you can fill out and mail in or drop off. It is a good idea to collect medical records as you go, and you just
might find something in there that you were not aware of.

To answer your question, yes, some people do take that amount of medication six months after fusion. Some take more...but generally speaking, something is not quite right.

Sometimes in the situation you find your husband in, you may have to be persistent with the doctor. Too many times you will be told that it takes "a long time for a nerve to heal after it has been compressed. Give it time...." If I were you, I would insist on a new MRI so you know (as much as is possible) if things truly are "OK" and it is just taking ages to heal...or if there is a new problem.

Please post with any questions you may have, comments or if you just need some support in dealing with all this. The experience of major back surgery is almost as hard on the spouse as on the patient.

 
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Old 03-10-2011, 09:54 AM   #3
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Re: 6 month check up after lumbar fusion - help

I just want to back up everything that has already been said and to tell you I'm sorry that your hubby is still experiencing this level of pain. I do hope that his surgeon will order a new MRI with contrast or a ct scan in order to be sure that there is not another problem. If he continues to refuse to do so, I would see if you can find an orthopedic spine specialist who will give a second opinion.

Best of luck, and please let us know how things are going.

Carol
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Old 03-12-2011, 09:18 PM   #4
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Re: 6 month check up after lumbar fusion - help

Thank you for your reply's. I did confirm that my husband is getting a CT scan for his appointment. He had surgery on Oct 4th to fuse L5 and S1 and then a nerve decompression. Immediately after the surgery his pain was unbearable so even though the MRI did not show anything they went back in to take a look 2 days latter. The Dr. said he did not see anything that was causing the pain however he added a bar to widen the spacing and cleaned out the root area as much as possible. After that surgery he did have less pain than after the first one and we were sent home 2 days later. 6 weeks later he was admitted to the hospital because his pain was so intense. They gave him high doses of morphine and then sent him home 2 days later. Mid December he passed a PE (blood clot) through his heart and it lodged in his lung causing significant damage. That was a 4 day stay in the hospital and then 2 weeks later he was re-admitted to the hospital for liquid build up in his lungs at which time they drained 18 oz of fluid and kept him for 4 days. Since then I am thankful that he has not been back to the hospital but he does not seem to be progressing at all. When looking at the x-rays it appears that he has rods, screws and a bar in that area. They did say that he does have conjoined nerves (multiple nerves rather than one) trying to fit through the root canal. They said that they see about 1 in 100 cases of that and that often they are successful addressing the nerve pain. Exactly like you predicted we keep hearing - nerves take a long time to heal, be patient, the x-rays look good, his fusion is healing well............my husband is really getting depressed and the constant pain is getting to him. I am wondering if I should get him in some sort of councling to help with the depression ? Being that I am asking I have just convinced myself that the answer is yes. I will do that this week. The message board is very helpful. Thank you for your support.

 
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Old 03-12-2011, 10:42 PM   #5
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Re: 6 month check up after lumbar fusion - help

Has your husband been given any medications for nerve pain such as neurontin (gabapentin), Lyrica or Cymbalta? Some people find one of these helps a great deal with nerve pain. I never had much result but perhaps your husband will respond to one of them. Cymbalta would also help with the depression.

I don't know what effect your husband's other issues for which he was hospitalized might have an effect on the rate of "healing" and growing bone. It sounds like he has really been through a lot.

 
Old 03-12-2011, 10:45 PM   #6
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Re: 6 month check up after lumbar fusion - help

I am so sorry that your husband has had to suffer through so much. Many years ago I had a fusion with complications and spent 3 wks in hospital. Then 3 months after the surgery I was bedridden for several weeks. Eventually things did improve. Unfortunately with this kind of surgery there are always some of us that end up with complications and a lot of severe pain. I pray that his pain lessens and he starts to improve but I know from personal experience it can be a long road back to good health.
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Old 03-13-2011, 11:22 AM   #7
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Re: 6 month check up after lumbar fusion - help

I am so sorry your husband is going thru so much. Having back surgery is tough enough, but with all the added problems he has experienced, I think he can expect recovery to be slow. Right now his body is gathering strength and about the only thing he can do is to follow doctors orders.

The depression just makes the pain worse and harder to handle, so I believe he could benefit from an anti-depressant and maybe some counciling from a doctor who deals with chronic pain patients and has a good knowledge of their special problems.

Unfortunately, it is true that nerve pain can take a long time to die down. In the meantime, drugs like Lyrica or neurontin can be helpful. I derived great relief using Lyrica while others do well with neurontin, so it's a very individual thing. You might ask his doctor to put him on one of these to see if he gets relief.

I do hope he will soon be able to start the healing process and get some of this under control. In the meantime, he may benefit from talking to the folks here if he is willing; if not, the board can help you deal with the problems of being a caretaker. No matter how much we love someone, being a caretaker takes a lot out of us, and the support of a board like this can be very helpful. I hope you will take advantage of that and feel free to post any time, to vent your fears and frustrations, and seek whatever advise we are able to provide.

Best wishes to you both.

Carol
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Old 03-14-2011, 10:20 AM   #8
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Re: 6 month check up after lumbar fusion - help

""Is this level of medication normal 6 months after surgery? ""

There are worse cases. Start reading about Pain Pumps. They implanted a pain pump into my wife's friends husband. It's the only reason he's still alive.

Spine surgery isn't guaranteed to be successful. He may wish to request different muscle relaxants. Some work better on different people, everyone's different. Also ask the doctor if there is something else besides Oxycontin to help him. Oxycontin was reformulated and released on the market in the last quarter of 2010. The new formula doesn't help pain. The Federal Govt forced Purdue Pharma to reformulate it and cover the narcotic medicine in a waxy material so kids can't get the pills and chop them up and snort it. Problem is our bodies are just passing the medication thru it and it's not being absorbed due to what they did to it.

Best of luck.

 
Old 03-14-2011, 06:08 PM   #9
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Re: 6 month check up after lumbar fusion - help

Yes. I had fusion L4 L5 in May 2010. I woke up with horrible pain in my right leg. The doctor gave me a bunch of tests, but told me nothing was showing up except for some nerve damage. He sent me to a pain clinic, but the side effects of all the meds were too much for a mom of 4. So then he told me he could no longer help me and sent me to a neurologist. He at first thought I was just trying to get meds, but after giving him back the left overs after they didn't work again, he said the thinks my sciatic nerve was nicked during surgery and it could take up to 2 years to heal. Now pain has started back on the left side and I was sent back to the surgeon who wouldn't meet with me and sent in his PA to tell me they would do one more MRI and if that didn't show anything I would have to go back to a pain clinic. Not only that, but in NC once you see a surgeon for your back, no other surgeon will even speak to me. I am stuck in pain. It is an impossible situation. I wish you luck and keep going to doctors until you get an answer.

 
Old 03-17-2011, 08:55 PM   #10
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Re: 6 month check up after lumbar fusion - help

That is so odd that you are also not having any luck getting another dr to look at you. My husbands Dr. moved out of state 3 weeks after operation on him! He never told us he was moving. Definately borders on unethical behavior. Because he was paert of a clinic the other dr in the clinic did pick up my husbands case but we have still never met him. First time back to the office he was on vacation, next time back he sent in his PA and again we never seen him. We are going for a check up on the 24th and we better see him or I will most likely loose my cool. I wish you the best in figuring out what is causing your pain.

 
Old 03-19-2011, 10:05 PM   #11
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Re: 6 month check up after lumbar fusion - help

I finally got to go see a neuro specialist 2 years post-XLIF.

I asked him if the massive bulging scar tissue around L4/L5 is pinching off the blood flow to my lower extremities as well as all the nerves that are in that area....

Dead silence. He wouldn't answer it. I asked him again, look at the Xrays/MRI/CT Scan there in your hand and tell me if that bulging scar tissue around L4/L5 is pinching off the nerves/blood flow to my lower extremities....he wouldn't answer it.

Femoral nerve is destroyed. They beat my knee caps with a hammer now and the legs don't move.

We can see why. Going to a Neuro specialist post-op won't help you.
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