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Old 09-15-2011, 07:34 AM   #1
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7months post ALIF sudden new sciatic symptoms

Hi all,

Thought I'd post again here as it has been a wealth of information in the past. I am now 7 months post ALIF l5-s1 I had been seeing very very slow gradual improvement. Most of the discomfort residing in my left side of my back as a dull aching sensation and a tight gripping sensation in my legs but 'no' sciatic symptoms to speak of. I had been pronounced statistically and technically fused.

About 10 days ago, I noticed a bit of an uptick in discomfort in my back. No big deal right? Well it has been accompanied with a periodic severe stabbing pain down my left leg into the ball of my foot. This happens a couple times a day always when I am sitting and lasts from a minute to 30minutes or so. It is quite different from the sciatic symptoms I experienced pre surgery. I cannot point to a specific event or activity that brought this on. Needless to say, I am concerned and also it has spurned a bout of depression as I thought I was recovering.

Has anyone experienced something similar that happened this far out from their fusion with no real reason? I will see my surgeon as well but now that I am done from surgery the last two visits he has been less responsive. It would help before I do to have additional perspective.

 
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Old 09-15-2011, 08:24 AM   #2
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Re: 7months post ALIF sudden new sciatic symptoms

I cannot speak specifically to your issue as I haven't experienced surgery from the anterior side...but I can tell you that it is not all that unusual to have new symptoms, or a return of prior symptoms months out from fusion. Not to depress you further, but I had a 3 level posterior fusion a year ago June and still get sciatic symptoms when I do certain activities.

Believe it or not, seven months is on the path to recovery, but you won't be there for at least another five, if not longer. While you are "fused" all that means is that the bone has knitted together. It takes the bone many months after that to set and what I think of as "cure." The bone fills in and becomes strong.

Also, a lower lumbar fusion changes the mechanics of the lumbar/sacral area, which requires that all the muscles and soft tissue of the pelvis have to get used to new arrangement and functioning. This rearrangement puts additional stress on the SI joints and can result in pain in the sciatic nerve.

If the pain continues, I would consider asking your doctor for a course of physical therapy. Sometimes the SI joint will slip out of position during this process where your body is learning the new positioning. It can cause the piriformis (which runs across the buttock from the sacral area over to near the hip) to become taut or inflamed. The sciatic nerve runs directly beneath the piriformis so it often gets caught up in this irritation to the point that it results in the old familiar sciatic pain.

Usually as the patient gets a little further out from the surgery date, he/she becomes more active...which often results in new pain sensations. These are usually temporary. As the muscles get stronger, and muscles that have maybe gotten lazy while the patient was in pain and perhaps walking differently due to pain, etc. learn to work in new ways, the pain will go away.

Sometimes it is worthwhile to have an x-ray so you know the hardware is in place, hasn't slipped or broken, etc. Then you might be able to relax a little bit and adjust to the fact that it just takes a long time to recover from the surgery.

My surgery was more complex than yours, so I would assume my "learning curve" is longer, but my PT told me yesterday that it may take another year or two for my body to adapt to the new positioning....what I am doing, and it is VERY slow, is to strengthen all the muscles in a way that does not cause the sciatic to flare. Sometimes he will give me what appears to be a simple exercise...but after trying it a couple times, I realize it is going to cause problems. So then my PT breaks it down or figures out a yet simpler way to get to the same muscle through a different movement that is not going to affect the sciatic nerve. He is definitely NOT treating me with that "no pain, no gain" attitude. He was under rigid instructions from my surgeon to avoid anything that would inflame the sciatic nerve...so we are moving slowly.

I started PT last fall but the smallest movement was inflaming the nerve...so I stopped PT and just walked and did a few simple exercises and stretches. Then I resumed PT about six weeks ago and again, we are working slowly and carefully to keep the nerve happy!!

I imagine that you have picked up your activity level, or perhaps are sitting for longer periods at a time --something is causing some irritation of the S1 nerve, or so it sounds to me.

 
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Old 09-16-2011, 08:27 PM   #3
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Re: 7months post ALIF sudden new sciatic symptoms

[QUOTE=Bgranda;4842906]Hi all,

Thought I'd post again here as it has been a wealth of information in the past. I am now 7 months post ALIF l5-s1 I had been seeing very very slow gradual improvement. Most of the discomfort residing in my left side of my back as a dull aching sensation and a tight gripping sensation in my legs but 'no' sciatic symptoms to speak of. I had been pronounced statistically and technically fused.

About 10 days ago, I noticed a bit of an uptick in discomfort in my back. No big deal right? Well it has been accompanied with a periodic severe stabbing pain down my left leg into the ball of my foot. This happens a couple times a day always when I am sitting and lasts from a minute to 30minutes or so. It is quite different from the sciatic symptoms I experienced pre surgery. I cannot point to a specific event or activity that brought this on. Needless to say, I am concerned and also it has spurned a bout of as I thought I was recovering.

Has anyone experienced something similar that happened this far out from their fusion with no real reason? I will see my surgeon as well but now that I am done from surgery the last two visits he has been less responsive. It would help before I do to have additional perspective.[/QUOTE]

Hello Bgranda,

It's not uncommon to have bouts of pain after back surgery. I had a single level fusion in 2004 and it was 14 months later before I stopped having pain that was similar to before surgery. Like tetonteri said lower lumbar fusion changes the way that muscles react to movement.

I just had a 2-level fusion 9 months ago and I've had numerous times of pain. There's been days and weeks that I felt pretty good but also days that I didn't want to get out of the bed. I just recently am having the same mid back burning sensation and right leg pain that I had 11 months ago. I'm seeing my spine specialist next week and I know I'll have a x-ray done but expect to hear that it's only inflammation. It's something we all have to deal with as back sufferers. Our backs will never be as strong as they once were.
I've been depressed before too. But remember, there is people that are a whole lot worse off than you or me. I don't want to seem harsh but I've had 6 back surgeries and I''ve always tried to keep a positive outlook. Take it easy for awhile. You will be okay. Keep us informed.

 
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