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Old 09-27-2011, 02:03 PM   #1
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Question Pain after ALIF L5/S1

Hey everyone!
Hope this finds you all doing well!!

I am just struggling like heck with the different pains after this ALIF surgery! I have problems when I walk....It's a pain that comes on Suddenly, and will catch me, and almost make me fall! I can be standing, like at the store, in front of the grocery cart, and then I get ready to take a step, and BAM! it hits! It's all in my lower back area, and my legs; with the left being the worse.The left leg will drag some days.The foot flops easily, and I was told that I had nerve damage in the left foot, not pertaining to my back, but that there was nerve damage in my leg from my back, and damage in the right side of my back.

I walked with a walker for about 2 weeks, and am using a cane right now. I just feel better with the cane, in case that pain all of a sudden hits. It will be a bit faded, like its always "there" and then it will bam hit! It also made my legs go numb, and couldn't move them. so, I went for an ambulance ride!!! emergent MRI showed nerve compression,and severe swelling within the area. and there was some mention of a bulging disc above the area..Will the other discs start compensating for the fusion now?

Well 6 weeks post op, I developed a DVT left leg. I had been VERY active, and now that pain is somewhat gone, it comes back with sitting, and makes that leg even worse. ugh!

I see my pain management doctor this coming Friday. Any advice on what I should be asking him? I would like some better pain control, so that I can maybe go for a walk? That'd sure be nice to be able to go for a walk, without someone in case I fall!

Ive also been having back pain in the levels ABOVE the fusion. Feels just like my back did before it started bulging, and then herniatd. That burning,achey feeling. and having quite a bit more muscle spasm in that area now too.

I read that Patients with Scoliosis are more likely to have the Stenosis, and degeneration...great!

So, Here is what I am on for pain meds:
Gabapentin 900 TID (can go to 3600mg TID)
Oxycodone 10/325 1-2 ev 4 hours
Tramadol 50mg 1 or two TID
Flexeril 10 mg TID
Cymbalta 60mg daily.

Any ideas? thoughts?
Thanks in advance! and Take Care everyone!!!

 
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Old 09-28-2011, 06:41 AM   #2
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Re: Pain after ALIF L5/S1

I only fell once since my L5/S1 ALIF on 8/8 but the doc said it is a nerve issue. He said it is sometimes like pressing "restart" on the computer...which matched my exp to a T (I was standing and then just wasn't).

My leg/glute pain has not been a big issue though. Could it be the way you sit or sleep adding to it? Or compensating for a weak back and being nervous? I do know folks here have talked about foot issues but I don't know much on that end. As for other parts of the back, my doc explained that the whole spine needs to realign after an ALIF...it is actually going to "normal" after being "wrong" due to the bad disc.

On meds...they do twice daily oxycontin for me and then oxycodone (aka percocet) for breakthrough pain which they've reduced a little since the start. I also use a generic of Soma which really helps the spasms (bad for me as the spine all realigns)...not sure if it might make the weakness worse but it is a BIG plus for me.

 
Old 09-28-2011, 07:10 AM   #3
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Re: Pain after ALIF L5/S1

How long ago was your surgery?

Even if it is difficult, I hope you are taking small walks several times each day. It is so important as it is the best activity to stretch out the spinal nerves, which keeps scar tissue from attaching to the nerves as it grows in.

It is not unusual for the next segment up from the fusion to develop problems, but it usually takes years for that to happen. Where the body's movement was spread among all the lumbar segments, now L4-5 is having to absorb the brunt of all movement, and it can take its toll.

The fact that your pain is more widespread is probably a result of muscle spasms and the fascia (the "net" that holds all the soft tissue in place that is cut during surgery) knitting back together. As Cheryl mentioned, the spine (and all the muscles and soft tissue) have to learn a new position and new function after such a big surgery. This learning curve can be steep!

Depending on how long ago was your surgery, I might have a couple suggestions for you.

 
Old 09-28-2011, 07:15 AM   #4
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Re: Pain after ALIF L5/S1

Thanks for the replies!!

My surgery was just this last July 19. I had an MRI 2 years before, and it looked ok, and then bam, this summer, another MRI showed the stenosis, and degeneration. Neurosurgeon couldn't believe how rapid it declined.

I walk short walks every day. Somedays I cannot go far at all, due to the nerve pain that happens.

I cannot sit for more than 20 minutes, as the pain gets severe, and then my left leg goes completely numb. scary!

Thanks again!!!

 
Old 09-28-2011, 08:41 AM   #5
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Re: Pain after ALIF L5/S1

First of all, you probably shouldn't be sitting longer than 15 to 20 minutes at a time at this point in your recovery. You need to get up and move around after that amount of sitting.

I think you probably still have some inflammation from the surgery...either the nerve itself or the tissue surrounding the nerve. When you see the PM doc, ask him about this and hopefully he will give you a Medrol pack or even recommend an ESI to settle down that nerve.

Take some time to document what activities make your pain worse. If you go to the PM doc and say generalized things about being in pain, you won't get too far...but if you can give more specific examples, the doctor will better understand what is causing the pain, and, take your complaints more seriously.

Ask yourself things like: am I better (less pain) when I wake up in the morning? Do I hurt more or less when standing up/lying down/sitting?

It sounds to me like you are on sufficient medication -- maybe you need things changed up somehow so it is more effective. The thing is, if you have nerve pain, there isn't a lot that can be done if the gabapentin isn't doing the job. You could ask him if switching to Lyrica might help.

 
Old 09-28-2011, 02:27 PM   #6
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Re: Pain after ALIF L5/S1

It seems like my doc takes a different view than Tetonteri's on this but he def expected by two months that I'd be pretty able to sit...maybe a bit more adjusting than normal but he said that's his desk job return projection for most ALIFs. At my one month appt, he said he expects about a mile a day of walking....though he okayed more in my case given my history.

I do agree on tracking your pain. A pain journal will really help the doc pinpoint the issues.

Last edited by cheryl1213; 09-28-2011 at 02:29 PM. Reason: mean browser...

 
Old 09-28-2011, 07:12 PM   #7
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Re: Pain after ALIF L5/S1

Cheryl, Did your surgeon tell you that you could probably return to your desk job at 2 months, or that you could sit most of the day without getting up and walking around at 2 months? Many people are able to get up briefly and walk a little before sitting back down...so to me there is a difference.

My point was that if someone is having lots of pain sitting, she probably shouldn't be sitting for too long at a time...as it just isn't going to be of any benefit in any way.

I think it benefits anyone who has had a lumbar fusion to make a point of being aware of how long at a time he/she is sitting, and to take a little break, if at all possible. Just by virtue of having had a fusion the adjoining discs are already at somewhat of a risk...so everything we can do to keep them healthy is helpful, in my opinion.

 
Old 09-29-2011, 06:48 AM   #8
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Re: Pain after ALIF L5/S1

It was more of a context for recovery since I'm unemployed (sadly...looking forever...) and he said I could hande the sitting at that point. I do think moving would be needed but not every 15min. Again, just a different opinion. Certainly don't aggravate the pain but it is worth keeping the doc informed of your status. They DO want to know.

 
Old 09-29-2011, 07:54 AM   #9
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Re: Pain after ALIF L5/S1

How about once every hour or so, if possible? I find that even though my last surgery was 16 months ago, on days when I sit here at the computer too long, it can stir up a bit of pain. In my case, it affects my piriformis, and when it gets irritated, it affects the sciatic nerve.

I just like to bring up the sitting time limits after surgery because many docs don't mention it at all, and most people don't know that sitting puts at least 30% more pressure on the discs than other positions -- standing, walking or lying down.

Last edited by teteri66; 09-29-2011 at 07:54 AM.

 
Old 09-29-2011, 10:30 AM   #10
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Re: Pain after ALIF L5/S1

I agree that you probably should contact your surgeon, you are only 6 weeks out of surgery and most surgeons want to know what is going on if you are experiencing more pain, if it is inflammation a medrol pack might help, I know that can be a common problem, I didn't have a ALIF so not sure how different the pain is with that, I had an TLIF, not the min evasive one. I spoke to the physician's assistant alot, I knew I was having more pain that should be, I did end up having a not so normal complication, that's just me, if there is more pain I want to know why and like the others said a pain journal is a good thing to keep, you'll be able to tell the DR's exactly how your feeling. Hope your feeling better soon.
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L3-4 Cyst Removal 8/31/11
TLIF Fusion L3-L4 March 2011
Micro-Lami L3-L4 March 2010
Broad Based Disc Buldges L4-5, L5-S1
Osteoarthritis
Left Knee Surgery x2, Meniscus Tears, Arthritis

 
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