I have had two microdisectomys the first being in march 2011 on the L5/S1 followed by 2 infections afterward. I then had the second in Oct 2011 with only a little relief with the radiating pain down my right leg. the reason for both surgeries was herniations on the traversing nerve root. My back throbbing has not stopped after the surgeries and now I have leg pain coming back. My last MRI before my Oct surgery showed a broad based posterior bulg in the L4/S1 with no definite sign of nerve impingement. I have had multiple nerve blocks as well as nerve burn on my right side. My surgeon said there was very little disc left over and said he spent 3.5 hours getting the scar tissue out when it was suppose to be a 45 minute surgery. My surgeon has told me numerous times that I should should just take aleve for pain since I have been on pain medicine since the first herniation to get my body back to normal. My pain management doctor dissagrees and prescribed hydrocone twice a day. My question is. How normal is this pain after 2 surgeries and with the joint messed up should I be thinking a fusion is in the future or am I stuck tryiing to get injections the rest of my life?
Welcome to the board. You ask some good questions that are probably the same ones your surgeon is asking.
Usually after the same segment has been operated on more than once or twice, a fusion is usually the next step. However, there was one thing unusual that jumped out at me. followed by 2 infections afterward. Could you elaborate on this? Where was the infection? What caused it and how was it dealt with? Of course none of us on the board have formal medical training, but this would concern me a great deal and might make a fusion difficult.
If you have a radiculopathy in your leg, one would think there is a compressed nerve in your spine. But you mention that a MRI revealed that no nerves were being compressed...so, what is causing the radiating pain in your leg? Perhaps a nerve is permanently damaged. In any case, medications like hydrocodone are not going to affect the pain if it is nerve-related.
My first infection came about a week after the surgery when I could smell something weird. they did a blood test and said I had an infection and gave me about a week worth of antibiotics. I continued to have fevers and they did another test and gave me a 30 supply of antibiotics. My surgeon thinks the infections inside my back caused all the scar tissue. My last MRI was before the last surgery so that is why it showed no definite nerve compression at the L4 level. I think because they cut so much out and I havent been able to be active it has caused the L4 to be overworked as well as the joint. I have just recently started to have the pain in the leg again. I am active duty military so I do get pretty good treatment but usual dont get very many answers. I am at the point where they think Im not healthy enough to be on active duty anymore but still have me working long hours. I guess thats just how it goes. Im clearly frustrated and not sure if another surgery is worth it but the contant injections and nerve burns are not a solid solution as well. I am weary on a fusion because these 2 surgeries havent been effective. I appreciate any advice and or comments.
I would continue to pursue whether the infection has cleared up. Even under the best of circumstances, infection is the number 1 risk in patients undergoing additional spine surgeries. Your chances of infection being a big problem if you were to have further surgery goes up significantly (and is even worse if the original infection has not cleared up--) If there is infection, your chances of fusion taking place are put in jeopardy.
I agree with you that it is not a good long-term plan to try to manage the pain through injections. Injections have their place, but they are not meant for ongoing pain management through the years.
If there is little cushioning between the two vertebrae, eventually the nerves will be compressed, which may be part of the reason you are having pain now.
It would seem that a fusion would be the next step, with spacers between the vertebrae to keep the spacing open between the vertebrae. A two level fusion from L4 to S1 would not take away a lot of spinal movement, as the L5-S1 segment is already fairly stationary. However, carrying heavy loads on your back will not be a good idea, and repetitive bending is a bad idea, too. People in general are not encouraged to do heavy physical labor after a fusion.
Let me know if you have specific questions. I do think you need to return to your spine surgeon, let him know you are still in the same amount of pain and ask to be tested to be sure the infection is not an issue.