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Setrocana 01-04-2012 12:51 PM

Hip socket pain post fusion surgery
 
Greetings,

Just had a L4, L5, S1 fusion with decompression and spinal alignment on 12/27/11. The following day, I was able to get up and around with expected pain in the surgery sight. Worked with a PT for 'tips and tricks' on how to sit up, roll out of bed, stairs etc. I went home that evening. A couple tricks I've learned. Your 'zero clearance' recliner or couch is NOT your friend. The seat and back are not hinged together, and actually pull away from each other as you recline... Not a good thing. Post surgery, I had a general numbness across the tops of both thighs, and down my legs. Typical L5 nerve bundle area.

I continued my PT as prescribed. Pain was manageable in the 2-3 range. The first night sleeping on a firm bed was a bit tough. Woke up at a 4-5 but got that back under control. Thighs still numb, which my Dr thought should have cleared up. As I got up to do my PT, I started feeling a sharp burning pain in my hip socket. I found it was positional. Hurt most when I stood or sat. By 11:00am that day (29th) the numbness in my thighs had started to dissipate, but the hip pain continued to get worse. Even laying flat, if I moved my legs, the hip sockets would give me a shooting pain. Sleeping that night was almost impossible.

Morning of the 30th, I attempted to get up and walk to the bathroom. My whole body began shaking, and I could not support any weight. I tried sitting on the toilet, but the pain still was shooting... I woke up my wife who brought a kitchen chair and drug me back to the bedroom. I should clarify, that pre surgery, I did have issues with numbness in my left leg, but NEVER had this burning/shooter pain in my hips.

Calls to my surgeon after being transported back to the hospital revealed that sometimes nerves get 'angry'. (that was a big help) The ER staff was lost on this shooting pain. They'd ask my pain level. Well for crying out loud. While laying flat on a bed, my surgery sight was where it should be 2ish. My hips were fine as long as I was supporting no weight. But when I stood, I'd give it 8-9ish. I needed to use the toilet, so they brought me a walker and pointed me down the hall. Half way there, the shooters started. I made it to the toilet, and upon sitting was in a solid 7-8. I could not stand, or move. I pulled the little cord asking for help. Nobody came. I tried to stand using the walker, and ended up collapsing over the walker. This actually felt better supporting my body weight under my arm pits. Until this guy finally showed up. His first action was to grab my underarm and pull me up. Screaming is not generally a good thing for a full grown man, nor the tears running down my face. JUST HAD BACK SURGERY YOU *&$%**# :mad:

Long story short, I got admitted for 4 days of 'pain management'. Neuronton seems to be the ticket to bring down some hip pain. However, most important was a trick my new PT lady gave me.... She described a 'triangle' of muscle we have. We don't use two of them often, but they are related to your core strength. I didn't know men had a Kegel muscle, but we do. And the belly button is the third part of the triangle. Suck in the belly button, suck up the Kegel, and amazingly, the hip sockets sort of lined up, and my posture was much better... So I tell myself, 'Suck in and up' as I stand or walk. Strong doses of Neuronton, and good 'core' position have made this manageable. My surgeon still has not given me a reason that this new pain started, other than we 'angered' it...

Anybody else had this?:confused:

teteri66 01-05-2012 03:45 PM

Re: Hip socket pain post fusion surgery
 
Did you have a lateral lumbar interbody fusion (XLIF)?

Setrocana 01-05-2012 03:54 PM

Re: Hip socket pain post fusion surgery
 
I did not. Although I did read quite a bit about that on here, and it seems to cause problems similar to mine. Mine was straight through the back. 5 incisions (plus two drains). 4 Big screws with some cages where discs used to be. I suspect that I have some sort of inflammation of the L4 nerve bundles. Strangely, it's equal over both sides. Overall it's getting a bit better, but one slight twist while I'm walking/standing brings back the knee buckling pain. It seems to be along the sciatic nerve.

teteri66 01-06-2012 11:18 AM

Re: Hip socket pain post fusion surgery
 
Well, at least you know that it isn't the surgery itself that is causing new issues.

Any time a lower lumbar fusion is down, people seem to have initial problems with the buttock/hip/piriformis area.

What happens is that when the lower lumbar segments are fused, the first segment that has movement are now the SI joints. These joints are designed to have just a wee bit of movement, so it takes awhile for all the supporting muscles, ligaments and other soft tissue to get acclimated to the new demands of the altered spine.

The piriformis runs across the buttock and attaches near the hip. When it has any irritation, it can become taut and it can feel like pain in the hip socket...it can really hurt when a patient is on his feet. Also, the sciatic nerve runs directly underneath the piriformis, and in some people the sciatic nerve actually runs right through the piriformis...again, if there is irritation or inflammation, the patient can develop sciatic nerve irritation as well, with all those common, nasty symptoms of sciatic pain.

Oh, I just noticed how recently you had surgery. No wonder you are in pain. I'm willing to bet you still have a lot of inflammation that is causing or at least, partially causing these symptoms. Have you tried using ice over this area? It may provide some immediate pain relief. My guess is that you have pain on both sides just from nerve irritation from surgery. As your surgeon worked to free up the nerve/nerves, they were pulled and tugged on and as a result, they are irritated. It will take time for them to recover. You will need to be patient and diligent in your recovery as you move ahead!

I had a 3 level PLIF 18 months ago. It was my 3rd back surgery, 2nd fusion, and my surgeon was bound and determined that I would not irritate my sciatic nerve in the post surgical period. As a result, he was very conservative with what I could and couldn't do, when I could start PT, etc. For awhile I thought I was going to have to do something about my SI joints as they were causing all kinds of issues for me. The left side kept popping out of place and then I would have difficulty getting my walks in due to pain.

It took almost a year of careful management to get to the point where I could do more...and I just realized as I was getting ready for the Christmas holidays, that I was just pretty much functioning normally. I could shop without pain. I could stand and cook for hours without even thinking about my back. But this was 18 months post surgery!

Your last paragraph is very significant. You are lucky to have someone who gave you this information and who stressed structural alignment and body posture. It is extremely important and something you will usually not learn from a doctor.

Once you are fused, it is very important that you learn to move in a way that does not put any additional stress on the spine and that keeps everything balanced, not favoring one side or the other. For example, I realized that a stood with my weight on my one leg with the other turned out to the side, with the hip kind of jutted forward. When I sat, I always crossed my left leg over my right. This results in all the weight pushing down on the right side of the spine, the right "sit bone," etc. I have to remind myself several times each day to sit with both feet on the floor, with the weight split equally between the sit bones! These are just a couple examples of lifestyle modifications that a patient can make to help prevent adjacent disc disease in the future.

Setrocana 01-06-2012 12:07 PM

Re: Hip socket pain post fusion surgery
 
Big Hug!!! Thanks for that information! Makes a lot of sense, and I think you are dead on. I'm not one that takes a minimalist explanation from the surgeon well. I need to understand what is going on.

And I've figured out that posture is everything. For example, I use my walker whenever I'm moving. Not so much because I need it to support my weight, or actually assist me in walking. I figured out that I use it more as a guide to keep my upper body straight as I move, and it slows me down from making quick twisting turns that by habit I've done all my life. I found that without it, I have a tendancy to sway as I walk. Just having the walker lightly in my hands reminds me to stand straight.

Suck it in and up, and walk straight. I got released last Monday, and here on Friday my pain is very manageable. I'm having very little issue standing or sitting. My constant pain is a tolerable 2. So time to start cutting back a bit on the meds (I'm a pill phobe and dislike taking medications). I want to keep my pain in the 2-3 zone....

Thanks again for your information.... finding this sight was a big help. Then again, what else am I going to do as I sit at home for the next few months...

And I heard a good saying as it applies to us fusion patients.

There is an old saying, 'A rolling stone gathers no moss'. In fusion, we want moss to gather, so stop rolling'.

Cheers

teteri66 01-06-2012 03:00 PM

Re: Hip socket pain post fusion surgery
 
I'm glad you're feeling better. I think you're over the worst of it and things will s-l-o-w-l---y get better...it just takes a long time for the muscles and soft tissue to get used to the new position and their new "jobs." I know I am still making progress regarding the nerve issues and it is 18 months out from my fusion....

I like your saying -- good to remember when we want to run when we can barely walk!

imaj 07-07-2012 04:49 PM

Re: Hip socket pain post fusion surgery
 
five days out from surgery....your story sounds very familiar....good to have affirmation....patience is not my strong suit....will have to work on that....hope your 100% better by this time....thanks for all the good info....


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