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Old 01-19-2012, 09:04 PM   #1
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Radiculopathy

This is my first post, and I was hoping that someone might have a suggestion for lessening radiculopathy pain. I herniated L4-L5 in November 2009, MRI in January 2010 showed full thickness annular tear with redundant ligamentum flavum and mild/moderate spinal stenosis. After three epidurals and two years of physical therapy, massage and chiropractic treatments, I had an ALIF on December 6, 2011.

The surgery itself went really well -- it was intended to be a combination ALIF/PLIF, but the surgeon said my bones were really hard and the nerves snapped right back in place. He did indicate that there was a large amount of scar tissue. I was feeling okay after the surgery until today, when the charley-horse-type pain came back in my left leg. Apart from stretching and pain medication, has anyone found an effective way to manage this type of pain? Any help would be much appreciated.

 
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Old 01-19-2012, 09:21 PM   #2
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Re: Radiculopathy

Welcome to the board. You will find that your recovery will take some zig-zags. You may be pain-free for a bit and then suddenly have some nerve pain. This is a fairly common occurrence with lumbar fusion.

Be sure you are taking small, frequent walks each day. This is the most important activity you can be doing right now. It is the most effective way to stretch out the spinal nerves, which helps to keep scar tissue from attaching to the nerve when it is forming and filling in. Don't worry how far you walk or how quickly...just try to walk at least several times each day...on a level surface if you can find one where you live! Avoid walking up and down hills until you are much further along with your recovery.

Also, be sure to limit your sitting time. 15-20 minutes is what most doctors advise their fusion patients. Sitting puts 30% more stress on the discs than standing/walking or lying down. Even after you are healed, it is a good idea to get up every hour or so and walk around the room, just to give your spine a little break.

If the radiculopathy continues, you might want to ask the doctor about taking something for nerve pain, something like neurontin or Lyrica. For now, try using a cold gel pad or icing the lower lumbar area for 15-20 minutes at a time. Some people find heat more satisfying...and you can alter between the two. But first try the ice. It is usually most beneficial, particularly when you still have some swelling.

You will find that even a small increase in activity can bring on some inflammation -- enough to irritate a nerve or the sciatic nerve. Since you are still very early in recovery, please be very careful stretching. Don't perform any stretches without clearing them with your surgeon.

 
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Old 01-20-2012, 12:17 AM   #3
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Re: Radiculopathy

Thanks for the reassurance. Given the ease of recovery, particularly compared to the three hip arthroscopies I've had, I sometimes forget what six weeks post-op means. By way of clarification, I've been doing calf-stretching/nerve glides, as opposed to lumber stretching, so I think I should be okay. I've been in physical therapy since week three, pretty easy stuff, and I will make sure to take my exercise diagrams when I see the surgeon on Monday.

And, yes, the walking. I walk at least twice a day for 30 minutes continuously, and sneak in little bits of walking here and there, as well. The surgeon's goal is three times per day for 40 minutes each time, but I get too stenotic and my hip starts getting aggravated. So, I am focusing on what I can accomplish, rather than someone else's outlandish goal.

Okay, back to go ice some more. Not sure if it helps with the nerve pain, but it makes my back feel better. Thanks!

 
Old 01-20-2012, 07:33 AM   #4
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Re: Radiculopathy

Oh, OK on the stretching. Sometimes people just start stretching on their own without any guidance or supervision...but nerve glides are great.

Sounds like you are on old hand with surgery, so that experience will help with this recovery. I again would like to emphasize taking several shorter walks and thinking of your doctor's suggestions as goals that you will achieve a bit further into recovery. Particularly when you are dealing with other physical issues (hip in your case) you have to plan accordingly.

From my personal experience with fusions and from participating in boards like this, I think the most important goal is to do everything in your power to minimize scar tissue. You can't do much to prevent it from forming, as that's what the body does as a natural part of healing, but you take some action to keep it from attaching to the nerves...and the way to do that is from walking.

If you think of it in cooking terms, if you want to keep something from forming a crust on top, you have to stir the pot every so often to keep the surface broken up. Think of every walk as an opportunity to keep the scar tissue from attaching to those nerves...and just like you don't have to stir the pot for ten minutes to break up the surface, you don't have to walk for 30 minutes at a time to stretch out those nerves.

I was a bit of a fanatic about it, I guess, but I found after both my fusions that I couldn't sleep for more than about 4 hours at a time...so rather than fighting it and trying to stay in bed for a normal night's sleep, I just went on a 24 hour schedule...where I'd sleep for awhile and then I'd be awake for awhile and I just did that around the clock. This way I was up and walking at least every four hours or so, even if it was just to walk around the house a couple times. Obviously this schedule doesn't work if one has kids to take care of, etc...but just my husband and I are at home, so it worked for me.

The point is, particularly in your case with your hip problems, you want to walk just up to the point before it is too much for the hips...you don't ever want to tire yourself. Much better to take ten walks for ten minutes...you get the idea. You'll end up at the same goal without causing unnecessary inflammation and irritation.

My recent fusion was what I, and everyone else who took care of me, regarded as my "last chance" to resolve my particular pain generators. My surgeon was determined that I do nothing that would get my sciatic nerve inflamed. As a result, my rehab was very, very, very slow! I started and then stopped physical therapy several times because I was so limited in what I could do without stressing the nerve. I really thought I had a major SI joint issue (which is not uncommon when one fuses the lower lumbar area)...but by working slowly and carefully and gradually getting stronger, primarily through walking, I'm OK now and the SI joints are not an issue.

If you don't feel icing is helping, you can try using heat...just don't put it directly over the incision area...oh, with ALIF I guess you probably won't be doing that! If you have access to a pool, walking in water is very helpful.

Sounds like you're doing everything you need to be doing. One little tip: try not to look at progress day by day or even week by week. Just take the long view -- think where you want to be in a year. Do what you need to do each day in terms of walking and stretching and avoiding all the no-nos. Don't be surprised when there are little set-backs along the way. You will learn how much you can do before you start to fatigue and how much you can push ahead before it is "too much."

 
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Old 01-20-2012, 10:59 AM   #5
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Re: Radiculopathy

I'm in the pool for hydrotherapy once per week. The ability to get in the pool was the primary attraction to starting physical therapy so early. I have a pool in the backyard, but it's not heated. I suppose I could get a wetsuit!

From what I remember him saying in the hospital, it sounds like the surgeon removed a good deal of scar tissue, which he said was indicative of long-term instability which did not show on the flexion and extension X-rays. I woke up after the surgery with no sciatica, which was a feeling that I have not had since before high school. I liken the experience to having your hair in a really tight ponytail for a long time. When you take out the ponytail, all of a sudden you realize how much pain and irritation you've been ignoring.

I think that the improvement of symptoms in some areas is tricking me into thinking I'm better, but the stabbing calf pain is a good reminder to keep it slow. Of course, with a long-term injury of unknown origin, the recovery will take a while. Off to go take a short walk.

 
Old 01-20-2012, 09:45 PM   #6
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Re: Radiculopathy

Quick update: Figured out that the rain system that moved in on yesterday probably contributed to my pain. By this evening, the calf contractions were so bad that they were causing my foot to flex, making my whole leg jerk up and down. Booked a massage, and the therapist found the muscle and the work on the area helped. Felt like it was on fire, but still helpful overall. Now, I'm going to go heat up a gel pack in the microwave.

 
Old 01-20-2012, 11:20 PM   #7
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Re: Radiculopathy

I'm a bit confused why you are having so much cramping and pain in your calf. That distribution is more typical of a problem with the S1 or S2 spinal nerves. Did you have calf pain prior to surgery?

 
Old 01-21-2012, 08:29 AM   #8
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Re: Radiculopathy

I agree w/ Teri that calf pain isn't typical, but I'll provide general pain mgmt thoughts. I wonder too if it is a matter of compensating when walking or sleeping "odd" to protect other areas. I know my heel/foot issues have acted up b/c I was just off in my gait.

Using meds is a VERY individual choice, but it is NOT a sign of weakness. DO talk to the doc about it...they will NOT think you are a druggie....Dr Dad promised me they EXPECT you to need pain managment help for some time after surgery.

I like the Tiger Balm patches for some "non-pill" relief....they work better for me than the other brands. I like using a TENS unit too, but that really varies so it is good to try one before ordering one (and make sure the ordering folks call to get an in-network provider....mine's gotta go back since they didn't and it isn't cheap to get a GOOD one but SHOULD be covered if you get i prescribed).

You are also very early in a pretty long process. I posted a note yesterday but I'm 5.5 months out from my ALIF and really still seeing improvements. DO get in some walks...they are key for healing AND sanity...but also take the rest your body needs.

Oh, and both Dr Dad and the PT agree that rain/weather definitely makes a difference so it is very real to struggle a bit more.

 
Old 01-21-2012, 02:00 PM   #9
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Re: Radiculopathy

The calf pain was present prior to surgery, but more on right. My extrusion was neither right-sided nor left-sided, but straight back into the spinal cord. About 50 percent narrowing and the extruded material had migrated caudally (toward the feet). My March 2010 EMG noted that there was increased spontaneous activity in the paraspinal muscles at L4-L5 bilaterally and left L5-S1. But, the MRI showed that all levels but L4-L5 looked great. I'm thinking that some of the disc material from L4-L5 wandered down to the L5-S1 area.

I go back to the surgeon in two days and will get a copy of the most recent MRI report (funny how the imaging centers give you the films to take home and stare at, but not a copy of the report). I will also talk to him about whether another epidural at L5-S1 will help if the pain doesn't diminish in the next year or so. Maybe another round of steroids.

And, no, I'm not afraid of asking for pain meds! I currently two-three Tramadol during the day, then one 5mg oxycodone and a Soma at night. Except Thursday, when I took a second oxycodone, because the pain was keeping me up.

 
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