As I've stated before, I don't believe that neurosurgeons make fusion patients aware of this risk prior to surgery. It may be listed on a sheet of paper, but I'm sick of people blaming the patient. My surgeon never mentioned the risk, which seems to occur often enough to be something that should be mentioned. Drop foot is a terrible affliction, both physically and mentally. There also seems to be a pattern (based on anecdotal evience only, so please don't attack me with site requests) of doctors telling those who wake up with a foot drop following fusion that the foot drop is only temporary and will go away within a number of months. I've yet to talk to a fusion patient who had foot drop as a result of the surgery who recovered. Believe me, I'd love to hear of such occurences.
As for me, I had surgery December 22 to remove the screws on the left side of my fusion and to enlarge the left L5 foramen. I still have an incision halfway up my back that is healing form the inside-out due to suture failure. It has been continually seeping as it heals and was infected for a couple of weeks until we finally found an antibiotic that worked. It has finally started to scab over at skin level and the discharge has diminsihed quite a bit, as has the pain from the wound (which was about a cubic centimeter in size below the skin level at the start).
Has my foot drop improved? Well, I went to see the neurosurgeon who performed my last EMG. He said that I was showing some nerve improvement in my left leg. He said that it appeared that the nerves were regenerating properly and that I should show significant improvement within three months. Is this true? It's only been one week, so I don't know. I do know that this is the first time that a positive examination (subjective) was backed up by an objective measurement (the EMG readings). Perhaps this is the healing I've been told about for months. First, I was going to be fine after three months post-op, then 4 months, then 6 months, now it has been more than 7 months and the only real indicator of progress is from EMG readings. We'll see what things are like over the next three months as I should see "significant improvement."
Any success stories out there or people who want to share their stories of unsuccessful recovery? Once again, I'd like to hear your comments.
The following user gives a hug of support to bracer: cheryl1213 (01-31-2012)
Thanks for the reassuring words, SpineAZ. As much as I'd like to believe you, I've heard those very words from variuos sources for seven months now. It always seems that small amounts of improvement are just around the bend, but then a couple of months go by and nothing has changed. In my case, more than seven months have gone by and nothing has changed. No decrease in the foot-slapping, no increased strength in the foot, the big toe still bends down just as easily as it always has, and heel-walking is nothing but a dream. I'd like to think that come April I'll notice some change, but it's hard to believe that there will be a difference come June - the one year anniversary.
I've read about and talked to people who have had foot drop for different reasons: knee injuries and strokes, mostly. Those people have a significant chance of recovery and I've actually made contact with several who have recovered almost completely. However, I've yet to find a person who has recovered from foot drop that was the result of spinal surgery, particularly fusions. I hope they are out there, but believe me when I tell you that I've done loads of searching for those folks and they simply aren't there.
I've found many who have not recovered even though theeir surgeon assured them that recovery was coming if they would only be patient. Well, patient they were, and years later they are still waiting. I know that most people who recover are not hanging out on boards like this, but I've gone to many other places that have little or nothing to do with back problems looking for someone who might have recovered from foot drop due to back surgery, but no one is there.
It's led me to believe that foot drop due to lumbar surgery is almost always a permanent condition, but doctors will not tell their patients that. They tell them to wait a few months, then a year, then 18 months, then two years, by which time most patients have adaptedt to the problem and given up on recovery. I'd love to be proven wrong, but it hasn't happened yet. Even my therapists, when pressed, can't come up with an example they've worked with or even heard of. My surgeon says he has never had it happen before and doesn't know why it happened. Nobody knows why. No test has shown why things are the way they are, other then the EMG and nerve conduction studies which show definite L5 damage. Is there something preventing it from recovering? No one knows, though my CT myelogram was clean. I think sometimes something occurs that is unknown to the surgeon and the result is a permanent foot drop. They say things will get better only because past experience with stroke and other patients other than lumbar surgeries tell them that things should get better. In the lumbar surgery cases, particularly fusions, the healing doesn't happen.
I was wondering about you just a day or two ago...someone in a different group mentioned a drop foot issue (not related to back stuff). Sorry to hear you are struggling. I DO believe strongly that being a vocal "advocate" is important....you got screwed by a side effect but you are helping others be alert to the danger and that rocks.
Keep pushing for answers and progress! It IS worth it. Do let yourself wallow sometimes, I think that's actually healthy, but also keep pushing and asking and striving for answers.
The Following User Says Thank You to cheryl1213 For This Useful Post: bracer (01-31-2012)
Have you been able to return to work since the revision surgery? People are always asking how the recovery (having hardware removed) compares to the original surgery...any thoughts?
It's not just to drop foot that surgeons tell patients "wait and see." That is pretty standard/typical advice for any problems that pop up after surgery, particularly anything that is related to nerves.
I guess I don't know anyone personally who has had drop foot from back surgery, so cannot comment on that. My aunt had her stroke a year ago and she is doing very well. But she had a lot more damage than you to begin with. I think in her case, it is a matter of developing new pathways in the brain.
She was completely paralyzed to begin with. Two weeks later she moved her big toe for the first time. I guess with drop foot as a result of nerve damage during lumbar surgery, the nerve in the spine is affected, rather than in the brain.
Did removing the screws make any difference? Are you in less pain in your back?
I've found with my loss of feeling in my calves, ankles, feet and toes, that I think I am still making some progress, and I'm 20 months post 3rd surgery...but the original nerve compression is from about 9 years ago. It is hard to tell because the changes are very small -- minimal, really...but I know I have been regaining feeling in my toes. When I last went to the neurologist(for a head problem) and he did a general neurologic test, I discovered I was way more numb in my legs than I had realized...but I now have a little feeling in my toes. (which had been almost 100% numb.)
So, I don't really have anything to add to the discussion. I just wanted to say hello and encourage you to keep plugging away. I'm not sure how much time has to go by before one concludes things are as good as they are going to get....
My neighbor has drop foot following a fusion (he had no back pain, first symptom of disc collapse was drop foot). He feel some gradual improvement. He was fitted with an advanced thin brace for the foot and is back to hiking. He had to adjust his gait and did so with some physical therapy, but even with the brace is working, hiking, etc.
Hi, teri! It's nice to talk to you. It has been a while. Let's see if I can answer some of these questions.
[I]Have you been able to return to work since the revision surgery? People are always asking how the recovery (having hardware removed) compares to the original surgery...any thoughts?[/I]
I went back to work about 10 days after my revision surgery. It was not too bad, other than this incision wound for the CT that had the inside sutures fail, so it's been healing from the inside out. It became infected for a bit and has been draining constantly, though the drainage has almost gone away now. I'll be glad when we can stop putting a gauze bandage and tape on there twice a day. My students enjoyed seeing the screws and rod that they took out. I didn't even clean them for maximum gross-out factor. It's hard to believe the screws are that long. The area hurt for a couple of weeks, then went down to just being sore all the time. That's mostly due to the incision that is still healing. The scar they had to cut open to get to the screws was never really a problem and is still a little sore, but not bad. The revision surgery, even with the removal of some of that L5 foramen bone was nothing compared to the fusion and not as bad as a laminectomy -- really no big deal. My fusion is almost complete, so that was good news.
[I]It's not just to drop foot that surgeons tell patients "wait and see." That is pretty standard/typical advice for any problems that pop up after surgery, particularly anything that is related to nerves.[/I]
The problem is I wasn't told "wait and see" at first. I was told three months max and everything will be fine, then four months, then end of the year, and now we're back to three months again (based on the latest EMG and nerve conduction study).
[I]I guess I don't know anyone personally who has had drop foot from back surgery, so cannot comment on that. My aunt had her stroke a year ago and she is doing very well. But she had a lot more damage than you to begin with. I think in her case, it is a matter of developing new pathways in the brain. [/I]
Yep, I think that's right. And for those of us with nerve injuries, it's supposed to be 6-24 months of slow but steady healing. So far, I haven't had any of that, though as I mentioned, the latest EMG was supposedly encouraging.
[I]Did removing the screws make any difference? Are you in less pain in your back?[/I]
Not really. Pain is the same. The suregeon said that after he got in there, it looked like I was saving myself some trouble that would have happened sooner rather than later. I was more interested in the possible lessening of compression of the L5 nerve root. The next few months will tell whether that was worthwhile.
[I]I've found with my loss of feeling in my calves, ankles, feet and toes, that I think I am still making some progress, and I'm 20 months post 3rd surgery...but the original nerve compression is from about 9 years ago. It is hard to tell because the changes are very small -- minimal, really...but I know I have been regaining feeling in my toes. When I last went to the neurologist(for a head problem) and he did a general neurologic test, I discovered I was way more numb in my legs than I had realized...but I now have a little feeling in my toes. (which had been almost 100% numb.)[/I]
I had much more numbness/nerve pain in my legs and feet (and the drop) following the fusion than before. My new neurosurgeon said that will go away very lowly, with most of it disappearing with two years. I can live with that, as long as this drop foot leaves as well.
[I]So, I don't really have anything to add to the discussion. I just wanted to say hello and encourage you to keep plugging away. I'm not sure how much time has to go by before one concludes things are as good as they are going to get....[/I]
You always add plenty to a conversation. I enjoy your perspective (and those of my other friends here, too). There's nothing to do but keep going to therapy and hoping for the best. Hope is what gets me out of bed in the morning. When this drop foot starts to heal, I'll be shouting from the mountain tops. I have to have faith that it will improve so I can get back to a full life. Pain is OK and can be handled, but not being able to play ball with my class and family is not. That stinks, especially since I'm still in my 40s. I feel like I've aged 20 years. I'd like that feeling to go away until its actual time arrives.
Take care, teri. I hope your aunt continues to get better. My mother had two strokes back in October and is starting her recovery. She can get around OK, but has lost the ability to read. She can see just fine with her glasses and can write. She just doesn't know how to read any more. She has a therapist come a couple of times a week to help her. Mom says it's like being a first-grader all over again. She's handling it reasonably well, but has good days and bad days -- just like all of us with nerve issues.
Will your mom listen to audio books? Strokes do such weird things. When my aunt was in the rehab unit of the hospital for 3 weeks, almost all the other patients were in their 40s. It kind of puts things in perspective...nerve pain no longer seemed all that bad.
Right now I'm helping plan (long distance, so I'm not a great deal of help) my aunt's 90th birthday party at the end of March.
I can't believe they didn't clean up your hardware before giving it to you. What did it look like? My was presented to me after having gone through the autoclave and was in a nice, clean little jar...looked just like it had come from Ace hardware!!
My hardware was returned to me in a white plastic container inside a clear baffled that said biohazard . The screws and other items had dried blood on them. Nothing particularly gory, but my fourth graders thought it was all cool.
That was my first thought. "Wow, these things are huge." Seeing them on an x-ray doesn't give the proper impression of size. I still have the oones on the right side and it is hard to believe they don't poke out of my back.
My hardware from lumbar fusion in 93 was huge. Every xray tech who took pictures was amazed. One said she's fascinated by the history of hardware and asked if she could keep a copy, she printed it out without identifying information so I was fine with it. My new hardware from 2 yr ago is one more level of fusion but more sleek. My current physical therapist is doing a huge life sized person seeking to find xrays at each level of the body so I'm giblvine her my neck and back xrays. When done she'll have a "person" with hardware everywhere.
I have a 30 yr old fusion. L4 to S1. I have 8 screws period. There is no plates or rods. The fusion is solid. Also I had no physio therapy but due to complications I spent 3 weeks in hospital. So hardware had not always been large. Also something I notice on here is all the comments from patients calling their fusion surgery a success in the early years. The domino effect can and does take place on average at the 6 year mark and then you can be in even worse shape than before surgery. I don't think that surgeons are honest enough about surgical outcomes with their patients. But then again surgery is their livelihood.