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Old 03-01-2012, 06:34 PM   #1
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3 months post-op a lumbar fusion and frustrated!

Hi,
I am 3 months out from a L5/S1 fusion. I am still pushing through a great deal of pain during the day. I am not on any meds, and there are days (few and far between) that I feel amazing. Then, the next day it hits me and I am miserable. I am very discouraged. I am riding the rollercoaster. I have a lot of pressure when I sit. Is there anyone out there that truly saw a difference past 3 months? My Dr. says this is all normal. I am 50 percent fused. Is my pain because the fusion isn't solid? It drives me crazy that there is no pattern to this. IS it too much activity, not enough, too much sitting, etc. I have a teenager who needs me to take her on college visits.

 
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Old 03-01-2012, 07:57 PM   #2
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Re: 3 months post-op a lumbar fusion and frustrated!

I am also three months post-op, but for an L4-L5 fusion. I wish I could say I was med-free, but if it's not my back/legs, then it's my hip, which is a separate injury. I don't know whether your activity is too much or too little, but here's my experience.

I try to walk about 20 minutes at a time, at least twice a day. (I was walking longer, but it got really painful, so I cut back.) I concentrate on time, rather than distance, which is really hard with a Type A personality. I also sit on the exercise bike for about 30 minutes and slowly pedal. I try not to sit for more than 30 minutes at a time. I have been back to work (sometimes from home) since about week four; I found that working part-time at the beginning really helped me to get used to working again. I am fortunate that I can work from home. At the office, I have a saddle chair which keeps me from slouching and a table that goes up and down so I can stand or sit.

I also have ups and downs. Today, I slipped in the garage. YIKES. Fortunately, I did not fall, but I definitely "tweaked" my back and have been icing today. Other times, the reason for my pain is far less obvious. I definitely notice increased pain with inclement weather. I don't whether my fusion is solid; my next appointment is next month.

You will probably continue to improve well past the three month mark. We are just getting over the initial shock of the surgery. My doctor indicated that many patients see improvement as much as two years past surgery. The length of the recovery is typically affected by the amount of damage and the duration of the injury.

I noticed in another post that you asked how to tell whether pain is nerve or muscle. It's hard, because sometimes it's both in the same area. In general, if it feels closer to a bruise, it's muscle pain. If you stretch the area (like your calves, don't try to stretch your back) and feel a tug or a burning sensation, it's nerve pain.

Hang in there!

 
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Old 03-01-2012, 10:46 PM   #3
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Re: 3 months post-op a lumbar fusion and frustrated!

I can assure you that most lumbar fusion patients are dealing with varying amount of pain/discomfort at 3 months post-op. I think many spine surgeons do their patients a disservice by minimizing how difficult recovery can be and how much patience it requires. So many err on the side of "optimistic" time tables that leave the patient feeling frustrated and wondering if something has gone wrong in his/her particular situation.

My advice is to think of recovery not in a linear way but in a series of baby steps where you often go two steps forward and then fall back one step.

It takes awhile to learn to listen to your body and to figure out just how much you can do without aggravating things and causing a flare.

Everyone's story is different. We all begin at different points with different issues and we all recover at different rates...so every story is unique. My first surgery of any kind was a PLIF at L4-L5. I didn't start to feel even somewhat OK until 3 months out, and saw quite a bit of progress between three and six months. But it took me a full year to feel like my energy levels were back to "normal" and I realized that a full day would go by and I never had thought about my back.

How long are you sitting at one time? Sitting puts 30% more stress on the spine than either standing or lying down, so it is important that you not sit for longer than about 20 minutes at a time in the beginning.

Also you have to remember that having your spine fused at its lowest level changes the mechanics of your spine. This often results in some initial problems with the SI joints and/or the piriformis muscle that runs across the buttock and attaches over by the hip. This muscle is susceptible to developing tautness, particularly when sitting. This irritation can result either in a feeling of "hip pain" or in sciatic pain, as the sciatic nerve runs directly underneath the piriformis muscle. Sometimes surgeons will tell their patients who are facing a L5-S1 fusion that they may be exchanging "leg pain for butt pain." There is some truth to that, unfortunately.

I would urge you to continue to follow all your surgeon's instructions, walk several times each day and be sure to get enough rest, as well. It takes energy to grow new bone cells...and keep in mind, that is your body's main job at the moment! Try to just take it one day at a time and forget whatever expectations you may have had.

 
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Old 03-02-2012, 11:22 PM   #4
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Re: 3 months post-op a lumbar fusion and frustrated!

I had the same fusion and I only sat reclined while I recuperated. Either in my recliner or in bed. I took a lot of short walks and stuck with the PT. back pain can be all over the place for awhile but if you stick with what your dr ordered hopefully you will be better soon. Also I started out on Percocet but switched to lortab in the first week. Lortab is weaker than Percocet but it worked better for me and my surgeon said a lot of people had better results with the lortab. I also did better with continuous walking rather than any kind of stop and go like grocery shopping. Talk to your Dr and hopefully everything will work out. Just don't try to do too much too quick. Good luck.

 
Old 03-05-2012, 09:11 AM   #5
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Re: 3 months post-op a lumbar fusion and frustrated!

I soooooo needed this message today. Thank you! I am walking daily on a treadmill. The walking is very helpful. I just want to go through a day where I don't stop to judge my level of back pain!

 
Old 03-05-2012, 04:15 PM   #6
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Re: 3 months post-op a lumbar fusion and frustrated!

I had a fusion too and had pain after 3 months and a little more. The Dr. lead me to believe that I would almost be pain free after surgery. He also told me I would be in a wheel chair if I didn't have surgery. I am not in a wheel chair and can walk so it wasn't all bad.

 
Old 03-05-2012, 05:09 PM   #7
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Re: 3 months post-op a lumbar fusion and frustrated!

Baseballmom,

I am also 3 months post-op for an L3-S1 fusion and I can tell you I am impressed that you are med free; I wish I was!

I, like Bradley, pretty much only sit in a reclined position even in the car (I cannot drive yet because of such restricted motion from my brace) but I have just been okay-ed for an assessment from a physical therapist who will begin to wean me off of my brace.

I have good days and bad days (sometimes I think the good just make the bad seem worse) though most of that is of my own doing. I have a habit of treating healing like an event instead of a process....always have for some reason

I agree with Teton about how most surgeons are not really being upfront about the healing process until AFTER surgery...they wouldn't want to talk you out of it once you decide I guess and after it seems no matter what "it's all going the way it should" is the standard answer after. Also, as Teton mentioned, I like many others am now having some pretty significant hip and SI pain which the surgeon says is pretty normal especially with the significant changes in my body mechanics.

I think the main thing is to remember it is YOUR recovery not just "a recovery". Every person is different and every surgery is different.

Best of luck to you!!
Katharine

 
Old 03-06-2012, 07:20 AM   #8
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Re: 3 months post-op a lumbar fusion and frustrated!

Katharine ~

I think recovery from a 3 level fusion is more like a full-time job...and, in many ways it needs to be.

What type of fusion did you have? Did you use a neurosurgeon or ortho spine surgeon?

What are the main issues you are dealing with right now? I trust you are getting in several short walks every day. With multi-level surgeries, it is most important to stretch out those spinal nerves by walking, which will remain your best source of exercise for many months. If you have access to a pool, you can also do pool-walking.

 
Old 03-06-2012, 11:23 AM   #9
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Re: 3 months post-op a lumbar fusion and frustrated!

teton,

I had decompression and TLIF with instrumentation (it has been referred to as lumbar reconstruction). They wanted to do an anterior/posterior fusion but said because of my diabetes they were unwilling to take the risk.

I had a neurosurgeon who specializes in neurotrauma who was recommended to me by the ortho and other neuro I saw previous to him (both in the same office). He was the only one who was willing to try to use the posterior only approach because of the encroachment on all three of the nerve roots in that area.

For the walking....it is mostly walking in place since I live in Minnesota and have already had a fall. I was doing it as often as I had the energy which was often but short because my endurance is not even close to what it was prior to surgery and that wasn't all that great. They have told me now to cut back on the walking because of the SI joint involvement that is becoming more and more of a problem. I had SI joint involvement prior to the surgery and I was warned that I would quite likely be trading the back pain for SI pain and he was right They are now referring me to a pain management clinic for SI shots and I am cautiously optimistic.

Of course I suffer from the "normal" reactions to a seven hour surgery... lack of endurance.

The main problem I am having that is new after surgery is pretty bad hip pain (luckily without additional sciatica) which they didn't warn me about prior to surgery but included in my discharge info. The trade off right now feels worth it but they are saying with the additional pressure from the fusion, I may be looking at hip replacement in as few as 5 years.

The other new problem is a lose of flexibility. I cannot lift my leg high enough to even put on my own socks and shoes. I was a personal trainer in my previous life and had never lost my flexibility through this whole process until now. But, of course, the answer is always "well you did have a MAJOR surgery with many levels involved so this is not surprising". Never do they say it was "expected", just that it isn't surprising. When I described the feeling of being ripped from the inside out whenever I lift my arms above my shoulders...again...not surprising they say.

Anyhow, that is my story. I am a short way into a long recovery according to all the doctors and surgeons involved and I do everything they say and don't do what they tell me not to.

 
Old 03-07-2012, 08:35 AM   #10
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Re: 3 months post-op a lumbar fusion and frustrated!

Were you walking on a treadmill? That is a somewhat controversial subject as some surgeons say it is fine, while others forbid it until later on in recovery. Also some PTs feel very strongly that a treadmill not be used.

With the SI pain, I would advice you to take short walks around your house. You don't want to run the risk of having scar tissue form around the nerves, and the best way to prevent this is by gentle walking. It doesn't have to be fast or far...just so you get up and move a bit every couple hours, or so.

Did you have hip issues prior to this surgery? Why do they say you may need hip replacement surgery? Sometimes, especially after lower lumbar fusions, what feels like hip pain is actually coming from the piriformis muscle tightening up, shortening or being inflamed. I fought with this, which goes hand in hand with SIJ issues, for the first 15 months post surgery.

 
Old 03-07-2012, 09:22 AM   #11
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Re: 3 months post-op a lumbar fusion and frustrated!

teton,

No treadmill for me, ever. Just walking in place and pacing through the basement. The walking in place is more of an alternating heel raising than actual walking because of the need for extremely low impact during the more painful periods. I don't know what comes next though I am sure there is a lot of water again in my near future.

The hip problem is from a long time back. I have what is called multiple epiphyseal dysplasia (Perthes of both hips) which basically has caused early arthritis of both my hips. I was lucky in that I have a fairly mild version and is mostly confined to my femoral heads. Of course the hip problem exasperated the back problem and the back exasperated the hip. Chicken? Egg? LOL I may never know.

The simple way to explain is that my back was compensating for the degeneration of my hips and vise versa...now with the fusion it is putting much more pressure on the SI joint. Luckily they say I will never get the SI's fused!!! The hip replacement has always been in my future but it will be sped up now.

There is a PT assessment for me coming up next week and the PT gal (been with her a long time) and I are hopeful that the hoped for reduction in SI involvement will help the exasperation of pain the hips. Hopeful optimism for the win.

Have a good day all

 
Old 03-07-2012, 09:24 AM   #12
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Re: 3 months post-op a lumbar fusion and frustrated!

Hmmm my reply won't post but tells me it did and to wait to try again I will check back later to see if it showed up

 
Old 03-07-2012, 07:58 PM   #13
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Re: 3 months post-op a lumbar fusion and frustrated!

Hi, Knomia -- I also have hip issues. Undiagnosed labral tear for 14 years, caused by underlying femoral acetabular impingement and hypermobility. The less painful hip actually has worse morphology, but I am leaving it alone for now. Three scopes in the other hip.

Apparently, those with back pain have less successful recoveries from hip scopes. That has certainly been true in my case, but I don't know whether it's a compensation issue or just a totally jacked-up issue. Yes, that would be the hyper-technical terminology.

I wanted to suggest a couple of options: First, for your hips, you may want to ask about resurfacing. (It was contra-indicated for me, because I am in my child-bearing years and can't wait to have kids once all this junk is behind me. I also have thick cartilage; it had just delaminated.) The resurfacing would involve less metal/plastic than a replacement and allows for easier revision as very little bone is removed. It also does not require the same types of long-term restrictions due to the danger of the replacement dislocating. I'm a big fan of preserving as much of the natural joint as long as possible, even if it wasn't perfect to begin with.

The second thing is that if you are having difficulty walking, you can also perform nerve glides to stretch out your nerves. Of course, this is a distant second to walking/easy marching. Nerves are very aggravated by long stretches, but you can gently tug on them for two-second periods. When you go in for your PT assessment, ask if nerve glides are appropriate for your situation and if so, how to accomplish them. (Solely to augment walking!)

Finally, as to your loss of flexibility: Some of this is just post-op tightness, which will resolve over time. As a former trainer, you likely know how to stretch your hamstrings without involving your back. I have found that my hamstrings are silent warriors, bearing the brunt of my back and hip problems, so I try to stretch or roll them as much as possible.

 
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Old 03-07-2012, 10:20 PM   #14
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Re: 3 months post-op a lumbar fusion and frustrated!

HAHA the board keeps eating my replies.

Thank you Sweetpea

Sorry to hear about your hip problems...they sure do suck!!

Hyper-technical, I love it!

I will definitely talk to my PT gal about the nerve glides and to my ortho about resurfacing. I have never heard of the resurfacing. It has always been "when you get your hip replaced" not if, nor have they ever mentioned any other options. I agree with wanting to salvage as much of my own bone as possible! I already have enough hardware!!!

Again, thanks for the info...I've got some Google'ing to do!!

 
Old 03-08-2012, 08:24 AM   #15
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Re: 3 months post-op a lumbar fusion and frustrated!

Hip resurfacing is the big new advance in hip surgery, particularly for younger patients. I hope you are a candidate.

 
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