First of all I'm a 53 year old male. To try and summarize everything, back in the spring of 2010 I noticed my lower back tightening up and as I was a runner I would stretch before and after running and could tell that my right leg was not as flexible as my left (I think that it's probably been that way for years). I had been noticing that my running gait was off, in that it seemed like I was somewhat "dragging" my right leg when I both walked and ran. In early June of 2010 while running I stepped up on a curb with my right leg and it felt like I had been shot in the hip. I actually thought I had injured my hip at that moment. I tried to continue to run but the pain was too much and so I just walked the rest of the way home. The back of my leg and hip were not surprisingly very sore the next several days. I tried to run again maybe a week later and it was a no go. So, other than taking Advil and resting I just basically walked for the next month probably. I again tried to run in the middle part of July of 2010 and I was still having the pain, so I stopped again.
Fast forward to the fall of 2010 probably October maybe, and I finally decided to see a ortho doc about this as it wasn't getting better. I described my symptoms as the pain in my buttock and running down my right leg and how it was particularly bad when driving. He had me do X-rays and he stated that it looked like the disk at L-4 L-5 level had in his words "collapsed". He then had me do an MRI shortly there after. He stated that yes, the MRI showed more detail of what the X-Ray showed along with some stenosis around a disk in that same area of my back. He recommended I try physical therapy, which I did. That only did some good but I did really strengthen my core muscles, ha. My ortho then recommended a steroid epidural into that L-4 L-5 area to see if that would provide any relief for my sciatica. I then had two steroid injections from a pain management doctor fairly close together (I believe that one was performed then two weeks later another). And frankly that didn't help my situation much. My pain management doc recommended that I try physical therapy again after the shots and see if anything improved. And it really didn't. Went back to my Ortho guy and he stated that it really looked like I needed to have a fusion at that L-4 L-5 level as well as cleaning out the stenosis around the other nerve root. He seemed pretty quick to recommend that so that kind of worried me. Therefore, I decided to get a second opinion.
Went to Houston in early 2011 for another opinion from a neuro surgeon. He looked at my MRI's and he wanted me to have some x-rays taken with me bending my back to see if there was any slippage of the disk and also a myelogram which I guess he felt would provide better resolution. Well I did all that, and after meeting with Dr. #2 he DID NOT feel that I needed a fusion. But he did recommend another steroid injection and further phyiscal therapy. Well I did have another injection and did the therapy. Again, these were only temporary fixes. Dr. #2, felt that if I were going to have surgery that only cleaning out the nerve root obstruction with a Laminectomy or a foraminotomy. But, I think he was really conservative and rather see if I could fix my problem with PT and the additional injection. He was definitely not "knife happy" to coin a term used sometimes.
Well, after several more months I decided to seek a third opinion from a neuro surgeon who was closer to me. He was pretty highly recommended by my physical therapist and by a couple of doctors who I know in the area. So, I decided to see Dr. #3 and see what he thought. He looked at my MRI and myelogram film and agreed with Dr. #2 that he did not feel I needed to have a Fusion. But that the Foraminotomy to clean out the nerve root obstruction would probably work to either eliminate or to greatly reduce the sciatic nerve pain in my right buttock and down my right leg. In the mean time, while he was examining me he had me lie down and he was pressing on the top of my right hip area and he pressed on one particular spot and I nearly shot off the table. He stated that I was having a periformus muscle issue and he thought that maybe a steroid injection directly into the periformus might provide me with long term relief. Well I had that done. And yes, that seemed to work better than any of the steriod epidurals that I had. After having the periformus steriod shot my leg felt better for 2 or 3 months and was able to do some pretty aggressive physical therapy as a result. However, of course it eventually wore off and I was kind of back to where I was.
So, finally by the spring of this year, I decided to go ahead with the foraminatomy that Dr. #3 recommended. He performed the procedure June 12th and I spent the night in the hospital and went home the next day. Before being discharged from the hospital my doc mentioned that in addition to the stenosis that showed up on the MRI and myelogram, he had to remove a bone spur from the same area around the nerve root. Me not being a doctor asked how could something like that not show up on all the tests I had done. My doc stated that it is very rare but sometimes it happens and that he doesnt actually know what he's dealing with until he opens the back up and looks inside. So, I guess my surgery was a little more involved than he orginally anticipated since he had to deal with the spur in addition to the stenosis. He wanted me to take about 3 weeks off of work and either lay down or walk. He gave me Soma and instructed me to take it every night before I went to sleep and also a combination of two drugs (Valium and Ultram). I was to take the combination of those two drugs up to 4 times per day as the pain indicated. At first it seemed like the surgery had solved my problem. As I layed around recovering I could tell my pain was either gone or "different" than before. It was more around my hip area if I had any. I had a couple of post surgery visits with him of course and at the first one the nurse cut the stich out of my incision but everything looked good according to her and him.
I went back to him a month after surgery and he recommended I start a physical therapy program. So, I go going with that. It was not taxing. All they did was massage my hip area with my sciatiac nerve was giving me problems. They also did electrical stimulation on my low back and they had me do some stretching exercises with bands, etc. In the mean time I returned to work for half days after about 2 1/2 weeks after surgery (I know a little earlier than my doctor recommended). But I work in banking so I am in a sedentary job and I don't exert myself. Although I know that sitting is probably the worst thing for back issues. After about a month of PT they had me add stationary bike riding and some squat exercises. Well after adding those too I noticed an increase in pain. By quite a bit in fact. So the PT backed off of those and I just continued with the stretching, massage and electrical stimulation. But frankly I seemed to be regressing in my recovery. That had me worried since I was about 6 weeks out from my surgery. Then one day after physical therapy I was in a lot of pain and I called my doctor from work and he called me in a script for Loratab. At this point I'm still taking the Valium & Ultram combo at least once per day, sometimes twice as well as still taking the Soma before bed. The Lortab maybe once per day. Also, he wanted me to have a CT scan on my lumbar area to see if there was possibly something else going on.
So, I did have the CT scan and just saw him this past Wednesday (August 22nd). He asked me how my symptoms were. I'm still in pain post surgery but it's a "different" pain than I had before. He examined me and had me lay on my back and raised my legs and asked if I felt pain. I said no for each one. My doctor commented that he could now raise my right leg to a higher degree than he could when he first examined me. So, that was a good sign about my sciataic nerve. He showed me the CT scan results and he pointed out the difference in the forma of the nerve root where he performed the surgery was much more open now, so that now the nerve was not being impinged as it was before. In fact, he said my spine now looked, in his words "very good". Well I asked him why am I having this continued pain around my hip area, especially my right hip "girdle" area (hip flexor) and down the front of my right leg? He thinks that I am having an SI joint issue which is causing my current pain. He thinks that I probably had this issue in conjunction with my sciatiac nerve problem, but that the nerve impingement in my lower back was causing me to notice that more than the SI joint problem. He thinks I could have developed the SI joint problem while I had the lumbar nerve problem which caused me to change how I walk (and run in particular, remember at the beginning of this long story I explained that I ran and how it felt like I was "dragging" my right leg as I walked and ran). He recommends that I have a steriod shot into my SI joint. He thinks that might help me enough so that I can get back into physical therapy.
So, I guess after that long, long story my question is should I go ahead with the steriod shot into the SI joint? At this point frankly I wish I had not had the foraminatomy as I seem to be having more pain now (especially when sitting at my desk at work) than I was prior to it. I know that it sometimes takes nerves a long time to heal from these things and it's been less than 3 months for me at this point. I guess if anyone who might have been in a similar situation or may understand what might be going on given my long and hopefully not too convoluted story please give your two cents worth. If anyone needs any further information please ask.
Thanks in advance. This board has been a great help to me over the past few months.
Re: A long story but maybe someone can give advice...
Hello to you,
I am so sorry, I know how frustrating this is, how your hopes get shattered, how painful your ordeal is...
I would like to ask you a question. May you please describe to me how your epidural shot procedure set up? The reason I am asking, I used to use my first PM who done 9 epidurals and nothing but increased pain for weeks after. Nobody was more disappointed.
I had my epidural done by my other PM, at HSS and it was done absolutely differently - great susses despite the fact I have a lot of titanium in that area. I explained to him how this procedure was done for me back than and he said he doesn't see how it could be successful.
Now I know the difference and wish to know if it was done advanced way or old fashion way - makes big difference who is doing it.
When I went for my first shots and read that it's so important who is doing the shots, I never gave it a thought, we all trust our Drs, right? Not anymore.
You are one smart man to go and see your 3 Doctors before your surgery. I done it too. I guess "banking/trading" people more careful?
I worked for 3 years same job as you after my car accident, having a lot of pain; you are absolutely right about sitting and back issues. Make sure you stretch at least every hour, take a short walk, don't worry, things will be there when you come back.
You mentioned "aggressive PT". Before my surgeries I was very fit and loved my gym, so my Dr sent me for my after surgery knee PT and the guy decides I can handle it all. His approach was aggressive for fit people and it cause me knee re-damage and another surgery soon.
Fit people don't want to accept that no matter what our bodies can't handle certain things as we age. No aggressive anything after 50. Especially when it comes to your back.
I had SIJ surgery as well, It was very bad in that area too. But my symptoms were different than yours and I am not sure if your symptoms relate to SIJ...
Wishing you to find every answer you wish to get, its not easy but doable. You are strong man, I know you can do it.
Re: A long story but maybe someone can give advice...
When I saw your post this morning, my reaction was that I had already replied to it. But when I looked, I couldn't find a response. Then I remembered. I had written several paragraphs when I managed to make my response disappear into cyberspace...and I didn't have the heart to start over at that point...so, I apologize for not replying sooner.
Can you describe how the pain is different from what you had before?
I had a foraminotomy in between my two fusions and the results lasted a brief time. When I told my first surgeon about this when we ran into each other at a hardware store, he told me he no longer performs a foraminotomy as a "stand-alone" surgery because he found they just do not last. I suspect this is the problem with yours. In theory, it makes sense and should work to relieve the nerve compression, but sooner or later, the nerve becomes compressed again.
My reaction would be to go ahead and have the SI joint injected, figuring it probably won't hurt anything and just might be enough to get you over the hump. But I suspect you may have an issue with L4-L5 that is still compressing one or more spinal nerves.
Do you have another orthopedic spine surgeon you could see for another opinion, or are you comfortable with the neurosurgeon (Doc #3)?
It may be that the "bone spur" that the surgeon removed was really cartilage rather than bone, and for this reason, it didn't show up. It may be that the facet joint at this level was impinging on the nerve and he shaved off a little bit of it. The main reason for me having 3 surgeries was caused by degenerative facets that did not show up on MRIs.
Do you know the condition of your L5-S1 segment?
Sorry for all the questions...I'm just trying to think out of the box a bit.
Also...would it be possible for you to make some changes in your office so you could also working standing up? My husband is also a runner and almost 20 years ago he ruptured L5-S1. When he returned to work I remember going along to carry his briefcase! But he quickly realized that he was much better off when he stood up whenever he could...and on occasion he would close his door and conduct business while lying on the floor.
Sitting puts 30% more stress on the discs than other positions....so avoid as much as possible and break it up as often as you can by taking just a few steps back and forth...just to give the discs a little break.
When you get home try this form of natural traction:
Lie on the floor in a straight line, knees bent, feet flat on the floor. Place arms close to your sides with the palms facing upward toward the ceiling. Now, relax and breathe deeply from the belly, so your stomach rises and falls. Stay like this for 5 minutes, breathing deeply and relaxing.
This position allows the discs to decompress and get out from under the weight of gravity. I still do this twice a day, and if I've been working in the garden, or doing anything that I know will cause back pain, I automatically hit the floor and rest like this. I think it is what has kept me going!
Re: A long story but maybe someone can give advice...
Thanks for your reply.
Well the pain is different in that prior to my surgery it was mainly in my buttock and down my leg. The classic sciatiac nerve pain probably. It bothered me mostly during driving long periods. Actually prior to the surgery I could sit at my desk for relatively long periods without any major pain issues. But there was something about driving that made it so much worse.
The pain I have now is more like around my hip area, particularly the right hip. I feel it mainly in the right hip flexor area, almost where the point of the hip is located. Also around where he did the actual surgery on my L-5 area. However, it now bothers me more sitting at work now than it did before the surgery. I was assuming because the nerve was disturbed during the surgery and it was still healing. I figured because he had to do a little more during the surgery than he anticipated that there was more disturbance to the nerve area. Maybe I'm completely wrong about that, I don't know. I do still feel the issue down the front of my leg (upper thigh usually also). It will occasionally go to my knee to my calf, although that seems to becoming less and less frequent.
And, yeah I have already made the appointment to have the SI joint injection for Sept. 6th. So, maybe that will get me over the hump enough to do physical therapy again.
Well, as I stated in my long post to begin with Dr. #1 felt I needed a fusion, although Dr's #2 & #3 didn't feel that way. Yes, I feel fairly comfortable with Dr. #3. He was pretty highly recommended as I stated. But no I didn't realize that some doctors don't recommend doing a foraminotomy alone without a fusion. I probably could get another opinion, but I'm not sure I want to start this all over again. I do know that after my surgery and Dr. #3 looked at my lumbar CT scan he felt my spine was perfectly fine. The disk at L-4 L-5 is "flattened out" in the words of one of my doctors. But Dr. #3 has never felt that was the one causing me the sciatiac nerve problems that seemed to come on so suddenly about two years ago. Hopefully that explaination makes sense.