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Old 01-17-2013, 01:55 PM   #1
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6 months after alif surgery

Hi,
I am new to posting to this board....but i have been reading it for about 7 months. Here is my background. I had my first L5-S1 discectomy surgery in 2006 done by a neurosurgeon. I developed scar tissue but it never caused any problems. About 2 years after that surgery i had another part of that disc fragment off. I had leg pain for a couple months but the doctors said it was a small enough piece that my body would absorb it. Then about 4 years after the surgery i started with a lot of back pain. Saw 2 different doctors at Yale...both suggested spinal fusion. I was too scared. So, i had been putting off the inevitable up until this past July 2012. I saw an orthopedic surgeon and he did standing xrays of my lumbar spine and found Retrolethesis and that the L5-S1 disc space was almost all the way gone..i was bone on bone. So he suggested a one level L5-S1 ALIF surgery with a PEEK Cage and bone morphogenic protien. I am now six months post op and have so many questions. I had been recovering nicely and was off all of my pain medications up until i slipped on wet pavement. I didn't fall but i did jar my back. I felt terrible pain in my back and went back to the doctor. He did xrays and said everything was fine and that i probalby just flared up the nerves. He put me on neurontin 300 mg
3x a day which seams to help. I still was not on any other pain medications. I have been walking and going about my normal life. Then at 5 months i was outside going up and down a small ladder hanging garland over my front door and then stringing lights on my Christmas tree. That landed me in bed for a week and another trip back to the doctor. He did an MRI and CT Scan this time. Results were that the fusion implant looked fine. There was evidence of beginning bone growth across the implant, no evidence of pseudoarthrosis. Still had the same scar tissue from the previous surgery. There was a little degeneration seen at a couple other levels in the spine...some are normal for a 40 year old woman. So, the doctor sent me away and said it was another nerve flare up. So then i was good until last week. I had been increasing my walking and even started to lift some very light hand weights. no more than 5 pounds. And here i am again...all kinds of leg pain and now back pain. Went to primary doctor and they put me on Prednisone which is starting to ease up some of the pain but not all of it. I called my surgeon and he still said that everything as far as the surgery is fine. He said that some people never get better and will always have all this pain. He said to decrease my activity and wait it out and he would see me in 3 weeks. And at that time maybe he would do another mri. Or just refer me to pain management or prescribe medication. I am not one to take medication. I have not lived on pain pills and have only taken them when extremely necessary. He also mentioned some people have a higher state of nerve sensitivity. Also, he has NOT allowed me to take physical therapy as of yet because i am still in the beginning stages of bone growth.
Here are my questions:
1. Has anyone else had the same feelings after surgery? If so, what did you do? and have they gone away yet?
2. Is anyone doing physical therapy yet? stretching? Sometimes i wonder if when i bring my foot up to tie my shoe...am i hurting my back?
3. Has anyone had a complete success from this surgery? if so...please tell me how long it took? I have had extrememly great weeks where i feel like it was a success and then i will have weeks like this one where i don't know what is going on in there. But i thought if your body is in pain...there must be a reason.
4. I had an orthopedic doctor do the surgery....should i follow up now with a neurosurgeon...or is this all normal pains that will eventually go away once i am furthur along in the fusion.
I know this was a long post. I really need some help here. I have 2 boys and we are super busy...but this surgery has really been difficult.
Thank you in advance for any advice you can give me.

 
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Old 01-18-2013, 08:41 AM   #2
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Post Re: 6 months after alif surgery

Welcome to the board. You ask many good questions and I will try to respond as I went through one fusion that ended up ultimately making no difference with my pain. First, there is a lot of confusion over how differently orthopedic spine surgeons and neurosurgeons handle spine cases. As long as the patient is seeing a fellowship-trained orthopedic spine surgeon (not a general orthopedic surgeon, but one who only works on backs and necks) there is almost no difference in their training. A surgeon needs to know about both nerves and bones in order to understand the mechanics of the spine. You don't need to consult with another spine surgeon at this point in your recovery unless you feel your surgeon is not handling your case well, answering your questions and responding to your concerns.

From what little you said, that does not appear to be the case as he has ordered new MRIs, etc. rather than putting you off and saying "Nerves take time to heal. Give it time...."


When someone has a fusion, particularly when there is a spondylolisthesis, there is some natural adjustment that the fascia, soft tissue, muscles, tendons etc, have to go through. Everything needs to adjust to a new "norm" of alignment and this takes time. Many people end up with some pain coming from the sacroiliac joints after fusing L5-S1 as they are now the first area that can move post fusion. This naturally puts more stress on the SI joints and it can take some time for everything to get used to the new things they are now being asked to do.

When you slipped, you jolted everything, which has done no permanent harm, but has caused a flare of the pain. You will be surprised to learn that using a step ladder is one of the worst things you can do after lumbar surgery (along with pushing a vacuum cleaner). I made the same mistake...my daughter moved into a new-to-her apt and I volunteered to wash the kitchen cabinets, put up shelf paper, etc. never giving my back a thought. There is something about the angle of the steps, the way one hauls all her weight up one step on one leg that can really cause havoc with the SI joints which then irritates the sciatic nerves, etc.

I would suggest you back off walking and maybe stop using the hand weights
until you get this flare back under control. Then, very gradually increase the time you are walking. Be sure to walk on a level, flat surface -- no inclines. The hand weights may be using muscles in the upper spine that are causing muscles in the lower spine to contract or work harder somehow...there may be some unintended consequence that you are not aware is happening....

The thing is -- once you get a flare going it can be very hard to get everything back under control.

You ask about physical therapy. Surgeons vary greatly in their attitude and use of PT. Some believe in starting almost immediately. Some don't recommend it at all thinking in many cases it does more harm than good. And some are just more conservative. The important thing is to walk and it sounds like, with two young boys, you do plenty of that. You are probably moving your body much more than you are even aware of just as part of your daily routine when you have kids.

Overall, it sounds to me like you are progressing nicely. The fact that you felt you were making progress up until the slip suggests to me that you are just going through a bit of a rough patch that has caused a flare, and that with backing off a bit and being patient, the pain will subside. Then you will need to start to slowly, slowly rebuild strength, etc.

It is really important to not get into a cycle where you feel better, then do too much which sets off nerve pain, then have to cut back and regroup. This is when nerve sensitivities really start to build and can lead to chronic nerve pain.

I'm a little surprised that with the use of BMP you are not further along with the bone growth process...but the surgeon seems to think this is progressing so that's what is important.

Are you sitting down when you bring your foot up to tie your shoe? If so, this should not hurt anything.

I'm not sure what your expectations were for this surgery so don't know how you define success. I know many people that are very satisfied with their results, and are able to pretty much go about their lives. No one is ever the same after fusion. Fusion will never restore the spine to the way it once was prior to injury or onset of pain. One is never completely pain-free. After all, even people with no spine issues have some back pain when they do too much of the wrong activity.

It took me three surgeries to finally resolve the issues that were causing my radiculopathy. Even though I had nerve compression for probably about ten years, I have been pleasantly surprised to see that they are for the most part recovering. I have almost no pain unless I sit too long, or do things I know will start to cause a sciatic flare like changing beds and vacuuming. So I have learned to pace myself and do what I can. I do what I know is comfortable and then if the task is not finished, I put it off.

I do a traction-type exercise that helps with my nerve recovery daily and whenever I feel like I have done "too much."

Just try to be patient. Recovery from fusion takes at least a year and I know plenty of people who were still making progress during the second year. Try to keep your activity level going forward at a slow, steady pace. There is little one can do to hurry the process along, and much to be lost by forcing the issue.

From what you've said, I think you'll be OK. Please post any time. Many of us have been in your shoes and know what you are going through.

Last edited by teteri66; 01-18-2013 at 08:44 AM.

 
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