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Old 04-23-2013, 09:04 PM   #1
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Long-term prognosis for nerve pain in legs post-ALIF?

I'm hoping to hear from members who have recovered from leg pain after ALIF surgery.

I had an L5-S1 ALIF on April 9th, 2013. It's my first surgery and I never had leg pain before it. My right leg was slightly weaker after surgery but no one seemed concerned. The week after surgery, I developed some cramps and aching in my right leg, especially while lying down. A Medrol pack helped but as soon as I finished it, the pain came back. Yesterday I went for a follow-up with my surgeon and he did a CT scan, which showed nothing. He assumes the pain is due to stretched nerves but didn't give a time frame for recovery. He prescibed another Medrol pack and Gabapentin (taking 1 a day now and will work up to 300mg three times a day). Today, the pain has changed. I'm fine while laying down, but while standing or walking I'm having shooting pains that force me to sit back down quickly.

I've been doing a lot of reading and I know nerve recover can take months. I would really love to hear from any of you who had similar problems and how long your recovery took, if you took meds then were able to get off them, etc. It's a little nervewracking to think this could be a long-term problem (although my back is feeling pretty good!).

Also, my instinct is to lay down and rest when I have the shooting pains but according to what I've read, maybe I should be pushing through to do keep walking?

Thanks.

 
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Old 04-23-2013, 09:19 PM   #2
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Re: Long-term prognosis for nerve pain in legs post-ALIF?

Welcome to the board.

I want to be sure I understand the facts before I write too much more. Am I correct that you did not have leg pain prior to surgery? No sciatic pain? What were your symptoms prior to surgery?

Let me just remind you that you are extremely early in recovery and you are bound to have some other new aches and pains along the road to recovery. Fusion is quite a violent surgery--it is not unusual for one or more nerves to be somewhat traumatized as a result. Nerves do not like to be touched or moved. If that occurred during the surgery it can take months for them to calm back down.

If a nerve was compressed for some time prior to surgery, it can take many months....up to a year and longer. I had a three level fusion almost three years ago and I still have feeling returning in my numb toes.

It is very important that you walk as it is the best exercise for stretching out those spinal nerves. This helps to prevent scar tissue from attaching to a nerve as it forms and fills in, particularly during the first twelve weeks when he tissue is most active. It is important though that you do not aggravate the sciatic nerve while walking. The most satisfactory way to accomplish this is to take many short walks during the day rather than one or two long walks.

I would always make a point of walking several laps around the house when I got up to use the bathroom or get a snack. Be sure to drink lots of water and fluids and get plenty of rest. it takes lots of energy to grow new bone cells.

Don't worry about getting addicted to gabapentin. You do need to wean off it when you decide to stop taking it, but that's just so you don't shock your system.

Overall it sounds like you are doing really well.

 
Old 04-23-2013, 09:41 PM   #3
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Re: Long-term prognosis for nerve pain in legs post-ALIF?

Thanks for your quick response. That's right, I luckily had no leg pain prior to surgery. My symptoms were all concentrated in my lower back, which I first injured in 2007 then over the last couple years has become progressively worse. I tried chirporactic, PT, meds, and epidurals before moving to surgery.

I'm not too worried about getting addicted to gabapentin. I'm just curious if others have been able to take it for months and then ease off it and have little or no pain.

I also think things are going pretty well, likely because I'm only 32 and have good health other than this. So many hours at home just cause me to worry about how long it will take to get back to "normal"!

 
Old 04-24-2013, 05:44 AM   #4
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Re: Long-term prognosis for nerve pain in legs post-ALIF?

Do you feel gabapentin is helping with your pain?

Since you didn't have leg pain previously and most of your pain was in your lower back, and now you don't have the back pain, my guess is that it is just a matter of time before the nerve pain in the leg will subside. That is assuming a nerve wasn't cut or otherwise damaged during a mishap in surgery, which does happen on occasion, but rarely.

Actually with a fusion at L5-S1 there are several possible causes of leg pain. First, let me ask you where exactly is the leg pain? Does it run down the back of the leg? If so, how far? Into the foot?

 
Old 04-24-2013, 09:52 AM   #5
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Re: Long-term prognosis for nerve pain in legs post-ALIF?

I can't really tell if the gabapentin is helping yet since I've only been taking it once a day for two days. I've definitely slept better the last two nights, so maybe it is helping with that.

Most of the pain seems to be running down the back of my leg, mostly in my calf. It bothers me some when I'm sitting up and a lot when I'm standing or walking. I haven't had any pain in my foot, but it is a little numb and slightly swollen.

My surgeon seems a little perplexed but I find it had to believe that none of his patients have had similar problems. He does have the stereotypical surgeon personality, though, and probably wouldn't admit any imperfections in his surgery! I will see him for a follow-up on Monday.

If I feel confident this will dissipate over time, it definitely makes it easier to deal with right now. Thanks!

 
Old 04-24-2013, 10:36 AM   #6
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Re: Long-term prognosis for nerve pain in legs post-ALIF?

Isn't it amazing how a patient with continued pain is always so unique and the surgeon is so perplexed!!

The more I come in contact with others who have had spine surgery, the more I believe that the person who comes through with the expected results and a successful outcome is unique!

It takes awhile for the nerve pain drugs (gabapentin/neurontin, Lyrica) to kick in. I remember after my last surgery I took Lyrica for quite awhile, finally deciding it wasn't doing anything, and quitting it. It was a couple days later that I started feeling some pain in various locations that I hadn't even been aware that I had! So the Lyrica was masking many of those symptoms. Give the drug the chance to work. If you develop side effects as you increase the dosage, give it some time, as the body usually adjusts to it after a couple weeks. Don't be too eager to try something else before you give it a very fair trial. I say this because there aren't many options to treat nerve pain, so don't blow through the trials too fast!

Just remember you are really early in recovery. It sounds like you are doing pretty well for just a couple weeks out....

 
Old 04-25-2013, 07:47 AM   #7
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Re: Long-term prognosis for nerve pain in legs post-ALIF?

Could Gabapentin be causin stomach upset and cramps? I'm scared to increase the dose like I'm supposed to if that side effect will get worse. My leg is bearable right now so maybe I should just stay on one 300 mg pill for a few more days? I've also left a message for the nurse coordinator.

Thanks for all of the advice!

 
Old 04-25-2013, 07:59 AM   #8
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Re: Long-term prognosis for nerve pain in legs post-ALIF?

Yes it is possible that gabapentin is causing stomach distress, although it is not a common side effect. More common is feeling kind of fuzzy-headed....

Yes, wait to hear back from your doctor's staff. The basic dosage is 900 mg per day so you may not get maximum benefit until you reach that level...but I doubt it would hurt anything to increase dosage more slowly...but I'm not a doctor or pharmacist so wait to hear from them.

 
Old 04-25-2013, 01:12 PM   #9
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Re: Long-term prognosis for nerve pain in legs post-ALIF?

Dear zog 81, When i read your post that the pain is mostly in the back of the calf, unilateral & a swollen ankle, pain on standing or sitting when calf is flexed & newly post op i was wondering if the surgeon mentioned checking for a blood clot in the calf & did he check you for one by physical exam or a venous doppler?

Last edited by gmak; 04-25-2013 at 01:13 PM.

 
Old 04-25-2013, 01:47 PM   #10
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Re: Long-term prognosis for nerve pain in legs post-ALIF?

Gmak, yes, I forgot to mention that he sent me for an ultrasound last week to check for a blood clot and everything was fine.

Also, the nurse returned my call this morning and said it may be the second round of steroids that is making my stomach hurt, so hopefully that will go away as I am ending those.

 
Old 04-25-2013, 06:36 PM   #11
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Re: Long-term prognosis for nerve pain in legs post-ALIF?

Hi zog, Im glad to heat the doppler was okay. Dosepaks hurt my tummy too & OTC nonsteroidal anti inflammatories just kill my gi system too. I remember i used my legs way way more than i ever had pre op to push myself up out of bed or to push up with my legs to stand from sitting & all the "use your legs" to keep from bending over made my calves sore & i had postop neuropathy too & it wasnt clearly one or the other but mingled together, does that make sense? I hope that you continually get better & better!

 
Old 04-25-2013, 07:15 PM   #12
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Re: Long-term prognosis for nerve pain in legs post-ALIF?

I don't know if this will help much but more info the better right. I had a disc replacement 6 months ago due to L5-S1 reherniation...I to felt nerve pain in the right buttock and running down the calf after this last surgery that I did not feel prior. Started Lyrica and symptoms of nerve pain slowly diminished...after taking it for six months and pain meds...stopped the pain meds first oxycontin and oxycodone then slowly weened off lyrica a month later. I do not have the right pain in the buttock and leg and still have left nerve pain in left calf and foot along with foot drop.. I guess the reason I am telling you this is, I know that lyrica did work on the nerve pain...did take gabapentin and made my head more fuzzy if you will...Lyrica was less fuzziness. I personally just needed to step back and see what my body was really feeling without taking the meds. I hope this helps, and hope that you will get better.

 
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