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Old 06-03-2011, 07:13 PM   #1
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Minimally invasive lumbar discectomy with spinal fusion

Hi,

My husband had minimally invasive lumbar discectomy with spinal fusion on May 18th. The pain that he had before surgery is mainly gone, but he is having a lot of post surgery pain. Mainly in hip, down the leg and his foot. Went to the doctor for his two week check up and said everything is healing well. Put him on Lyrica, twice a day, for nerve pain. He is also taking Robaxin and Percocet. Nothing is helping his pain. He said it's very deep in his hip and comes in waves.

Is there a better medicine for him to take for the pain? Doctor said walking would help. I would appreciate any suggestions on the best way to help him.

Thank you.

 
Old 06-03-2011, 07:47 PM   #2
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Re: Minimally invasive lumbar discectomy with spinal fusion

Welcome to HB...

Glad to hear everything went well in the surgery....Keep in mind that recovery is many months with this type of surgery...and up to a year or so to fully fuse...

It sounds like the Dr. is doing a good job with providing a nerve pain medicine..the Lyrica...a muscle relaxer..which is the Robaxin...and then a pain medicine...the Percocet..

On a pain scale...what does your husband say he is? Is this after trying to do some walking as ordered by the Dr?

As you mentioned...surgery is meant to help correct the mechanical issue which is the herniated disc...so that pain gets better...this is surgery pain that will take time to slowly get better...as well as even raise a bit at times as his activity level increases with PT and walking when Dr. ok's everything..

So having some pain is normal and expected for a few months...but usually where a patient can start to wean off some of the medicine week by week starting then..

It's really about the type of pain...and if he feels like there is something wrong and it's actually worse than the surgery...this needs to be discussed immediately...

I would have him call the Dr. and speak directly to him and let him know what type of pain and when it's the worst...and see what he suggests....

He may just raise the amount of Percocet to take each day...I can't see needing to change the medicine at this time as he will hopefully be getting better each day/week/month...

But obviously I'm not a Dr...so we are just speculating on here and thinking out loud...

I certainly hope he is one of the lucky one's that will get to a good place after the surgery and have minimal pain..

I've had 3 surgeries which were Cervical fusions...and now after the 3rd I am considered a 'chronic pain patient' ..

If for some reason your husband still has pain after many months...he would then be referred to a Pain Management Dr. to take over...as Surgeon's only handle the surgery and a few months recovery and don't provide long term pain mgmt...

Wish you all luck!

Last edited by Ilovemycutedog; 06-03-2011 at 07:49 PM.

 
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Old 06-04-2011, 06:50 PM   #3
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Re: Minimally invasive lumbar discectomy with spinal fusion

Hi,

Thank you for your reply and encouragement. My husband and I, neither one, really didn't know much about this surgery. The surgeon, naturally, was very matter of fact about it. It was out patient surgery and my husband was told he could walk up steps if necessary when he got home. He was also told that the pain would be gone, but he would have some pain from the surgical procedure.

Well, he wasn't really expecting the kind of pain he has had. He heard out patient, walk up steps and you can play golf in three months, so he has been really surprised at the amount of pain.

My husband felt pretty good today, pain wise, so we took a walk this evening. Now he said is pain is about at an 8 right now. We walked around our block which is about 3/10 of a mile. Maybe that's too much.

We were not given any kind of instructions on how much walking he should be doing.

The doctor hasn't mentioned anything about having physical therapy. Just said walk, ride a stationary bike or use a swimming pool. His only option is walking.

He did speak to the doctor the other day and told him his pain was worse at night. That's when the doctor prescribed the Lyrica...said it would help with the nerve pain.

I am sorry to hear about your cervical fusions...how frustrating and painful for you. I certainly hope the pain management doctor is helping you. It sounds like you have really had your share of pain.

I really thank you for taking the time to reply to my post. You have encouraged my husband and he sends you a big thank you.

Good luck to you too.

 
Old 06-04-2011, 09:27 PM   #4
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Re: Minimally invasive lumbar discectomy with spinal fusion

One of the most important things to remember about post surgical pain esp. if its out patient and your at home without a nurse to tell you these things. Stay ahead of the pain. If your going to take a walk, fine, but take your pain meds before you do, that way by the time your done walking your meds will be covering the pain. You just have to come with lil tricks like this. The meds your on seem accurate for post op pain, it's just a matter of using them in the best way. They don't give heavy duty LA pain meds, becasue you won't need them that long.

It will get better. If you've come in after a walk and are going to take a long hot bath to relax, take your pain meds and muscle relaxant when you first get in before you start running the bath, that way when alls done and your ready to cllimb in.....meds have kicked in and you'll be able to totally relax.

Good Luck,

Kat

 
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Old 06-06-2011, 09:41 AM   #5
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Re: Minimally invasive lumbar discectomy with spinal fusion

Hi Linjack, Walking is the only type of excercise or therapy you would normally do post fusion at least for the first 3 months. Any type of twisting or straining could shift the fusion material whether it's bone plugs, wedges or crushed bone mixed with biomorphic proteins before it has a chance to to set. The nerve pain he's experiencing if he didn't have it before is more than likely inflamationn from the surgery pressing on a nerves. Unfortunately antinflamtories can inhibit bone growth and the fusion taking place. Walking will help disapate the inflamtion. you can also use heat or ice, which ever feels better.

Ive had 3 fusions actually fail, where the bone didn't grow, Unfortunately Xrays don't really show whether the bone is alive and growing or simply dead and sitting in place. They told me my fusions were fine right up untill I snapped each set of hardware they used. The hardware wouldn't have snapped if the bone had grown. Recovery is very slow, you dont really notice day to day improvement this early. Recovery of strength as far as walking endurance and pain relief is more noticble week to week or month to month. Otherwise, the progress is more subtle, like noticing you need less pain meds than you did a couple weeks ago or the pain isn't quite as bad as it was oveer a period of weeks or months.

Nerve pain is tough to treat, and lyrica is pretty much the gold standard for treatment of nerve pain. Other meds like cymbalta can be added, But it would take huge doses of opiates to feel a difference in nerve pain. Just remind him it's only been a few weeks, It was major surgery and it takes time to recover. He does need to walk but not to the point of causing uncontrollable pain. 3 weeks post fusion if he's walking a block or two he's doing well. I'm sure the doc mentioned smoking can inhibit fusion growth, anti inflamotories are a no no and any type of twisting can pull things apart.

It really sounds like he is on track. Just because they did a fusion out patient doesn't mean it's minor surgery. Any fusion is extremely invasive and considered major surgery. The only benefit of staying in patient post fusion for a couple days is to have acces to IV meds for pain control. Either the doc doesn't believe in keeping people on IV opiates for a couple days or it's getting harder to justify to insurance to pay for in patient pain control with all the high potency meds now available. All mine were done in patient but the strongest thing anyone got for pain back then was 5 mg percs. 10's didn't even exist back in 99. In fact every surgery I have ever had whether it was wisdome teeth removal at 16 or the last 7 level fusion when I was 34, I was given the same 5 mg percs for post op pain. Fortunately they have a lot more to choose from now then they did back then.

I didn't start PT untill after the 3rd or 4th month with every fusion and the only excercise they wanted me doing was to walk the first 3 months. Sorry to hear about the nerve pain. That's usually the only reason they do back surgery is if you have nerve impingment or spinal cord impingment or spinal instability. Back syurgery for back pain is rarely an effective treament method.
It kind of sounds like the fact they did it out patient made it seem like minimally invasive surgery, but there is no such thing as a minimally invasive fusion.

I can see why someone would have expectations of a fast recovery because it was done out patient, but that's not the case at all. The first 3 months are tough. When I wasn't walking I spent 99% of my time flat on my back. Good luck and remind him it's a slow process. 1 year for complete fusion growth. Docs tend to minmalize everything they do, because they haven't experienced it themself.
Good luck, Dave

 
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Old 06-07-2011, 10:41 AM   #6
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Re: Minimally invasive lumbar discectomy with spinal fusion

Hi Dave, Thanks for your response and info. Interesting about anti-inflammatories inhibiting the bone growth. Nothing was said to us about that. He hasn't taken any. He does know not to do any bending, twisting, etc. I think he was trying to push himself on his walks and probably did more harm than good, as far as the pain. He has cut down on the walking, shorter distances. Also, a lot more time flat on his back.

He doesn't have the same kind of pain that he had before surgery. The pain now is mainly down the shin and into his foot. He said his foot throbs all of the time and particularly after walking and at night. We have been trying the heating pad and soaking his foot. Not much relief, but we're trying.

I can't imagine going through three failed fusions. Sounds like you have had more than your share of pain. I hope this doesn't sound like a silly question, but how did you know when the hardware snapped? Was it excruiating pain? I also didn't realize that you couldn't tell by an x-ray whether the bone had stopped growing. Did you have a successful fourth fusion?

Your response was very encouraging to my husband. Made him feel as though he is progressing somewhat. I certainly appreciate you taking the time to help us.
Thanks, Dave.

Linda

 
Old 06-07-2011, 10:45 AM   #7
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Re: Minimally invasive lumbar discectomy with spinal fusion

Hi Kat, We have taken your suggestion and changed the way he has been taking his medications. Seems to lessen the pain somewhat. I think we have been expecting too much too soon. He does feel better when he hears from others, that it takes time but will get better.

Thank you,
Linda

 
Old 06-07-2011, 01:49 PM   #8
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Re: Minimally invasive lumbar discectomy with spinal fusion

In the first 4-8 week, even after minimally invasive, pain meds are key to recovery. They help you get up and move around more and keep the pain under control. Hopefully he has some strong pain medications and muscle relaxants.
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Old 06-08-2011, 05:22 AM   #9
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Re: Minimally invasive lumbar discectomy with spinal fusion

Quote:
Originally Posted by katlin09 View Post
One of the most important things to remember about post surgical pain esp. if its out patient and your at home without a nurse to tell you these things. Stay ahead of the pain. If your going to take a walk, fine, but take your pain meds before you do, that way by the time your done walking your meds will be covering the pain. You just have to come with lil tricks like this. The meds your on seem accurate for post op pain, it's just a matter of using them in the best way. They don't give heavy duty LA pain meds, becasue you won't need them that long.

It will get better. If you've come in after a walk and are going to take a long hot bath to relax, take your pain meds and muscle relaxant when you first get in before you start running the bath, that way when alls done and your ready to cllimb in.....meds have kicked in and you'll be able to totally relax.

Good Luck,

Kat
I know thats what the doctors say to do but I do it differently. I just had a mircodisectomy on L4-L5 may 2nd and still have allot of pain just like what you were describing. I'm an active person by nature and can't stand doing nothing. the first few weeks I didn't have much of a choice but and would just do SMALL walks. about 2 weeks ago I started walking more and more and even riding my bike. how ever I'd make sure NOT to take any pain meds before the exercise so you don't over do it and hurt MORE later. My post op appt is coming up next week but I went back to work yesterday cause I was going insane. I worked for 8hrs and waited half the day to take anything JUST to make sure I could handle it and wouldn't hurt myself. I still hurt but the boredom was starting to bother me more than the pain.
I also take robaxin 500mg 3-4x a day & 10mg oxycodone 6x day. And night time is also the worst time for me as well, I mention it over and over and over to my doc that I can't sleep(3hrs is the most I get a night) but still haven't been prescribed anything to help me sleep

 
Old 06-08-2011, 05:28 AM   #10
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Re: Minimally invasive lumbar discectomy with spinal fusion

I forgot to mention I also take traumeel which is a blend of homeo-pathics, lots of homeopathic stuff for anti-inflamatories, nerve pain, and bone growth(symphytum officinale). if you can't find traumeel atleast try and find the symphytum, it helps allot believe me I've broken countless bones.

 
Old 06-08-2011, 05:41 AM   #11
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Re: Minimally invasive lumbar discectomy with spinal fusion

Sounds like your doing good minus the sleep. I actually wasn't speaking so much from dr.'s orders as from experience, I've had 21 surgeries in the last 12 yrs.....had to come up with quite a few well tested tricks so I didn't lose it altogether.

You can go to the pharmacy and get some Valerian Root for the sleep...it smells like stinky feet, but helps with the sleep, there's also melatonin.

Good luck.

kat

 
Old 06-08-2011, 10:27 AM   #12
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Re: Minimally invasive lumbar discectomy with spinal fusion

Hi Lin, I knew something was wrong with the fusions long before it showed up on Xrays or during flexion and extension observed under fluroscopy. However docs are slow to admit their surgery failed. So untill they could actually see sheared off screws, bent roods or screws pulling in and out of the holes, I got the same old everything is fine talk.

I've consulted a couple surgeons about going back in and revising and lengthening the last fusion, However the last one took 11 hours and the recovery left me bed wriden for a year. When you add up the decreasing odds of success with each subsequent surgery and the odds of failure with every level involved, Statistaclly it works out to be be about a 260% chance of failure if I went back under the knife. I have hardware from L1 to S1 and Im one of those people that has 6 lumbar vertabrea instead of 5. They want to remove 4 ribs and continue on up into my thoracic spine and run a bar from hip to hip to mount the posterior hardware too because the screws pull out of my sacrum when I bend or twist, Then do a global fusion where they not only fuse the back "Posterior" side, but they want to go in from the front and place spacers between each of the 9 vertabrea they want to fuse, I simply cant imagine that improving my condition.

If they were willing to go in and replace the broken hardware only and do something about the screws that pull in and out when I bend forward I would consider it, But docs won't let you outline the surgery they are going to peform. When they look at things in an Xray, all the bone they placed has been reabsorbed and I crunch and grind with every step.

Although it's hard to imagine things being worse, I know they can be. Each surgery was worse than the prior and the pain folllowing failure was worse. It makes you have to reset your pain scale when once unimaginable pain becomes your daily existance. a 10 prior to my first surgery would be a 4 on my pain scale now. I have an intrathecal pump that delivers meds directly to my spne which helps with the pain but I still haven't seen anything lower than what I would now call a 5 on a pain scale now and haven't slept more than 3 hours straight since the last surgery 11 years ago. When I move in my sleep, hardware grinds and slips out of place and then I'm up for hours trying to get the pain back under control. So I can live with what I call a 5 on good days rather than risk something much worse from a much more extensive surgery with minimal odds of success.

For example with every level they fuse their is 20 percent chance of failure, fusing 9 levels means odds of a complete succes are -180%. Each time they go in odds drop another 20%. A 4th surgery means 80% chance of failure or 20% success. When you combine the levls and number of attmpts, It adds up to be about 260% chance of failure. I have had several docs tell me what makes me think a a 4th surgery would be any more succesful than the first 3. I wore a bone growth stimulator 8 hours a day for 6 months after the 2nd surgery, had an implanted bone growth stim for the 3rd and still no fusion.

So this is probably as good as it gets unless something happens like a rod pops through the skin or I loose control of my bladder or bowels again. What prompted them to do the third attempt was when I went over a speed bump I lost control of my bowels when my spine and hardware shifted. They did an Xray and I had sheared of 4 of the 8 screws and sent a rod throuh a nerve branch that controlled those important functions.

After the first surgery people would say things could be worse and that would just make me angry. Now I know just how worse things can get and Im greatful for for what I do have, Like control of things from the waste down. Sorry to be graphic, But like I said before, Backs surgery for back pain isn't something most docs consider, Back surgery to decompress nerves and restore function or to add stability to the spine are actual things they can see and attempt to fix. Pain isn't something they can see or fix.

I do hope your husband continues to recover and doesn't have any lingering issues. Dont let worse case scenarios scare you, it doesn't happen to everyone. Their are plenty of pro athlestes that have fusions and and are able to go back to their sport. My story is a bit on the extrem side and certainly not the norm. However I am greatful for the level of function I do have. I can walk, drive, I work part time to ge out of the house and keep my sanity and although I am pretty much numb from nerve damage from my hips to my knees, everything functions normally and numb is better than pain. Forums like this are usually flooded with the failures. People that have succesful surgery don't need to look on the internet to see how people cope or function so you won't read a lot of success stories here because the succes stories simply move on with a normal life and don't need to research morphine pumps, nerve ablation and other pain management methods.

Nothing in your post at this time leads me to believe you will still be asking questions a year from now. Hopefully your husband will be one of those sucess stories that we don't read about because he too will have moved on with his life and won't be hindered by pain or disability.

Take care, Dave

 
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Old 06-08-2011, 10:30 PM   #13
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Re: Minimally invasive lumbar discectomy with spinal fusion

If only I could have read the statistics that Shoreline has posted here BEFORE I let my surgeon perform an 8 level lami. and spinal fusion on me in '07!! (My second fusion, and last!!). At least I could have had a heads up on the statistics. My surgeon said I had a 85% success rate for the surgery helping me with function and pain He also said, after recovery, I would be" able to do anything short of competitive sports". I'm now much worse off and live with a pain level of 7-8 every day. I fused wonderfully, but have scar tissue pressing on the nerves, and have the "domino effect" going on. Very difficult life to live, but I try my best...janiee

Last edited by janiee08; 06-09-2011 at 07:24 AM.

 
Old 06-09-2011, 04:23 AM   #14
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Re: Minimally invasive lumbar discectomy with spinal fusion

Shoreline:

Did your surgeons prescribe a bone growth stimulator? (BGS). I used a cervical one after ACDF in 2006 and lumbar one after low back fusion in 2010.
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Old 06-09-2011, 06:49 PM   #15
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Re: Minimally invasive lumbar discectomy with spinal fusion

Yep, I used a BGS for the last two. The first one was like a belt with a large loop in the front and the back I had to wear 8 hours a day. The last fusion they implanted one for a year and used BMP "bio morphic proteins" to promote bone growth and still no fusion. Basically the hardware is holding things relatively in place for now but as Ive leaned, Hardware doesn't last forever. Idealy it 's just needed to hold things in place untill the fusion sets or takes. That's why some docs routinely remove the hardware at the one year point as they believe the hardware itself can cause pain particularly in smaller framed people, It does hurt when it shifts, compresses nerves or when the screws pull out of my sacrum when I bend forward and dont slide back in when I straighten up. Ive also had the same problem with scar tissue. It took 4 hours just to disect through the scar tisue to get to my spine the last time around.

BTW for those that don't know what the domino effect is, when you fuse a couple vertabrea,it puts extra pressure on the disc above and below the fusion. That's how I went from 2 level L3-4-5, to L1-S1 and now T12/L1 is bulging and the vertabrea shifted, "spondy". compared to the junkyard of hardware and spondy, the bulge is a minimal problem. BTW, a 5 is at best on a good day when I have done all my excercises and stay active and am distracted. Work and sex are the best distraction from pain. Although I have a pump, on average my pain level is more like a 6 or 7 and when Im stuck bent over with the screws pulled out, It's just a nightmare. But it happens so often Ive learned how to pop them back in with some traction a little twist and a 2X4. No I don't hit myself. I slide it under my sacrum when in traction and my weight and a twist pops them back in.

 
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