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pressedflowerar 09-14-2019 11:29 AM

3 months post lumbar 3, 4, 5, S1 fusion
Hello, first time posting here and I hope someone would direct me if there's a better place for this question.

I had L3-4-5-S1 fusion on June 3. A seroma developed and two weeks later, it was aspirated. All was proceeding ok, then in early August I caught my toe on uneven ground. I didn't fall, however lost balance and my weight came down on left side. Severe soft tissue pain a few hours later, pain lessened with ice packs over night.

I had follow up with surgeon, x rays showed hardware and bone structures normal. I did find using walker helpful to bear weight. I lifted a pot in kitchen few weeks later, intense pain immediately around L3-4 occurred. Hours later swelling in lower back.

Since then, extreme weakness in lower spine/sacrum. Can't engage back muscles really at all with any activity, or the strained deep aching returns. ?

I just had another CT, MRI. No infection in bloodwork, however Sed rate and CRP are elevated. I'm seeing surgeon next week to 'discuss options.'

I'm worried that there is nothing that can be done. I've been very careful giving this injury time to heal. PT helping with passive hamstring & piriformis stretches. Doing some abdominal work as well. Back is just so painful right now.

thank you for any thoughts..

teteri66 09-14-2019 07:44 PM

Re: 3 months post lumbar 3, 4, 5, S1 fusion
Well....first, welcome to the board, and, you are in the right place.

I am fused from L3-S1, after first being fused at L4-5 for spondylolisthesis . Mine was a posterior surgery, 2010.

First, what was the approach for your surgery? I’m not sure they can do this major a surgery “minimally invasively,” but how was yours done? Were you muscles cut?

It makes a difference in what I would say to you....IF you had an invasive surgery, I would tell you that you are early in the surgical process and it will take a good year until you begin to feel “normal.”

I’m not sure what you have been told by your surgeon (neuro or ortho spine??), but a 3-level surgery is major surgery and you will not be anywhere close to “back to normal” in three months...unless you are extremely lucky!

I cannot remember when I began PT but, in my case, my surgeon’s goal was that we do NOTHING that even slightly began to aggravate sciatic nerves....As a result I began and stopped PT 3 times and each time returned to plain old walking until I became a bit stronger.

It may be that you are doing too much too soon and pushing too much.

It is very common to have SIJ and what seems to be piriformis issues after lower lumbar fusion. Once movement is lost in those lowest segments, the SIJ become the first area that is capable of movement. It takes the brunt of movement and since it is not designed to move more than a small amount, it often develops pain or even instability as a result.

It is important to develop strong muscles in the buttocks...glutes, etc. Often the glutes just kind of stop working and we are trying to walk and do all those other functions with other, less appropriate, muscles.

The most important advice I can give you is to be patient and realize recovery takes a long be positive and keep looking for answers...and to really learn to listen to your body and avoid any activity that you sense may cause you pain!

pressedflowerar 09-15-2019 05:43 AM

Re: 3 months post lumbar 3, 4, 5, S1 fusion
Thank you for your reply. Yes, posterior approach and 10 inch incision.
I'm trying to not be discouraged. I had L4-5 fusion (2015) and left SI fusion in 2017, both due to a fall on the ice. After each of them, I felt stronger in 2-3 months -- this is much different. !

At the moment I'd be happy just to be able to walk. Using walker but concentrating on posture and alignment, trying cane some but not able to much yet. Deconditioning as I'm more sedentary, and now I'm adding supine abdominal work and some hip flexor stretch on bed.

I'm also trying to find ways to mildly stretch hamstrings, etc. where there is much tightness, but without engaging the painful lower back muscles. PT used the neurostimulator to resolve trigger points in mid and upper back, that helped A Lot.

With this latest problem, I'm back to taking a half of a percoset at night to sleep. I had been totally off it for a month. This is worst flare so far, upsetting.

Thanks for the perspective and positivity, it's very helpful!

teteri66 09-15-2019 07:33 PM

Re: 3 months post lumbar 3, 4, 5, S1 fusion
Why do you need a walker? I assume the PT knows you are using one? It is so difficult to walk with any sort of structural alignment when using a walker as Iím sure you have found out. Did you use a walker from the beginning...right after surgery?

It may be that the SI joint fusion is causing some issues in trying to get everything functioning properly again.

You may find walking in a swimming pool would be a good way to regain strength. Just by walking forward, backward, and stepping sideways, both by using a cross-over step, and a step to the side and then drawing the second foot to it, you work many different muscles! Very safe, without adversely stretching anything more than it should be!

pressedflowerar 09-16-2019 10:15 AM

Re: 3 months post lumbar 3, 4, 5, S1 fusion
Appreciate the reply. Yes, I required a walker for stability - left leg buckled first time I stood. Then after a few weeks I was walking with cane, just keeping a little weight off the left side. I was also starting to walk without it. Things were going pretty well.

I did develop a 'seroma' - fluid collected, then had to have it aspirated 2 weeks after coming home. There was quite a lot of pressure. I'm finding that the swelling is continuing to come back if I engage back muscles at all. That's why I can't even walk in the pool -- have a great aquatherapy program and tried the walking and side stepping. BAD pain with lumbar strain returned and lasted for 3 days, ugghh. My SI joints have both been fine, the fused one is great and the other side holding steady. Glute medius strong, can do single-leg standing balance no problem. The weakness is in the area of the fusion, lower lumbar.

This Wednesday I will find out results of MRI with surgeon appt. and also any options for getting this fluid to resolve. I believe that could be the underlying issue with strengthening, if there is no apparent tear in soft tissue on MRI.

In the meantime I'm trying not to lose my mind and focus on upright posture while still using walker for some minimal support as needed. Without it, fluid returns. Determined to be better...

Thanks for all the thoughts & suggestions!

teteri66 09-16-2019 11:37 PM

Re: 3 months post lumbar 3, 4, 5, S1 fusion
Well, obviously every body is different! So it is in a way ridiculous to be trying to pass on”suggestions, “ but...ditch the walker and cane as soon as you can! Sometimes things like fluids need to just run their course so you can be done with them.

If you can withstand ANY sort of dry land exercises, there is no reason why you cannot walk in a pool. This wasn’t even available to me when I had all my surgeries...but now so many indoor pools have a dedicated lane for slow swimming/pool walking.

Again, I would just remind you to not be in a hurry! I think you are trying to press things rather than learning to listen to your body! Anyone with multiple surgeries needs to learn that subsequent recoveries take longer! Make it a goal that you do not want further surgeries...and be willing to take the time to listen to your body, work with it patient!

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