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    Old 09-24-2011, 07:03 PM   #1
    n3kf
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    Laminectomy Recovery

    Hi All,
    Looking for some advice and empathy! I am a 56 year old male. I have had trouble with my back ever since I was a young volunteer firefighter that was involved in a building collapse about 1975. Things got bad in 1997 with a disc herniation. I have had ups and downs and survived using meds and chiropractic care. Last October things went downhill bad. I managed to get out of it with a couple epidurals and did lots of core workouts. However, in April this year, I went downhill and the epidurals would help for a week or so and then I would get bad again. So my problem was bad stenosis at L4/L5. My luck had run out. I needed to get a handicap placard as I could hardly walk (tough for an extremely active person). So after much research I had a laminectomy 7/11 of this year. The Orthopedic Spine Surgeon said that once he got in there it was much worse then what the MRI showed. So both the left and right sides were cleaned out, I had a discectomy, the foramins were enlarged, and the facets were trimmed. Lots of work. All my leg symptoms have disappeared and I can walk upright. The problem appears to be the muscles (and maybe ligaments) in my back. They are still very unhappy. My surgeon says that with the 5 inch incision and the ligaments being lifted off the spine, it takes anywhere from 4 to 6 months to recover. He also said that since bone was removed from the spine, that the muscles and brain must relearn how to support the spine. He tells me that he does not believe he removed enough bone to cause instability.

    So here I am, 2 months plus out of surgery. If it was not for the muscle pain, I would be a very happy camper. The pain can get intense, especially if I do something dumb like ride my lawn tractor! I can not handle nsaids so if tylonol does not work, I must use percocet to make things bearable. I do use a tens unit, which takes me from pain to nothing almost as soon as I put it on. I can feel the soreness in my muscles, so I believe it is muscle and not nerve. Must of the problem is lower back and into the butt. I have been doing physical therapy for about 6 weeks now and am getting frustrated.

    So with the vast knowledge that exist here, am I in a somewhat normal path of recovery? It seems I am moving forward, but extremely slowly. What have others experience been? Is there anything else I can try to get the pain level down (my GP thinks I should try gabapentin)? My back can go from feeling pretty good to really painful quite easily. Of course that means I have been doing stuff. Also, sitting can still cause problems. Anyway, is there hope still with time? It seems to me that I still get some small spasms going on in the back muscles sometimes which then causes soreness and pain. I usually feel better after PT which would lead me to think muscular. Anyway, I have rambled enough. Comments and/or suggestions?

     
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    Old 09-24-2011, 11:19 PM   #2
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    Re: Laminectomy Recovery

    Your recovery sounds very normal to me. Recovery is always slower than patients feel it should be. And, you've already answered your own question. If you know something is going to increase your pain, and you go ahead and do it, you experience more pain. To keep this from happening, you have to avoid those activities until you are completely healed. If you are unable to restrain yourself from doing things that are ill-advised, you will increase your level of pain and you might just wreck what your surgeon has accomplished at the same time.

    There is no such thing as a small spine procedure. As surgeries go, a laminectomy is not as invasive as other procedures, but it can still take months for the body to recover. But, you had a discectomy and foraminotomy in addition to the laminectomy. Depending on how badly the nerves were compressed, it can take even longer than six months to heal completely.

    What you want to avoid are any activities that will cause a flare of the nerves and that may cause inflammation. It is very difficult to get inflammation under control once it gets going, and this can cause a surgery to be less than successful.

    You don't mention that the disc was herniated, but indicate you had a discectomy. This leaves the remaining disc weak and more susceptible to injury until you are fully healed...which can be at least six months.

    I would guess that the muscle that runs along the spine had to be bisected so the surgeon could get in to work on the facets, etc. That may be what you are having the most problem with at the moment. The muscles are just laid back into position, and they have to grow back together. Added to this is all the soft tissue, muscle and nerves that have been stretched and jostled, traumatized, really. So, it's no wonder we hurt after spine surgery.

    Try to be patient and look at the big picture. You want to do what you can to make this surgery a success. You do not want to be sitting for an extended period of time. Sitting puts 30% more stress on the discs than either standing or lying down. So try to get up after a half hour and walk around a bit. Be sure you are walking and are careful to use good body mechanics, good posture and structural alignment. Avoid activities that involve repetitious bending or twisting at the waist.

    Hopefully it will make you feel better knowing that we're all in the same boat...and cannot avoid the fact that it takes a long time to recovery from most spinal procedures.

     
    Old 09-25-2011, 07:27 AM   #3
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    Re: Laminectomy Recovery

    Thank you very much for the reply. You helped to lift my spirits. To be clear, I had my first herniation at L4/L5 that I know of in 1997. This progressed to DDD which had been confirmed by a discogram. After that point I had two additional herniations in that disc. Usually within 6 to 8 weeks the worse of the pain would go down after an "event". Epidurals were extremely effective then also since my muscles would completely lock up my back when an event would happen. The epidural would get me walking again. The epidurals became less effective as I had said above this past year. The MRIs always showed a herniation, but the doctors said it was not severe (including my spine surgeon back in the past - I have seen him for years). They were wise to keep me away from the knife for as long as was possible. However, once inside, the surgeon said that the herniation was pressing on the nerves pretty good and thus that is why he did a discectomy along with the other work. He actually said the nerves were very compressed and he was surprised it was not causing me more pain and symptoms. So yes, all the nerves at L4/L5 were disturbed during the surgery. The surgeon did say that he did not believe a fusion was called for and thus the laminectomy.

    Besides PT I am biking and walking and yes have been taught proper form by the physical therapist. The biking is stationary of course. I loved using the elliptical machine for cardio work, but find it intensifies my pain if I use it right now. Again, the motion must overwork the muscles trying to stabilize my back. So I have laid off of that until I can tolerate it better. I try to stay away from activities that aggravate the back muscles, but sometimes just trying to keep up with the family does it.

    I really appreciate your response as it does help my mental state. Too much thinking about whether you did the right thing or not can put you into the blues. Although I was not walking more then 100 feet before the surgery.

    As for the pain, if it is muscular, any recommendations for someone whose intestinal tract does not tolerate NSAIDs? I suspect that the Gabapentin will help with any nerve pain I have which may be enough to make things more tolerable. Well it may or may not work, just need to see. Anything else that can help with the muscular issues? I do use heat and ice, but while they both work, the effect is short lived.

    Again I really appreciate your response. And most importatntly it sounds like I am progressing as would be expected.

     
    Old 09-25-2011, 09:31 AM   #4
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    Re: Laminectomy Recovery

    You might want to talk with your PCP. Many people find themselves very low on vit. D after surgery...also magnesium is important and can be low and can cause muscle cramping. But your muscle pain is probably just due to being retracted during surgery. And, as your doctor suggested, the muscles and soft tissue have to get used to the new positioning, new alignment that now exists.

    Surgeons never tell their patients that spine surgery is really quite a trauma to the body. Reading words like "retract muscle", etc. does not describe the actual assault it is to body parts that are not used to being touched at all. The words sound gentle enough, but the actions are anything but. If you talk with a layman who watched a spinal surgery, they will tell you it is more like a carpentry project than what we tend to think of when we visualize working around nerves, etc. You'd think it would be gentle, but it is in reality fairly violent. There is cutting and drilling. The back muscles are split and retracted (and left in this unnatural position for the length of the surgery). Fusion is more violent than what you had because they also saw, drill and hammer, but you had bone cut, and your muscles were retracted almost as long.

    Have you tried a product like BioFreeze? This is a topical lotion that is used by many physical therapists, chiropractors, and sports medicine folks. Also you could use a tennis ball for a self massage on the muscles, being careful to stay away from the incision.

    The last thing I can suggest you try is a little exercise I still use at least once a day, and twice a day if I can fit it in. It sounds simple enough, but when done consistently, it is powerful medicine.

    Lie on the floor, (being sure you are in a straight line), knees bent, feet flat on floor. Place arms close to your sides, palms facing up. Keep the neck relaxed and the pelvis in a neutral position. Breathe slowly from the belly, and just relax.

    This position allows the discs to unload, and all the soft tissue that works to hold the spine erect will let go and return to a relaxed position. It helps the spine relax into proper alignment. It may feel slightly odd at first, but you will find that if you do it faithfully, it will be very relaxing. You don't need to stay in this position for more than several minutes at a time. I've been known to find a quiet corner in an airport and lie down when I felt I couldn't walk any further! So, give it a try. I think you'll find it is very beneficial.

     
    Old 09-25-2011, 10:57 AM   #5
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    Re: Laminectomy Recovery

    Thanks again. I will look for Bio Freeze. I am doing my PT exercises faithfully, since my surgeon said that the ball is in my court to get things back to normal. Whatever normal will be! My insurance only gives me limited time for PT, so I plan on working with a trainer that I have in the past who has back problems himself. The doc says the stronger the core muscles get and stay, the better the outcome. Of course it will be a while until we are doing advanced core exercises, although the PT has me doing some interesting stuff. On top of this I bike for cardio and also walk.

    I have been back to work for a month or so, and do a sedentary job (I am a software engineer). I do get up and walk to relieve the back issues from sitting. Some days are much better then others! If it gets really bad I use the TENS unit for a while. While TENS did not work for the nerve pain I had previous to surgery, it works gangbusters now. Not sure what that means. Probably it just settles the muscles down or masks the pain signals since its effect is not long lasting.

    My actual surgery was one hour and twenty minutes. My spine surgeon said experience really counts here. The longer you are open, the greater the risk of infection. He said for what he did, less experienced surgeons would have had me open much longer. But that is probably still a ton of time for the muscles to be retracted!

    I will try your resting position and see how it goes. I really appreciate the comments since day in and day out pain can make a person very pessimistic about recovery. That won't stop me from the exercising, walking, and biking though unless I get bad pain - which usually means stop!

     
    Old 09-25-2011, 11:28 AM   #6
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    Re: Laminectomy Recovery

    As you suggest, it is a little difficult to find the right balance between doing just enough so you're making progress, but not doing too much so you get the nerves inflamed, etc.

    Just so you know that it can be a long process, I had a 3 level fusion 15 months ago and I just returned to PT this summer, and am just now working with a trainer in a pool. I tried PT a year ago, but it inflamed the sciatic nerve too much so I quit and just kept up with my walking. People don't sometimes realize that in addition to tissue swelling, the nerves themselves can also become inflamed -- and that's what you really want to avoid happening.

    This was my third surgery and both I and my surgeon regarded it as my last chance to resolve my issues, surgically at least. So he has been VERY conservative with me -- x-rayed me every month up to the point where I liked the amount of fusion that was going on, then let me go every other month...up to the first year mark. He had to reconstruct the L3-4 segment, so my surgery was a bit more complex than the average fusion...if there is such a thing.

    But I've been almost pain-free from the 12th day post surgery...and that's why I am taking my rehab so slowly. Others would not have been as patient and cautious as I am being.

    It sounds like you are making all the right choices. Just don't overdo it with the biking, etc. Walking remains your best over-all exercise and you should walk every day -- doesn't have to be far or fast...but it is the one exercise that stretches out the spinal nerves. By the way, the elliptical trainer isn't as benign as it is made out to be. It can be hard on anyone who has had sciatic pain. If you watch people using them in the gym, the buttocks are very busy shifting up and down --this involves some "sheering" movement and can be very irritating to the piriformis muscles and the sciatic nerves. So I would avoid it until you are completely recovered -- and even then, I would rotate it with the other activities you do.

    Whenever you feel like this is taking forever, step back and look at the big picture. It took you a long time to get to the point you were at prior to this surgery...and it will take a long time to recover. You want to get this surgery right, so you don't have to have a do-over! If it means being patient and cautious for a couple more months, so be it! Two years from now when you are back to the activities you love to do, this will all be a distant memory...and you will be grateful that you were so sensible as to take your recovery seriously and cautiously.

     
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    Old 09-25-2011, 11:57 AM   #7
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    Re: Laminectomy Recovery

    Tetonteri66 you are wonderful! All I can say about your surgery is wow! I truly appreciate your responses. You took a man that was down in the dumps and put hope back into the future. I just have not had an injury that has taken so long to heal, but it is like I was involved in a major accident isn't it? Of course when I was in the building collapse, being twenty helped a lot!!! I hope I never have to face spine surgery again!

    I have bad genes heart wise so I have always run until the back gave out and then went to an elliptical. Believe it or not the elliptical (well actually my favorite machine was the AMT by precor) actually seemed to sooth the back until the final month or so. Anyway, this makes it hard on the brain, but I will survive, and like you said this will all be a distant memory in a year or so.

    Again thank you for the encouragement.

     
    Old 10-06-2011, 04:07 PM   #8
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    Re: Laminectomy Recovery

    Well I saw my surgeon on Tuesday. He had me get an MRI done before the visit. He says that everything looks fine mechanical wise. His words are you have a good foundation to build on. He did say there is still edema in the surgery area and the muscles still have edema. He said I am a little behind where he thinks I should be healing-wise, but not way behind. I know everyone heals differently. I am assuming that the edema can be a pain generator? I also know the edema means that I am still healing.

    I also get this tightness in the incision area quite often still. I saw someone referring to it as a "bear trap" somewhere else. After the surgery it felt like someone had a finger stuck in my back all the time. Now it happens when I am walking or standing after some time period. The time period gets shorter as the day goes on. Others have this? How long until it dissipates?

    He wants me to see a pain management specialist since he has now changed his view from 4 to 6 months to 6 to 9 months for healing. I said I heard about a year and he said well you had a fairly simple operation!!! So that is scheduled. Hopefully we can get the pain level down just a little bit.

     
    Old 10-06-2011, 04:42 PM   #9
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    Re: Laminectomy Recovery

    The way I look at it...a patient can either err on the side of maybe being a little too cautious as they are healing, and have "progress" take a little longer, but have the progress moving on a slow but steady forward projection, or, the patient becomes impatient, works on the edge of what he can safely do, goes over the edge on occasion and suffers the consequences. This progress would look more like a jagged line as he is often taking two steps forward, and one back.

    I have found out the hard way that I need to work very slowly so I do not cause any flare up of sciatic pain...so my progress is baby steps...but they are all going forward toward my goal. Whenever I get even a little bit carried away, when the sciatic flares, it sets off a chain reaction, affecting the SI joint, the piriformis and the hip, and it can take a long time to unravel the effects and get everything calmed down again. So it is just easier to keep it from happening in the first place.

    Any time there is swelling, you run the risk of one or more spinal nerves becoming irritated. Once irritated, it can take a LONG time for them to calm down again.

     
    Old 10-06-2011, 07:14 PM   #10
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    Re: Laminectomy Recovery

    Been there with the spinal nerves. I don't want to go there where I am now. I agree, I'd rather take longer to heal and get it right. The surgeon said "damn the torpedos, full speed ahead". I agree with you that a long, even, approach is the way to go. The SI joint, periformis, and hip sounds very familiar to me. Happened when I first started PT which the surgeon told me to do 2 weeks after the surgery. Lost the rest of that week (and you will probably say I was lucky for it to be that short!). I feel I am definitely in the 3 steps forward, 2 steps back. ALthough I am trying to be careful. Unfortunately I have plateaued for the last 3 weeks or so.

    But getting to the "finger in the back feeling" Is this a common thing that people get with this size incision? I assume it will eventually go away? I also assume it is caused by scar tissue and edema.

    By the way, just because I am trying to get the pain lowered a bit does not mean I will over do it. Its just a bummer having that constant ache all day. But I think I don't need to tell you that from what you have been through!!!

    Last edited by mod85; 10-06-2011 at 07:32 PM.

     
    Old 10-06-2011, 08:28 PM   #11
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    Re: Laminectomy Recovery

    Actually, through three surgeries, all going in over the same incision, I never had one bit of muscle spasm or pain. I had some pain associated with the incision healing and surgery itself, but as soon as that healed up, in 2 weeks or so, when I had pain, it was always nerve pain.

    Sometimes I think that my back is just numb in that lower lumbar area between L3 and S1 and I just don't feel anything...but it isn't numb to the touch...so I guess that isn't really the case.

    You can tell that most of these surgeons do not suffer from back problems, or they wouldn't tell their patients to go ahead and do whatever they want...my favorite piece of advice is "if it hurts, don't do it." The neglect to point out that you don't know it is going to hurt while you're doing the activity. You only find out after you've done it and the damage is done. How truly unhelpful!!

     
    Old 10-06-2011, 08:44 PM   #12
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    Re: Laminectomy Recovery

    Actually, through three surgeries, all going in over the same incision, I never had one bit of muscle spasm or pain. I had some pain associated with the incision healing and surgery itself, but as soon as that healed up, in 2 weeks or so, when I had pain, it was always nerve pain.

    Sometimes I think that my back is just numb in that lower lumbar area between L3 and S1 and I just don't feel anything...but it isn't numb to the touch...so I guess that isn't really the case. I'm not sure how I escaped the muscle spasms that everyone else seems to get.

    You can tell that most of these surgeons do not suffer from back problems, or they wouldn't tell their patients to go ahead and do whatever they want...my favorite piece of advice is "if it hurts, don't do it." The neglect to point out that you don't know it is going to hurt while you're doing the activity. You only find out after you've done it and the damage is done. How truly unhelpful!!

     
    Old 01-23-2012, 08:23 AM   #13
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    Re: Laminectomy Recovery

    Well I am back (no pun!). News is not so good. I have gotten into a spinal rehab program and am seeing a very good pain doc. The rehab program includes a salt water pool. I would say we are doing well in core strength and flexibility. My biggest problem is I can not sit for any length of time. This is still persisting. I have been officially diagnosed with Failed Back Surgery Syndrome. They are not quite sure why I am having the sitting problem. But being six months from surgery, and not seeing a lot of improvement, I think I am stuck with this. I can walk a couple miles a day, but can not stand still for more then 5 or ten minutes. When the pain cranks from standing or sitting it takes hours to get it under control (and it is unbearable since it is around a 9 pain level). So it looks like having surgery was suppose to keep me from being disabled, but so far the surgery has made me disabled.

    The pain from sitting and standing feels as if someone is slowly squeezing a pair of pliers over the operation site. Of course this becomes unbearable in short order. My pain doc thinks that the muscles and ligaments have not healed correctly and this is causing spasms. He is talking about prolotherapy. Failing that he thinks Botox might be an option since trigger point injections help for a short period of time. Since the tens unit helps a lot, if all the above fail could be an implantable spinal stimulator. Just had an epidural which helped for 3 or 4 days. I have had reactions to Cymbalta and Gabapentin.

    So this surgery was not the right choice for me. But that is water over the dam. However, it is looking like I will be disabled for the rest of my life.

    Did anyone else have this sitting issue and did it ever resolve. Anyone have prolotherapy and/or Botox? Did it help?

    Thanks,
    Ken

     
    Old 01-23-2012, 10:45 AM   #14
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    Re: Laminectomy Recovery

    Could you tell me specifically what pain you have and where it is located when sitting and when standing? Do you have leg pain?

    Have you had a flexion/extension X-ray to check for instability?

    I would not accept the fact that you are going to be disabled. You are six months out from surgery, which is too early to throw in the towel. Personally I would not accept that news until I had several opinions from other spine surgeons, and had tried a variety of therapies and treatments.

    I have not had prolotherapy but know people who have...and in some cases it has been very successful. I would certainly try everything before even thinking about a spinal cord stimulator. That should be your very last resort.

     
    Old 01-23-2012, 11:21 AM   #15
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    Re: Laminectomy Recovery

    Leg pain like I used to have is gone. The pain is a very high intensity ache at the l4/l5 area in the lower back (where the surgery was done). If I lay down on my side I can make it go away. Sometimes it takes half a day if it cranks enough. The pain feels like at clamp at l4/l5. As it worsens, it radiates to the butt. If I really push it I will get leg pain in the left thigh. It is a burny achy feeling in the thigh. If it makes it here, it can take days to get the pain under control. I think it is a stability issue, but my spine surgeon says absolutely not. When asked what it is he shrugs his shoulders and said the spine work I did looks great (this is a highly respected surgeon in the Phila area) so it must be your body.

    As for disability, I have been trying to work from home, and this has been extremely trying. That means it is not working. There is no way I can survive in an office environment. So disability is probably the only option. My company has been very loose in letting me work from home, but this can't go on like this for ever. I do have insurance, but once I reach using 6 months of short term, I will go on long term disability and will be terminated. Basically the belief is once you reach 6 months of short term, they believe you will never come back to work.

    This back issue has not changed one bit from 2 weeks after surgery until now (a lot has gotten better, but not the sitting standing problem. I can walk 1 to 2 miles a day without to much problems). I no longer believe it is going to change unless a reason is figured out. As of now, no one knows why I have this issue. I believe it is stability issues which causes back spasms. When it is bad the area over l4/l5 is very painful to the touch.

    I need to be able to sit again and waiting around for a couple years for that to happen is not a reasonable expectation.

    Ken

     
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