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Increased pain years after L1-L4 fusion

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Old 11-23-2011, 05:03 AM   #1
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Increased pain years after L1-L4 fusion

I am looking for some help. In 1999 I was in an accident and had an L1-L4 fusion. Up until about two years ago, I was relatively pain free. However, that has now all changed. The lower back pain began and then started working into butt and back of legs. I have been through extensive physical therapy which did no good. I saw my original surgeon and he said the fusion looks fine. I am now seeing a pain management doctor who does nothing but prescribes a bunch of drugs to help me get through the day. They say the problem is a result of scar tissue which has built up over time. I am only 50 years old and am extremely active (when possible). I don't like taking the drugs and believe there has to be help out there. I can only imagine what my life will be like in 10 years if things continue to deteriorate the way they have the past two. Any suggestions would be appreciated.

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Old 11-23-2011, 05:27 AM   #2
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Re: Increased pain years after L1-L4 fusion


Hi, so sorry you are going thru this pain. I was wondering if you were any meds for nerve pain or just pain meds? Has the Pain Dr tried injections yet?

There are several meds out there besides pain meds that can help with the pain going into the legs (lyrica, neurontin, topomax, etc). The pain into the butt sounds like L5/S-1 but I'm no Dr. Have they done any recent test to make sure?

Hope the med info helps.

Old 11-23-2011, 07:13 AM   #3
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Re: Increased pain years after L1-L4 fusion

Welcome to the board.

I presume you had a recent MRI or CT scan and that it didn't show any degeneration at the level below your fusion?

Obviously none of us have formal medical training, so always keep that in mind as you are reading on this, or other similar forums. I imagine your fusion does "look fine", especially if you have been relatively pain-free for the past ten years, but there would probably be some degenerative changes in your back, under the best of circumstances, in ten years time.

It is a well-known fact that the spinal segments adjoining a fusion (L5-S1 in your case) are subjected to a great deal of stress as they become the first area where the lumbar spine can move post surgery. I would think it very plausible that you may have developed some issues at this segment, or possibly with the SI joints.

I would really question that scar tissue is now causing a problem ten years after surgery. Who am I to question what you were told by your surgeon...BUT, everything I've been told about scar tissue leads me to believe that it is static tissue that fills in a void after surgery, collagen that grows into a specific space, then stops growing. If it just continued to grow for the remainder of the patient's life, it would eventually squeeze out all the organs of the body.

I don't begin to understand the mechanism within the body that allows new tissue to grow for a specific period of time and then "turn off" but it is my understanding that that's what happens -- scar tissue forms and fills in from about 6 weeks to 12 weeks post surgery. Apparently what allows it to turn off is applied internal pressure -- in this case, stretching. This is why walking is so important after lumbar surgeries. It remains the best way to keep those spinal nerves stretched out. This applied internal pressure causes an enzyme to be produced, which signals the brain that the growth is complete, and, at this point, the production of scar tissue turns off.

I've been told that scar tissue is similar in appearance and texture to cotton candy...and, it is sticky. The major problem with it is not its existence, but it causes problems when it attaches to a nerve or adheres to an organ or elsewhere. It is often a big problem in pelvic surgeries.

What type of pain are you having now? Is it all the time or what activities make it better or worse? If it is nerve pain, are you taking something like neurontin (gabapentin) or Lyrica? These are the meds that are usually tried for nerve pain as the usual pain medications have little effect on nerve pain.

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