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    Old 01-23-2012, 12:14 PM   #16
    teteri66
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    Re: Laminectomy Recovery

    I'm really sorry you are having these continuing problems. It is really frustrating when you have a "mystery" problem.

    Have you gone to a different spine doc for a "second" opinion? I think doctors that did the original surgery can get really stuck in seeing only one way and it is hard to get them to think "out of the box."

    Perhaps you could try someone in the DC area or at Johns Hopkins?

     
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    Old 01-23-2012, 12:26 PM   #17
    n3kf
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    Re: Laminectomy Recovery

    But isn't Failed Back Surgery Syndrome, just a name for we don't have the slightest idea what your problem is, so here is a name fr what you got?!

    I agree with the second and more opinions. A second set of eyes on the MRI can really not hurt. I have tried to make appointments with a couple top docs in the Phila area, and they say that any problems I am having should be addressed by my surgeon since he knows my back best. My guess is they are trying to avoid getting involved in litagation. I am not there, just want a second opinion. Is this a common problem after you have back surgery (other doctors not wanting to see you)?

    Ken

     
    Old 01-25-2012, 06:41 AM   #18
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    Re: Laminectomy Recovery

    Well saw may pain management doc yesterday. He has decided to do a sitting MRI since that is when my pain gets the worst. It would certainly be nice if this would show something. In addition I have been having some pain in my neck the last couple months (fusion C7/T1 11 years ago). He said we should go ahead and do an MRI there also since I am having some pain in my arms. When it rains it pours! At least I will have films for second, third, etc opinions on my back. As long as I can find a doc that will see me!

    Ken

     
    Old 01-25-2012, 09:00 AM   #19
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    Re: Laminectomy Recovery

    Failed Back Surgery Syndrome is a diagnosis that most doctors will not write down or include on any chart because it can cause problems getting insurance carriers to pay for future treatment. It is a bit of a catch-all for pain that remains after a patient has surgery...and your definition is as good as any.

    However, just because that is one doctor's opinion, it does NOT mean that what you are dealing with cannot be remedied. It just means this particular doctor is losing interest and/or has no idea what to try next. As I mentioned earlier, if you think back to your visits with surgeons, generally they walk in the door to the examining room, spend all of 5 minutes looking at the MRI and then say what is wrong and what surgery they would perform. If there is something obvious, that tends to be the extent of their thinking. They do not spend hours pouring over the MRI slice by slice trying to determine if something else might also be causing the pain, or something in addition to the obvious thing is also a pain generator.

    It can be a common problem to try to get another back surgeon to take a look at you. In many cases, it depends how you approach them. I personally have never had a problem getting others to consult with me...and I consulted after my first surgery, a fusion, and after a second surgery for the same problem.

    In a way it depends on how much time has elapsed. Many will not see you until after one year from the surgery. I had my first surgery in Jan and by the fall I was convinced I was no longer still "recovering" and in fact, my pain was back to how it was prior to the fusion. I began making the rounds at that point.

    My approach was always that my initial surgery had been fine and I had healed well from it. The surgery just had not resolved my issues and I wanted to find out if something additional was causing the nerve pain.

    I can tell you, and I cannot back this up with any facts, but from my experience and what I have been told by other doctors, neurosurgeons are more fussy about who they will operate on. Ortho spine surgeons often are the ones who do the really messy cases, who do the revisions, the botched surgeries, etc. My surgeon was a trauma surgeon before he decided to switch to back and neck surgeries and went back to school for the spine fellowship, and I think that's one reason he was able to eventually resolve my problems.

    I am eager to hear what you learn from the sitting MRI. I had been placing my hopes in one as well. When I went to Chicago to consult with a "well-known" neurosurgeon, he refused to look at it, calling it a gimmick. I was stunned. Because they are done in an open machine, the quality of the images is not quite as detailed...I had mine done both sitting and standing, the two things that caused me great pain. I had neglected to think ahead how difficult it was going to be to stand perfectly still long enough for them to get the images when I couldn't stand more than a minute or two for any other purpose!! It was agonizing!

    Anyway, I will look forward to hearing if yours reveals anything. Your cervical issues may be coming from compensating for the pain in your back. You are probably holding your spine in a "new" alignment that is acerbating any cervical issues you already had.

    I'm not clear on where your pain is. I gather it is in your back near the L4-L5...but where is the pain when you are sitting? And you just had a laminectomy, right? You don't have any screws or rods or any type of hardware, right?

     
    Old 01-25-2012, 12:21 PM   #20
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    Re: Laminectomy Recovery

    Wow thanks for the excellent reply tetonterri66!!

    Yes the MRI is going to be interesting. I just plan to dump a bunch of narcotics into the system and hope I can make it! Yes I have discussed with my doc. I suspect the cervical issue is from laying down and trying to watch TV and the laptop. But it has gone on for about 3 months now and its time to be sure nothing bad is going on. Trigger point injections help for a week or two.

    As for the back pain. I had a Laminectomy, Discectomy, Foraminotomy, and The Facets were cut. All at l4/l5. When walking I get pain in the upper buttocks. I could deal with that. When sitting the pain is originating right at the incision over L4/L5. It starts as a dull ache and will intensify to an unbearable ache. When the latter happens, if I touch the area over and around the l4/l5 area it is very sore. Rubbing it lightly will make the pain subside some as long as you rub it. Tens can bring the pain down to a tolerable level for a period of time sometimes.. I really suspect this is muscle spasms, but could be wrong. Vicodin is very effective in helping with the pain. But in order to bring the pain to a tolerable level, I have to go to La La land with it - that is take a lot. The pain doc wants me to try Nucynta? I have tried Flexeril and Skelaxed, but both were like elephant tranquilizers for me.

    So the question really is, what is causing that area to be so sensitive to sitting. I can go from tolerable pain to all out I need to lay down for hours pain. I can lay on my side with very little pain (this it is my rescue position).

    Help?

     
    Old 01-25-2012, 12:35 PM   #21
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    Re: Laminectomy Recovery

    I should also mention that as the pain increases over l4/l5 when sitting, it also spreads down to the upper butt area. It is also a very bad ache. We are talking 7 or 8 pain level pain.

    Ken

     
    Old 01-25-2012, 12:46 PM   #22
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    Re: Laminectomy Recovery

    It doesn't really sound like a nerve compression, the nerve being pinched, because then you would have pain going beyond your buttocks area, down into your leg...down the back of your leg at least to the knee. I'm wondering if the trimming of the facets, etc. has maybe caused some slight instability that is causing pain in a certain position, but not others. Is it predictable when it will hurt?

    It makes sense that it would hurt to sit if it is something in the spine as opposed to a pinched nerve because sitting puts at least 30% more pressure on the discs when sitting than either standing/walking or lying down.

    One of the major common pain complaints stemming from facet joint issues is pain when sitting. Are you more stiff in the morning...I mean noticeably so...not just normal stiffness?

     
    Old 01-25-2012, 02:12 PM   #23
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    Re: Laminectomy Recovery

    I agree about the nerve compression tetonteri66. I have had bad nerve pain pre surgey and this is not that. The pain occurs sitting and standing still. With walking it will take longer. Laying on my side is the golden zone. Laying on my back can be OK sometimes, but on my side the pain level can be almost non existent.

    I am usually not more stiffer then normal in the morning, but sometimes the pain can get set off laying in bed also. Not sure what happens that causes this as it wakens me from sleep. Looking up facet joint pain, it certainly sounds similar. If this introduced stability issues would the only real cure be fusion? I have religiously been doing PT and that is not helping this pain. In fact, it can aggravate it.

     
    Old 01-25-2012, 02:57 PM   #24
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    Re: Laminectomy Recovery

    Usually, if there is instability it is hard to exercise the muscles and soft tissue sufficiently that it will overcome the instability, and yes, this is one reason why fusion is done. It would also make me think that since you are having difficulty with PT and it seems to increase your pain, that instability is a factor. At least in my experience, PT rarely improves anything when there is instability going on.

    But this might be a good reason to try prolotherapy. It helps to strengthen ligaments and tendons...and is just about the only thing that does. If you determine it is an instability, you could also try a platelet rich plasma injection.

     
    Old 01-25-2012, 03:30 PM   #25
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    Re: Laminectomy Recovery

    I also think you would agree that second and third opinions would be a good idea. My surgeon says that my problem is muscle pain. I said can it be caused by instability. He says, no way did I do anything that would cause instability. I say what is causing it and I get the shoulder shrug. I was worried when post surgery he told be he cut back the facet joints, but maybe this is normal for a Laminectomy? I knew there was something wrong a month after surgery.

    It would seem if the pain is coming from the facet joint trimming, that an orthopod would be a better consult then a neuro? Not sure exactly what testing can be done to determine if this is the problem? It would seem an MRI may not really show this type of instability?

    Thanks again,
    Ken

     
    Old 01-25-2012, 08:45 PM   #26
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    Re: Laminectomy Recovery

    Probably the best way to determine if your pain is coming from a facet joint is to have your PM give you a facet joint block. CT scan is supposed to be better than MRI for facet issues, so I've read...I personally have never had one for my spine.

    I personally with go to an ortho spine doc for any of my spine issues...but that's just my personal preference!

     
    Old 01-25-2012, 09:04 PM   #27
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    Re: Laminectomy Recovery

    I was thinking about that, but there is Facet Joint Disease which would be like osteoarthritis. This would respond to injections. But if the facets were cut back too far, that would create instability. Would instability respond to facet injections? Cause if it did, that would imply a Ryzotomy would work. I would think instability would be a different beast? However, you have much more experience then I do! Yes, an ortho would make sense for this one. I'll probably try and go back to the Rothman Institute in Phila. We shall see.

    Hope hope hope. All is not lost with hope!!

    Ken

     
    Old 01-26-2012, 01:28 AM   #28
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    Re: Laminectomy Recovery

    If there is instability, there is generally some nerve irritation or compression. With a facet block, the joint is numbed up and you are instructed to do the activities that would normally cause pain. If the activity does not cause the "normal" pain, they conclude that they have found the right spot (or one of them, anyway).

    You keep a pain diary and make note of when the pain starts to return, etc. This helps the doctor figure out if the block was effective.

    It is strictly diagnostic, not therapeutic. Often they will also put a bit of steroid in with the numbing agent, so after it wears off, the steroid will help a bit with the pain...but if it is strictly for diagnostic purposes, they want to know when the pain returns and not have it masked by something that alters the pain.

    A rhizotomy is often done if a block works...but in this case, I don't think it would work more than briefly, because the real problem is caused by the instability. If the joint is sliding around, it irritates it and the body's response is to lay down more bone in an attempt to stabilize the joint. This is a great plan in theory, but in reality it is the start of arthritis in the spine and just causes more pain. So you want to do something to keep the joint from moving...thus, the fusion.

    There have been some experimental surgeries in facet joint replacement, but so far, they haven't been successful enough to gain coverage with insurance carriers.

    If you don't have a doctor at Rothman, I have a suggestion for you. I have not seen him but he was recommended to me by a doctor friend who lives in Bucks County. His name is Jeffrey A. Rihn, M.D. He is young but a very skilled surgeon and has the reputation of spending time with his patients, is patient about answering questions, etc. You can find information about him on their website, etc.

    Last edited by teteri66; 01-26-2012 at 01:30 AM.

     
    Old 01-27-2012, 02:50 PM   #29
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    Re: Laminectomy Recovery

    Thanks for the reply. I had seen Dr Albert previously. He was one of my choices for my laminectomy. Not sure if I will see him or not. The Rehab facility people say the doctor you recommended has a lot of positive outcomes and does a good job with revisions. They say they have never seen a failure case from him (yet - they all get them as we know!). So I appreciate the recommendation.

     
    Old 01-28-2012, 11:47 AM   #30
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    Re: Laminectomy Recovery

    I will be interested in learning how you decide to proceed. I hope you don't give up in your quest for answers. I think it is a matter of finding the "right" surgeon for your issues.

     
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