Back pain returned after microdiscectony
Posted , 7 users are following.
Hi all
I had an L5 S1 microdiscectomy on the 17th June 2016 (10 weeks ago). I had a large hernia and leakage from the disc and had sciatica and weakness in my left calf muscle. After the op, at first my recovery was really good. Pretty much no back pain at all, and strength coming back steadily to my calf. I had started work doing 4-5 hours a day standing at my desk with no ill effects, and as much walking on the flat as I liked. I was doing Physio with lots of gusto and felt great.
Then after my 6 week check up, I blew it. I did a 100 minute mountain hike and a 30 minute bike ride. Idiotic. I know. I was feeling great before and during and thought I could handle this if I went steadily. 100% wrong.
The next day I woke up with 7/10 pain in my back and leg. I stayed in bed for the best part of a week. It started to get better but still bad. Then at the end of the week I had a crisis at work and had to stand about for about 3 hours. That was the last straw.
Since then I have had ongoing pain around the site of the op. I can't stand for more than a couple of minutes without getting a sharp progressing pain in my lower left back. The leg pain is mild for now thankfully. I tried continuing to walk while I recovered for the first 2 weeks. About 1km every couple of hours. That was a bit up and down and I was getting depressed at the lack of any progress. My surgeon gave me an MRI that showed no reherniation, just more scar tissue as expected. She said it ought to get better, gave me a load more painkillers and said to keep moving around and walking. The relief alone actually helped with the back pain a bit bizarrely. But not for long...
I tried continuing walking daily, about 3 x 20 mins, but the pain just stayed the same for another 10 days. I went to my GP to get some meds to deal with my terrible mood and lack of sleep. The frustration, lack of confidence in my recovery and anger at my own stupid action has been causing me to get really depressed.
He told my to do much less walking as this would aggravate the damage to the tissue in my back and that I should lie down most of the time. He said to do very light Physio only. He gave me Valium to help sleep and put me back on 20mg of steroids to help with the inflammation.
I am 5 days into this and going a bit crazy. First I don't know if I should believe my surgeon and go with the active recovery, or the GP and 'let everything calm down'. Second I don't notice any difference to the symptoms with either approach. Honestly, if I had confidence in either course I could relax but they basically disagree completely! And no one is saying what specifically is wrong and how/when it will get better.
In writing this and comparing to other people's posts I do appreciate that many have it much worse than me. Plus I also have the luxury of being able to take a bit more time off work and having a saintly wife to look after me. But my state of mind is kind of in free fall as I don't know when all this will bottom out and get better, and whether I will ever get back to the very active lifestyle I had before... So any words of wisdom would be hugely appreciated.
2 likes, 77 replies
emily31887 Guest
Posted
This is interesting because I seem to be having the same experience with doctors regarding this issue. The pain doctor responded to me say that I think I am finally healing " it will never heal, it is a mechanical issue" . He said that the disk is worn from over use and will not become unworn . So I went to my family doctor and he said he was unsure why the pain doctor said that. That the inflammation will go down and a scan would likely look different now. I don't understand and am not really sure how to proceed . I feel better and then all of a sudden for I known reason I feel just as bad as before , only the pain lasts for hours and then rest seems to eliminate the pain. It's almost as if it goes in and out of place. But suddenly I have an appt with the back specialist Oct 3 . So I'll go but I don't expect to get any enlightening information . I feel even more sure after hearing about your visit. I guess we just listen to our own body and manage as best we can.
Definitely mood intensifies pain. I think for myself I can ignore and move past some pain until emotionally I'm not feeling so great and the pain is overwhelming . I think of when I was in labor with my first child . I could control the pain of contractions , it was very painful but I was managing . Then my sister in law barged in and said " I know the pain is really bad, it's ok , just cry if you need to" ( her presence upset me, we didn't get along very well . All of a sudden it's like I lost my focus and control and the pain was unbearable . I immediately had to ask for an epidural and was numbed . So , definitely figure out how to
Improve your mood. I've read a lot of time with chronic pain that an anti depressant helps. I'm not sure how you feel about that but it was documented in a journal.
My doctor did say herniation pain generally takes three months to decrease on average, and I read that as well. So maybe focus if that for now. He also said because I am so active he was sure that I would get back to normal just with possible moments of pain. Hang in there !!!!!
jessica_78456 emily31887
Posted
Once a disc is damaged dried out bulged herniated or what ever it dose not heal its self . In some cases pain may reduce due to your body becoming used to the issues . So many doctors ect using different terminology for what's wrong . At the end of the day none of these issues are normal they can be very disabling. We need to be more forceful with these doctors and consultant s . We need to be telling them what we want to see happen. You can be referred to a private hospital via the nhs. It's ur right . But I believe a MRI should always be done to find out the cause
Guest
Posted
So here is where I am up to now. It's not bad. It's not awesome. I am feeling a lot less freaked out than a month ago at least.
I saw the pain doctor again on Monday. He didn't have much to say other than that the issue is with the S1 nerve, and maybe a bit in the L5 nerve. He is convinced based on tests he did (pulling my leg around and getting my back to hurt) that the nerve is unhappy (I guess damaged and/or inflamed) and this is causing the back pain. I think for other people, the radiating pain into the leg is more common but the nerve does also serve bits of the back locally so they can feel painful if the nerve is firing off. I do still get mild radiating pain when my back hurts so I am prepared to believe his take. It also fits the symptoms pretty well. My initial activity that kicked this whole thing off was hiking uphill. That means lots of movement and stretching of the nerve as you raise your knee and push off it. Cycling arches the back, again stressing the nerve. Not sure about long standing but I imagine there is an explanation.
My pain is ebbing away but really really slowly, tbh, it is sometimes hard to really even be sure that it is going but I know it is better than 3 months ago at least. I have got a reasonable sense of what to do and what not to do now so I am avoiding stuff that I have learned causes problems. For example I can bear to sit for about an hour, but the pain later that day and the next day goes up a couple of notches, so I avoid this now, even though it's ok at the time.
Having a theory to go on helps psychology. If the pain is indeed the nerve then I am in the same boat as everyone else is when they have leg pain after the op. I just have to wait, be careful not to stress the nerve, and do PT to build up the muscles to support my back. Here, I am making progress and stuff that used to get my back angry straight away does not, or takes much more activity to do so (stomach pull exercises used to hurt, now they rarely do).
Its all a bit of a moving target but I am trying to control the variables as much as possible. I don't do stuff the I know stretches the nerve as this can't help. I avoid activities that I have learned hurt later. I am not taking meds that completely mask the pain (like Tramadol) as if I am going to let the nerve heal, I need a bit of feedback as to when it happy and when it isn't. I am icing the area after activity in case that's helps to minimise any inflammatory response.
Now I just have to hope and wait that the nerve will get better and the pain goes as it does so. People talk about this taking many months, like 12-18. I wish I could find posts from people saying "yes that was me. I am 12 months out and the pain has gone" but I guess that is the nature of a forum like this. Many times when people are better, they cease to hang out here! I would love someone to prove me wrong on that front though
jessica_78456 Guest
Posted
Ask for a second opinion and did u drink a blue dye so that when yr latest MRI was done,they could distinguish between old scar tissue and any new problems. Sound like another dodgy disc . Defo seek a second opinion but don't discuss previous as they will just let what's already been done influence there judgement. Trust me I've been there.
Guest jessica_78456
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Hi Jessica
thanks for the advice. In fact, yes a couple of other doctors have looked at my MRIs and they don't see herniation. They do all mention scar tissue though... From what I have read, that is tricky to fix.
M
Guest
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Just an update with the latest on my condition a month on from my last long post.
I switched to a new doctor just after the last post as the pain guy did not want to see me again. He just said do the physio and hope for the best,
The new Dr said that I needed to build up my back muscles so put me on a course of exercises with a machine called a medx, basically glorified lumber extension machine. This caused more pain at first but I got used to it and had been doing it twice a week for 3 weeks but all the while my back pain was just the same and sometimes worst. I was told not to swim as it demands a lot of stabilising of the spine. My physio (working with the dr) was convinced it was more muscular than nerve pain. I was therefore doing quite a lot of work on my abs, quads and glutes to get more support for my back.
I wanted to believe the muscle pain theory but was sceptical as when my back hurts my legs usually does as well. I had contacted my surgeon after the first painful medx session and asked if an ESI might help. She came back to me at this point and arranged this for me. My new Dr okayed it so long as I resumed my medx and physio after a couple of weeks semi rest.
I had the ESI on Monday - 3 days ago. I have not been happy with the results so far to be honest. The nerve pain I had before is not better, in fact it seems to have spread from my back, now affecting my buttock, calf and foot from time to time. I also have more discomfort around where the injection went in and some slight swelling. Reading posts I see that not everyone does well from these injections and it looks like that could be me.
It is now 3 and a bit months since this back pain started so I have to start considering some not nice possibilities. It could be I have not just inflamed the nerve but actually damaged it and this could take years to heal, or it might never heal. Or maybe I have some scar tissue interaction that again is very difficult to fix. The radiologist that injected me did mention this was evident on my last MRI from August.I have read of people who have had surgery to remove excess scar tissue but it does not sound a common procedure and often the scar tissue grows right back.
Does this sound familiar to anyone? Any tips on what works with these symptoms of tenacious sporadic back pain along the nerve path? Right now, I am stuck as I am scared to get back to more activity as I think it will just set back my chances of recovering. So I spend hours cooped up doing nothing interspersed with exercises and basically nothing in the seemingly vain hope that the pain will go away... I have even had to dial back walks as these seem to set off more bouts of pain so can really only go about 15 mins max. Sorry it's all a bit moaney. If anyone has advice then I would really appreciate it. Thanks.
jessica_78456 Guest
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Guest jessica_78456
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Hi Jessica. Yes, microd L5S1 for big ruptured hernia in June. It worked well and I had zero back pain until I overdid exercise at the end of week 6. Then the back pain started. It has moderated maybe 25% in that time but not enough for me to get on with my life. My whole story is in the thread for when you are bored :p
Seeing as a steroid injection seems not to have done any good, I am thinking scar tissue right now. The onset of pain was the normal point for scar tissue to become a problem. What I still don't get though is why the overnight onset the day after I did the exercise? That's not a coincidence. Maybe the exercise roughed up the healing disc and brought on more scar tissue over the next few days or something...
jessica_78456 Guest
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NK04743 Guest
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Guest NK04743
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Well, another few developments. After the failed ESI I contacted my old highly trusted GP and asked him to recommend a second opinion from a surgeon. He put me onto a professor of Neurosurgery and I managed to get a appointment for yesterday.
Now ahead of this, in the last few days, I had noticed some lessening of the back pain especially if I was being careful, but I went to the appointment to see what the doctor had to say.
He looked at my scans and pointed to a black area right up against the nerve, that has moved slightly between my week 4 MRI when I had no back pain and the week 10 MRI when I did. In the second image the nerve is more swollen and more distorted in shape due to the black area (a thin black triangle) lying right up against the nerve. He described this as being like a thorn in a lions foot, meaning a sharp painful pressure on the nerve. He thinks it's a stray bit of material from the original micro D op.
So now I have several feelings. I am really furious that my original surgeon or the awful rehab doctor she referred my to completely missed this even though I went on and on that something was wrong. Worse, I actually had the opportunity to see the new prof back in September but my original surgeon convinced me that my MRI was fine so I did not bother as I did not want to waste his time. In fact the last time I heard from my original surgeon she said she would not look at anything again until January...
Anyway, now the prof has given me three steps to fix this.
Step 1 is another ESI. The last did eventually have some effect it seems and maybe the nerve can be shrunk down enough to come away from the stray material and avoid the painful contact. It's easy so it's worth a shot.
Step 2 would be a revision to the micro D surgery, just to clear out this junk near the nerve. They apparently use some special gel to avoid adhesion of scar tissue and there is very little to do in there, although of course any surgeon near the nerve is risky he seems pretty confident and when asked says the rate of success of these small revisions is about 85%.
If neither of those work then step 3 would be installation of some rubberised screws between the vertebrae to limit movement of the segment. He says I am too young for fusion and this should do the job while still allowing 50% movement. I saw the hardware - it's pretty chunky so I very much hope that is not required.
So let's see what happens. Thank God I finally have a doctor who is interested in helping me. My lost one had totally lost interest. He also has a diagnosis that fits my history of symptoms pretty well. Fast onset due to movement of the fragment, a mixture of back and leg pain, gradually better as the nerve inflammation goes down but not gone, regular changes in the area of the pain as the fragment shifts slightly fromday to day. And although the change on the MRIs is small it's unmistakeable.
And the surgeon has taken pity on my due to the long time since my op without much recovery so he has made me an urgent case. If step 2 is required he wants to fit me in before Christmas, so with 3 weeks!
Anyway thanks everyone for your advice. Who knew surgeons can miss vital clues like this! Hopefully my story to date will help others who come upon this thread with similar issues. And also hopefully, step 1 or 2 will work and come the end of January 17 I will be feeling more like myself!
jessica_78456 Guest
Posted
I be had back surgery lower back . 3 year ago .but it only helped a little.i also have fibromyalgia and hyper mobility. Now am back to square 1. I was seeing a rheumatologist as I also have inflammatory joint diease . The last 6 months have been hell. Had a X-ray on neck as problems there to and an MRI . Showed bulging disc and bone spur c4/c5 he said there was no nerve comprehension. I wrote to him regarding his findings also with the issue of chronic Lower back pain and server symptoms, asked why the MRI did not include images of my lower back . He had me back in with in a week to do that. His findings once I wrote to him . He came back with what he meant was there's no spinal compression and he believes the bone spur was the culprit for iratating the nerve s . So now he's saying yes there is some nerve iratation . ( make I mind up) any how moving on to lower back diagnosis. 3 completely dried out disc all black on MRI . L4/l5 s1 again no nerve compression. Bollocks giving the symptoms I was having. Paid to see a private consultant at private hospital . He said my back an mobility was terrible . He wanted to see me again once the MRI had been complete (at this moment it had not been done) I new I couldn't afford to go private ( nor could I get insurance as it's a long standing issue) I went back to my doctor the day before the scan told everything broke down as I could barely move with numb leg and buttocks, asked if he would refer me back to private hospital under nhs . No problem he said . To cut a long story short, I do have potential nerve compression and deteration of the left facet joints at the disc mentioned above. A week later a spinal block was offered and administered. First response very little change 2nd response in a lot of pain never again . So when consultant s say oh it's nothing it s common or quite normal (grit yr teeth and count to ten) there is nothing normal about this. Follow up 6 wks
Guest
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Jessica, that sounds really bad. I'm really sorry. I really hope they can offer something more helpful at the follow up.
i have been pinging back and forth on an emotional roller coaster. At my last ESI the radiologist told me that the new surgeon was wrong about the reherniation or disc material pressing on the nerve. He said the MRI did not show this and that more surgery would only make the scar tissue worse. This left me really miserable as my way out was effectively yanked away again.
i went for my next meeting with the surgeon. He said, look you have symptoms that suggest something pressing on the nerve. They MRI may not show anything clearly but they don't always capture everything that's actually in there. I was sceptical as the last thing I want to is plough ahead with unnecessary surgery and make things worse. After some umming and arring we agreed I would have another MRI and schedule one last ESI in my IS joint in case that was inflamed.
i had the MRI on Monday. I got the cd and took it home to look at it. I could immediately see that a structure that the surgeon had pointed to as a potential problem (a black line standing sitting right next to the nerve) was even more clear and was also clear in the contrast image so could not be scar tissue. I thought 'that's it! That's the junk that has been irritating the nerve all along'. I got myself mentally ready for surgery and was really glad that there was something to explain my symptoms that could be removed.
The next day the radiologist called again. He said 100% that is NOT disc material. He said it was most likely a blood vessel and that there is no disc material impinging on the nerve.
So I am back to where I was. I would really love to believe the new surgeon. He is a professor of neurosurgery with years of experience. His narrative says that a minor surgery will fix me. But the images and all other doctors (4 so far) that have seen them say no reherniation or problem material in there except scar tissue. No one else has suggested revision surgery.
My next appointment with the surgeon is 20th January... My last ESI is 28th December. God, I hope that works but the last 2 have done nothing really.
Merry Christmas everyone...
jessica_78456 Guest
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Well I ended up been admitted a wk after the injection. I believe I had a reaction while o medical professional will admit to this been the case, all blog suggest this was the cause and many people have had the same complications. Well here's were I am today, no relief from spinal block. after the new year the procedure is , numb back push nerves into the disc s to confirm pain. If this is positive I have the option of another op decompression take up to 3 hrs, might get a few years relief or spinal fusion take up to 7 hrs a bit more risky more recovery time need but possible 5 to 10 year relief. Decisions decisions. Or both might have little relief. What have I got to lose stay the same or improve
Guest
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I have now spoken to the surgeon. He says the nerve is under less pressure now and any material from the disc has been reabsorbed so that is a relief. He does not want to operate.
My disc has lost a bit more height since August which is a shame but still has some white in it. It's gone down from 11mm at the front pre op to 7.5mm now
it is still doing something but I agreed with the surgeon that lots of core strength training and general healthy activity will be key to maintaining it. My main condition now is DDD and that is what I need to focus on.
I woke up feeling fairly comfortable this morning. Then decided to try some stretches that I saw are good for DDD (lying hamstring stretches). I only did a couple but was very quickly reminded that my nerve is by no means normal and needs to be treated very gently. Evidently the scar tissue is tethering the nerve and I can't do whatever I feel like trying on that leg. I can touch my toes with my leg on a table if I'm careful but what I did today was way too much much and the leg and back are both very unimpressed. I have had to take a gobful of ibuprofen and am feeling incredibly stupid.
So I reckon a quite week or so now while it hopefully calms down again. Just goes to show though. Overdoing it is some kind of mental illness, really! As if I have not experienced enough to know better by now... even when you feel ok, nerve pain can be lurking just around the corner if you don't respect your body's limits. Note to self, do what is on the physio' programme and no freestyling...
emily31887 Guest
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Hello!
I can't believe you are still struggling like this . You do push yourself and I do the same and is likely one of the reasons we ended up this way. ( however , yours seems much worse ) . I'm not sure i still understand all of this completely however , I do know it will never be 100 percent . I see on my scans that my body is slowly deteriotrating however , I can't say not exercise at all would be any better . I guess just somehow being able to find other things besides exercising all the time to feel good is what I have tended to do. I still exercise but not as much as I did before , just trying to take it down a notch. There are days I almost feel 90 percent but always feeling something . I can be totally fine and then I woke up one morning last week and couldn't even put my foot in my boot it hurt so much . It was a different pain , like shooting down from my back but making my foot feel broken . Am flying down didn't not stop it . I took my pain meds again which I thought I was done with , but I truly couldn't handle the pain. And then after just 2 days of this strange pain, I woke up and it was gone . Weird . I swear sometimes I can feel this bulging feeling ( not pain just pressure ) in my back where I herniated my disk. It feels like it moves . I don't know if that what it is but it's also a weird sensation . I still have small numbness sensations sometimes , but not constant and some workouts trigger pain . I know you will get to this point Michael you just have to try and look at exercising a little less intensely . ( just trying to be supportive and positive !)
Have you been able to work ? Are you a little bit better before ?
I have returned to work and seem ok so far .
Guest emily31887
Posted
After this latest debarcle I think I at least have a picture of what happened to me in July, with the help of my new surgeon. I managed to do 3 things - inflame my nerve, cause a slight reherniation or sequestered a bit more gel from my disc and roughed up the healing tissue causing a thickening of the scar tissue. The inflammation goes down eventually, especially with steroids, the sequestered gel was reabsorbed in the last few months but the scar tissue is there to stay. I did lots of nerve movement exercises so managed to reduce the nerve tethering reasonably well but not enough to get away with what i did earlier. So now I just have to wait for the nerve to calm down again and feel dumb and achy in the meantime.
Your symptoms do seem confusing. So odd that they come and go so much. Which disc is deteriorating? Staying active is certainly good for you as keeping the circulation goes in the area of the disc ought to help it. Do you do lots of core exercises which are good? Do you do any running which I gather is not?
TBH given I have been doing all the right things for months and mine is still going suggests that nature will do its thing and all we can do is avoid helping it doing anything bad!
jessica_78456 Guest
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Guest jessica_78456
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I know. It's something I had no idea about until 6 months ago. People tell you they have pain but until you experienced it you cannot possibly appreciate what it means to your state of mind. I have managed to make some progress but know I will never be right again.
Re your pain have you tried Lyrica or Neurontin? These seem to help some people where other meds have failed. They were designed as anticonvulsives and "turn down" the whole nervous system so can dampen the neuropathic pain we are getting. They have side effects but maybe a price worth paying.
Have you been given any surgical options? Three discs fusion or similar sounds a big job though. My surgeon likes a system similar to Dynesis which is a posterior support system to give the spine support without losing all mobility. Not sure if it works at your c levels though...
Guest
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jessica_78456 Guest
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jessica_78456 Guest
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Been offered decompression or fusion my choice but I don't think it s all 3 going bck after the new yr to have a proper discussion. But first I have to have a procedure where they prod the disc involved to make sure they are definitely the culprit. As a spinal injection failed 5 wks ago. I believe if this had worked they would have had there answe from this?
Guest jessica_78456
Posted
Hi Jessica
Just for fun, try Googling Dynesis before you agree to a three level fusion. It's one of several dynamic stabilisation systems available. It has better results than fusion for preserving the neighbouring discs. With fusion the neighbouring discs have to do more work and that can prompt them to deteriorate. I think Dynesis has been around 20 years and is still in use. There are new better versions as well. The surgeon I have been seeing recently likes it (or its successor apparently). He is a neuro rather than ortho and I think is a bit more clued up than my original ortho surgeon who only knows about fusion when microd does not work.
Also, are your discs actually herniated and poking out the back? If they are not herniated then maybe they should not be offering microd/decompression as what would they be taking out? If the discs are just degenerate and have lost their height then the nerve pressure is maybe due to the foramens closing up, and back pain might be due to the facet joints coming under lots of pressure.
Sorry I know this all very general. Just regurgitating the hours of YouTube videos and chats with docs and articles I have been reading :p
jessica_78456 Guest
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I think one of them is slightly herniated and yes there's signs of erosion in the facet joints in that area left side . I'll have a look ta
Guest
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Just a periodic update (as getting better is no reason to not post here!)
Christmas was up and down but I am better now than before. I had an ESI in my SI joint for diagnostics purposes on the 28/12/16 and in fact it did somewhat help with the pain in that area.
Since then I did do a bit too much sitting and standing on NYE and felt that the next day so a depressing start to the year, but getting better. I am doing more exercises on my back (4 point stability) and so on. I did a bit of swimming (300m in 10 mins) and more or less got away with it so will aim to do that every other day if that works.
Some times I am feeling almost pain free which is nice. I think I have months to go but it is harder to fear that I won't be more or less normal one day. That's not to say that some days are still frustrating but the long term trend is consistently "getting better".
I know that my long term issues are the degenerative disc and the scar tissue. The DDD I can mitigate with a strong core. The scar tissue I just have to keep challenging with stretching and exercise. If that hurts a bit now and again then there is always ibuprofen to take the edge off. Fingers crossed that plan will work and I can get back to life as normal (more or less) by the summer... and I can keep the faith and avoid any more depression.
jessica_78456 Guest
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I mentioned this to my neurosurgeon he's says he's had a mixed s response from patient s who've had this. He said fusion is 70% successful. He also says there's an option of disc replacement. He wants to do the least invasive surgery. A want the same but I want the surgery that will give me the best out come .
Guest jessica_78456
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Hi Jessica
This is medicine. Doctors like to do what they know and they often disagree! Fusion has been in use for decades so most surgeons are most comfortable with it. That makes sense.
You don't necessarily want to be the guinea pig for a new procedure, especially when the long term outcomes are not known. But the possible benefits can still make something more advanced attractive. FYI the meta study I found on Dynesis said the results were about the same as fusion in the short term but with improved mobility. But that was about 500 cases with an average follow-up of 36 months, and we hopefully have decades left to live.
The downsides to fusion are permanent reduction in mobility and long term risks (increased risk of neighbouring discs degenerated over time because they have to accommodate more motion). And it's not reversible. Nor is disc replacement.
I would not dream of advising against the advice of your surgeon of course. He has years of experience. I have 6 months reading internet articles and a few consults with doctors and surgeons.... :p
jessica_78456 Guest
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Totally understand. It's always good to weigh our options up .