Back pain returned after microdiscectony
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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
Guest
Posted
I just thought I would update this thread again in case it helps anyone else.
As usual, nothing is reliable or predictable. I would say that I am probably still improving though it is sometimes hard to tell.
Since New Year, I have had good days and bad days. I have upped the physio I am doing a bit with the physio introducing a few easy weights exercise exercises for my hip flexor, upper back etc. I am able to swim more which is good. I am now up to about 550m every day or every other day without any side effects that I can tell. Before too much swimming would leave my central lower back very sore.
i have found that I have two distinct types of pain now. Nerve pain is affecting my leg and the left side of my back. Then I have disc pain which I feel very central in a confined band across my lower back. Nerve pain tends to come on after too much activity that requires the nerve to move like cycling or just from pressure caused by lying or sitting a lot. The disc pain happens when I do anything that requires "shock absorbing" so walking down slopes or going down steps for a while, or any kind of bouncing up and down (one of the physio machines - Senso Pro- had some of that which did not help!).
I had a consult with the doctor overseeing my physio. He was happy with my progress in terms of my physical capability but was not interested in talking about the nerve pain as he does basically not have a plan for dealing with it!
Last week, my kids had a week off school so we went away. A 90 min drive each way. I just about managed that with a couple of 10 min breaks on the road to lie down, and propping myself up on my hand to take the weight off my back when driving! Not fun but tolerable. The place we were is where my old GP is and he is great, so he agreed to examine me, look at my MRIs and look at the report from my last MRI. He thinks the nerve is not damaged but still has some scar or other tissue irritating it. He prescribed be a ton of oral steroids. 80mg prednisone a day tapering down to 20mg over 16 days. I am on day 4. It hasn't been miraculous but it has taken the edge off the nerve pain which is appreciated. I will speak to him in a couple of weeks to report back. Then he thinks it may be worth speaking to the neurosurgeon again for more advice.
So, I am still getting a limiting amount of ache, pains, numbness, hot feelings and tingling from the nerve in my left leg up to the lower left back. It means I can't sit for work, don't sleep great and know that I have to very carefully ration the activity I do.
The disc pain is there but predictable and somehow more tolerable. I still get days when it all looks bleak. The week away was good for opening up my horizons again a bit. The boredom and repetitiveness of the last 9 months has certainly not helped with my state of mind. But if I compare my condition now against where I was 3 months ago, I am a further along I think.
Guest
Posted
Time for another update.
The steroids in my last post did no good really, indeed I think they affect my mood so tapering off them was not fun.
I went to see the surgeon again. He suggested an operation. No surprise there. He gave me two options.
1 to install a dynamic stabilisation at the back of the spine with pedicle screws and a stiff nylon-like cord linking and supporting the L5 vertebra and the sacrum. Like half a fusion. 80% chance of success. Or 2, to clean up the nerve of scar tissue and anything else around it. 60% chance of success.
We decided to go for option 2 as it's less invasive. We could always do option 1 later. I got booked for that on 6/4/17. As I was coming up to the date I decided that my condition was still getting better on its own, albeit very slowly. I thought very hard about it and decided to pull out of the operation, for now at least.
I have had a few ups and downs since then. However I am get less feeble than I was. I swim 1500m every day now which does not cause any nerve trouble. I have sadly now done my rotator cuff in my shoulder so having to take a break, but it is really good to be able to actually exert myself for half an hour in the pool each day. Plus the weather has been great and I could not resist going out for a quick bike ride and was able to ride at 80% effort for about 35-45 mins a few times now without a big reaction.
Generally it feels like nothing has miraculously gone away but the intensity of the discomfort has been reducing, though like I say, very slowly. If I do recover without surgery, I probably still have quite a months to go before this will be just irritating rather than life changing. I can't work as normal yet. I still spend a lot of the day in bed, driving any distance needs to be planned carefully etc. But compared to 6 months ago, it is a big improvement, physically and mentally. Being able to get out and do some exercise, even if I have to be careful is very satisfying and hopefully a sign post.
When I decided against another surgery, I did it by asking myself "where will I be in 3 months with or without surgery?". I figured it was unlikely I would be swimming 1500, or 2km a day after surgery, but that was possible without. With surgery I would have those months of being super careful about bending and twisting etc. Plus the surgery was far from guaranteed to work indeed it's not like this surgery would be risk free. People do say that more ops cause more scar tissue so potentially more pain. My surgeon says he has a gel, Medishield, to stop nerve sticking to scar but it's still a risk....
If I really run out of road on my current path I can always go for the surgery, but for now I want to see if my current very slow steady improvement can continue. Fingers crossed.
Guest
Posted
Hmm, so. I changed my mind. Again.
I continue to have good days and bad days, but I have realised that it's the same pattern repeating over and over. I have a bad day. I decide in my head to have the op. I have a good day. I think, no, one more try.
But this pattern has been just like this for probably 3 months now at least. I still spend much of the day in bed. I have learned to manage my situation, and I am often relatively comfortable. But I can't work at a desk. I can't walk for more than 30-40 mins without it causing back and leg pain. If I go out for a meal, we always have to leave after, at most, an hour and that includes breaks to walk around. I am kidding myself if I see this as recovery.
So I contacted my surgeon, but this time to ask for the dynamic stabilisation op. I figure my disc is only getting worse. ITs less than half its original height and it lost height in the two MRIs I had post op. And I need to be better than this.
I asked him a bunch of questions by email which he answered with what I think are all good answers. High chance of success. 60 plus patients that he has implanted with this system (Spine Save System IV). However he has now said that as well as the degenerative disc at L5S1, he is not happy about some Spondylarthrosis at L5/L4. So he wants to put screws in S1, L5 and L4.
He reckons recovery will be 3-4 months and the biggest risk is the screws loosening, but he says that rate is 5% or less if I behave myself.
The system allows for more movement than many so is good for the rest of the spine as well as the levels it is stabilising as it does not force adjacent segments to work too much - so I gather.
I have not booked a date yet, but unless I can think of good reason I will do so on Monday. Anyone with experience of this kind of op out there with any comments?
Guest
Posted
I have now had the op to implant a dynamic stabilisation system is my back. I got lucky and the surgeon managed to fit me in and I was operated on early yesterday.
The op ran a 30 mins long (total 3 hours) because when he opened me up he found that the facet joints were very big with arthritis at L4 and L5. He had to chip away some bone to be able to get the screws in. We discussed how maybe these bad joints contributed to the herniation. I.e. Stiff joints restricted motion of the lumbar vertebrae. This pushed abnormal loads onto the L5 S1 disc, and eventually it failed.
So now I have the 6 screws and two rods in place at L4 - S1. The surgeon was happy to use the more flexible rods so I should expect to lose about 50% of motion at these two levels.
As for my condition, it's not bad considering. I am on 20mg of Oxycodone daily have have a Fentanyl pump for top up if needed. I used that a few times overnight but gradually less today. The pain when I am lying down is not more than 2-3. A bit more if I shift around etc.
Some parts of my legs went quite numb for about 18 hours after the op (various parts of both legs). This is wearing off quite quickly now. The surgeon says that when you screw into the vertebrae it plays havoc with the nerve signals in the nerve roots but it's always temporary.
He says to the expect a range of feelings on account of that including pain so I have been warned. So far, it's not bad though. I have been able to walk a bit and sit a bit and it has been ok. For day two I am pretty content.
I have been told to start very slow. Walks of no more than 2 minutes in week 1, then 5 mins in week 2. And slowly up from there. No stress on the screws if possible. Screw loosening is the thing to avoid so I am on best behaviour.
Guest
Posted
I am now... 20 days out I think.
still spending most of my time in bed. Up to 4 walks of 7 mins per day as advised by the surgeon, more or less.
still a fair bit of pain in my back and leg from time to time. It's worst if I twist at all when rolling over in bed. I am down to 5mg Oxycodone a day plus 1800mg of Ibuprofen. the surgeon said on the phone to expect some pain for a while due to screws I the spine mimicking the pain from a fracture. Other pain is directly from the screws I think - literally the feeling of something in my back. Fingers crossed it will actually start tailing off in a meaningful way soon.
Guest
Posted
So, I saw the surgeon last Monday after an X-ray. He was very positive about everything. He says the screws are perfectly placed with a lot of engagement in the outer parts of the bones, which is the strongest part rather than the softer middle. Indeed the screws into the sacrum actually protrude about 3mm but he says this is no problem as there is nothing important there to damage.
The various pains from after the op are gradually receding though not gone. I have different things at different (though certainly not all) times including (in order of intensity) a fairly focussed pain at the top of the left SI joint, some hot ache in most of the back of the leg and some pinching in my buttock. They are by no means that bad, maybe 2-3/10 at worst. I have taken myself off pain killers now so I remember to behave myself.
The surgeon explains these pains as various disfunctions in how the lower back muscles and tendons are working. With the firm fixation in place, he describes the base of my spine as something like a "steel fortress" which is nice to think, though it seems to miss the point when it hurts anyway! Actually, I have some proof that the screws are well fixed given that two days before the X-ray, it was baking hot, and I managed to faint after getting out of bed - completely ga ga and hit the deck where I stood, on my right buttock. Everything did hurt considerably more that day and the next but by day 4 I was back to where I was before. The surgeon said I had just irritated all the tissue in the bone where the screws are fixed and that causes radiating pain, what he refers to as pseudo radicalar pain - it feels like it's coming from the nerve root, but in fact it isn't.
Which leads me to some other advice he gave me - in fact is was on the fact sheet I was given about recovery. It is very common to experience this pseudo radicular pain due to disfunction in the SI joint, the joint between the sacrum and the pelvis. There is a video on this on the spine health site and its common after fusion as well. As the lower lumbar joints are stiffened or fixed, more load is transferred into the joints below as well as the vertebral joints above. He described the SI joint as the "L6" to illustrate this. He says that this can be resolved with time, physio and, if necessary, steroid injections. When he saw me last week, he said we are just at stage 2. I started physio last week.
My first physio session was good and bad. The good news was a genuine surprise (I have got quite glass-half-empty through all this so stuff working comes as a genuine surprise these days). The physio did the usual leg extension as I lay on my back to see how tight my hamstring and nerve are, on the left side, which has been the problem throughout. The hamstring was tight as expected - I can get to about 45 degrees max, but, when asked to then also raise my head which pulls on the nerve, I felt no additional tension or pain, suggesting that the nerve, so far, is more free to move than before
The unfortunate thing was that the physio then decided to do some mild massage on my lower back for 15 mins. This was to loosen up the muscles, but it did be no favours at all! He was not hard, but I felt more bruised after it than loosened up.
Oh, which reminds me. The surgeon put me on 3 to 4.5mg of lexotanil / bromazepam daily. This is to relax the deep muscles that need to loosen up to allow my spine to relearn how to articulate properly. In the few days after I started taking them I did notice things getting better. Then the drowsiness kicked in. On 4.5mgs a day I really had to fight to stay awake in the middle of the day so on the surgeons advice I am back to 3mg.
As for activity, I am doing 3-4 18 min walks, about 2 hours sitting in 30 minute stints and 12 mins swimming (breast stroke only, head down and standing to breath to avoid felxion of the extension) with 25 mins driving here and back) daily. I also have about 2x20 mins of gentle exercises daily. This is tolerable for now. With the meds I am a bit knackered but who cares. I am conscious that this is much more than I could have taken on a few weeks ago, but I can't help continuing to notice the limitations and aches I still have. Still, I am more hopeful now than 4 weeks ago, so les just see how it goes. I had a total meltdown after my fainting episode so I am still feeling a bit on a knife edge mentally. I wish I could get back the unquestioning confidence of the few weeks after my first op but I guess I am older and wiser now and that does rob you of the youthful optimism I once had... God, I can go on can't I. Needs to be said though as the mental side of all this is a big part of the experience.
As for the future, the surgeon has advised to increase activity my about 10% every 5-7 days. My next consult with him is now September. He said that after another 4 weeks I can start very gently getting back to more sporty activity, but to go slow and take 3 months to get to full intensity. That the plan anyway.
So, I will post back in a few weeks, and many thanks to those wishing me well. Very kind of you and much appreciated. I hope all this is useful for someone.
Guest
Posted
So another development probably worth posting.
The SI joint pain has become a real problem now.
After 13 weeks I emailed the surgeon a series of questions and he cleared me to swim crawl (slowly) and ride my bike (gently) so I was looking forward to actually building up my activity meaningfully.
To date I had been doing a series of core physio exercises plus about 18 mins per day of spinning on a exercise bike at very slowly increasing intensity.
so the first week (13) I had a problem trying to get back to work to much. For a couple of days I tried a total of 3 hours sitting and 3 hours standing (broken into 30-40 minute chunks). At first it was ok, then late on the second day I realised that it was too much. I then got pain in my SI joint and burning in my buttock, back and side of leg and calf for a couple of days. I took a ton of ibuprofen and it calmed down. Bullet dodged although disappointing that I was not able to do the work.
So the next week, with the all clear to swim and cycle a bit it tried those. The first swim, I paced it wrong and ended up with ache in my back but that went away on its own so lesson learned, go slower. Which I did the next time and that was ok.
Then the next day I tried a 10 minute bike ride. This was a bit twingy, but nothing that stuck around to punish me. So I thought, ok, I can do that. So I did again the next day, with my wife which was fun as she has just bought a bike after thirty years of not riding while I am a very very keen cyclist. It was nice and felt, again, nothing too weird.
About an hour later I was scheduled to do my spinning, 12 mins, feeling pretty confident. It never usually caused any trouble. But today it did.
About 7 mins through it started to feel a bit uncomfortable but I have had that before so I pressed on. When I got off, it felt tired and achy but nothing too bad. As time went on though the scale of the problem became clear. Everything was on fire down my leg and most of my lower back was feeling really bad as well. I took ibuprofen and paracetamol in max quantities all evening. I considered some opiates left over from after hospital but managed to get to sleep without.
Since then, now a week ago, it has all been pretty ropey. I have not got anywhere near the pre spinning pain level. I am up to 2-5 pain most of the day. It's nearly all in my sacroiliac joint I think. It radiates a bit but all over the place so pretty sure it's not the S1 nerve specifically.
So given the surgeon expected me to be getting more active at this point and in fact, I am mostly in bed again, he has set me up with a steroid injection into my SI joint and MRI to confirm the problem. I got very lucky and this is scheduled for Wednesday in two days.
Its really frustrating as in other ways the op seems to have worked fine, but the SI joint pain, if that's what it is, has left me with more pain than before this op plus, walking and standing are really bad for it. I can walk maybe 10 mins before it starts telling me to stop at the moment. And as much as I like, respect and trust the surgeon, he did not warn about the danger of this pre-op, only afterwards where his fact sheet said that it is a common side effect... hmm.
Anyway, I will report back on the outcome of the procedures on Wednesday in due course.
Guest
Posted
I had my SI joint injection on Wednesday. In fact, I first had an MRI (no contrast), then I went down for what I thought was going to be one injection, but I got three! Both SI joints and an epidural one for the S1 nerve.
The good news from the MRI was that what is left of the L5/S1 disc (about 50% there) is stable and the S1 nerve does not look inflamed.
The SI injection on the right and the epidural were really nothing much. The one on the left (where the pain is) was quite something. After injecting the steroid it felt like someone had hit my left buttock with a sledgehammer! I was quite taken aback. It got better over about 10 minutes thank god. But I figure it make sense as if the joint was swollen then the space between the bones would be reduced. The injection probably forced open a gap between the bones hence a big reaction.
Anyway, as usual it was not much fun the rest of that day, especially having had 3 needles in me, but by the next day most of that immediate discomfort was gone.
Today (+2 days), the pain in my joint and leg are definitely better, maybe 50-70% so, but I can definitely feel that the joint is not happy still. I can feel pressure in the hip, my "sit bone", the joint itself and a bit of referred hot pain in the leg and buttock as before. But hey, it's nice to know that most of the residual problem I have now Is my SI joint not my spine itself (so far anyway).
The question in my mind is now what next? What can I do to settle the SI joint long term? What should I do now (while the steroids are still in there doing their thing) to rehabilitate the joint and get the whole system used to the new status quo with the screws and rods in there?
Just trading S1 nerve pain for SI joint pain is a bit of a crappy deal! I am hoping that it's more of a fixable problem without more surgery!
Any advice gratefully received
Guest
Posted
quick update. And it's not good.
I did some exercises for my hip abductors and adductors to try to support my SI joint last Sunday-Tuesday. Sunday and Monday I had no problem. Then on Tuesday morning, I came away uncomfortable. But over a few hours that grew into severe pain in my sacrum and leg. I am back on lots of painkillers and been in bed since. Every time I move around I get back and leg pain kicking in within a few minutes. I went to ER on Thursday in case I had fractured something or they could spot anything else. They did not spot anything but they could not explain the leg pain either. Looking at my X-ray, I have a dark area around the screw in my sacrum which was not there a few weeks ago so I have a very bad feeling that I have loosened the left screw in my sacrum. This was week 16 after surgery. I have an appointment with my surgeon tomorrow and will probably have a CT scan to confirm. If this is the case then I understand from a previous conversation with him that I will have to have fusion, although I don't know if that would be just one level (S1/L5) or whether they would have fuse l4/L5 as well as that is stabilised at the back as well. That would be a big shame as the l4/L5 disc looks good so far.
I am feeling pretty miserable about this again. Even if the fusion works it has lots of downsides, not least even more SI joint stress than I already have with a dynamic stabilisation system. Once even one segment is fused, that is bound to get worse... I am just so shocked that I have managed to break myself yet again. My surgeon said the risk of screw loosening really was past at 12 weeks, but apparently not.
Anyway I will have confirmation tomorrow and will report back.
jessica_78456 Guest
Posted
Guest jessica_78456
Posted
Hi Jessica
I have found that 3-4 months after my dynamic stabilisation op, my back itself did seem to settle down noticeably. I think with fusion it is normal to have to wait longer as the bone has to set etc. Which segment did you have fused? Do you think you are getting SI joint pain as well?
Plus I have found that I have lost a lot of core strength while I waited for my screws to settle down. So now I have to redo a ton of muscle training that I had done pre op. Looking online, there are some exercises that physios recommend to tackle SI joint inflammation long term so I am trying those...
Where is your pain coming from?
Have you had a scan after your op?
When is your next follow up appointment?
Good luck. Keep at it, and if you have a bad day or week, don't give up. I have in mind that my surgeon said that realistically these ops can take a year to get over fully so 3-4 months is still relatively early in the process. Although I do wish the trajectory towards being well was much faster...
jessica_78456 Guest
Posted
To be honest I don't think a bone graft was used I've definitely now got rods and screw l4/l5 but not sure on bone graft as bone was not taking from any where else. Unless some artificial stuff was used . Back pain in lower back round area sciatica back down my leg pain in my ankle. A heavy feeling in my back as though am carrying heavy weight but iam not ? Think the fact I have fibromyalgia didn't help and arthritis in my facet joints . Hey ho life goes on .
Guest jessica_78456
Posted
how are you getting on? It looks like I will be joining you and am having fusion at L5S1, plus my surgeon says my lumbar facet joints are very arthritic as well - the lower down the worse they are.
How are you back and nerve pain after the fusion? Any better than before? How are things like sitting and standing for you now?
I do hope you are better. I could do with some examples of surgery that worked as both of mine have failed...
thanks
Michael
Mariav Guest
Posted
I had microdistectomy/lam 1/2015. I felt great most of the time except for pain one side going down leg once in a while. Had 6 months of therapy which ran out and had to do at home. Realized that after that type of surgery, your spine feels so thight. What I was getting were muscle spasms which was diagnosed by my therapist. 2nd MRI didn't show anything but pain continued. Now I am 99% paim free. I stretch my back at leat 3 times a week. That's helped a ton... I wish that I could send you my routine to help you... It does get better.
Guest
Posted
hi again. So first of two posts here...
I saw the surgeon last Tuesday. Looking at the X-rays he did not see obvious signs of the screw coming loose after all. What I saw is not consistent with loosening. He does not rule it out completely but if the screw is loose then it could only very slightly loose (I.e. The only reason to think it might be loose is the pain, not the X-ray). Maybe a CT scan could show it but even then maybe not.
He thinks a more likely cause of my symptoms is more severe dysfunction of the SI joint. He thinks the symptoms have changed as I had the steroid injection the week before and so the pathology has changed slightly, and then combined with the exercises I was doing, this has left the SI joint worse than before, and the symptoms slightly different. So much for trying to fix the SI joint with exercises.
So he is urgently sending me in for another steroid injection into the SI joint plus a radio frequency ablation of the nerves in the joint as well. He told me to expect the latter to hurt a lot on the day but the effect is to dull the nerve endings and reduce the pain. I read up on it. It looks like a bundle of fun. Not. Anyway, tally ho I guess. This was booked for this Friday. I think my town is like some regional centre for radiology. I am amazed at how quick they booked me in.
So while I still have a problem, and it still hurts plenty, it's not as bad as the one I thought I had. I know SI joint dysfunction is still a pretty big deal in itself but it beats having a screw rattling around in my spine.
Interestingly he said that even if the screw was loose, it could potentially be replaced with a bigger one as a first step before anything more invasive. He did that very op the day before it turns out.
So overall a "good" result and a relief. It's not impossible that the screw is loose but it's less likely than the alternative diagnosis, and that should be relatively straightforward to verify with my next treatments.
I have to do pretty much no exercises for the next month but I am starting osteopathy next week. The surgeon says he has seen good osteopaths fix lots of patients with SI joint dysfunction, so fingers crossed I guess. He freely admitted that, as a doctor, and surgeon, it was something of a blind spot for the profession. They can spot it but they aren't good at correcting it. He has tons of experience with patients suffering from it after surgery and said, ruefully, that it gets in the way of the recovery of lots of patients when the dynamic stabilisation surgery was itself successful. He says the SI joint can be thought of as a sixth lumbar disc in the way it acts, but with completely different anatomy of course. Anyway, he thinks the RFA and steroids will manage the pain short term then a good osteopath and PT will restore the joint to proper function long term. So that is the plan now.