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.
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Posted
And part 2
So I have seen the osteopath twice this week. Monday and Tuesday.
Monday, I saw him at 9 in the morning. Nothing very exiting. Just a chat and some gentle manipulation. Was feeling ok, not great after. No worse anyway. I went for my daily swim at 2pm. Something happened in my joint as I was swimming. I felt it do something unusual. A quick bloom of pain. It subsided so I kept swimming, I went home and things got bad for the rest of the day. I had to stay in bed motionless on my side for the pain to abate. It did after about 5 hours. I went for a 5 minute walk and it came back again so the rest of the day I was In bed.
Tuesday, I woke up feeling not great but went to the osteopath again. This time he released my neck and my mid back with a flourish as they like to. This made it no worse. At the end I was feeling ok, but I had been lying down for most of the hour so hard to know if anything was working. As it was I tried a few short walks in the day and they did not go well so again, most of the day was in bed.
This morning I re read my whole thread and some of my pain dairy notes from the last year on a hunch. I realised that it's probable that I have had SI joint pain for ages, not just since this last op.
All my problems started when I fell of my bike in May last year. I fell heavily onto my left hip. That ruptured the disc, but the immediate pain was actually in my groin. In fact I went to hospital the next day and the X-rayed my hip as the pain felt like it was in my lower pelvis. Guess what? Groin pain is a symptom of SI joint dysfunction or injury. That pain mostly went away, but I think I had damaged my left SI joint. Following this though, I lost strength in my left leg due to the disc rupture so everything else was forgotten about and I had the microdiscectomy. Then that all went wrong when I did some cycling and hiking, these were probably no good for my recovering back but they probably also inflamed my SI joint. Then I went to see a supposed pain specialist and he put the pain at the top of my SI joint down to nerve pain, which I went on believing. I'm pretty certain he was wrong. I found a section in this thread where in March I described one of the sources of pain I had then, and it matches the SI joint pain I have now, only it wasn't so bad back then. At the time I put it down to the nerve as I had been told...
My second surgeon prescribed me a diagnostic SI joint steroid injection in December which I noted had worked but not for long. Guess what? That is exactly the same as the injections I have had recently. At the time, a radiologist said he did not see inflammation on the SI joint in an MRI so I dismissed it as a possible source of the pain, and I guess so did the surgeon. I think that is where we went wrong.
Months later, getting no better, I had this second op to stabilise the lumbosacral joint, but that had the side effect of putting even more load on my already weak left SI joint. And so as I recovered from the op and tried to get more active, I got the SI joint pain back, but even worse than before.
So the second op did more or less fix the axial pain in my back, and I don't have some of the other nerve symptoms I had before like back pain when the S1 nerve was moved (by stretching my leg say), but it did make the SI joint pain much worse by stiffening my lower spine and so pushing more load onto the already weak SI joint which is now much worse than before...
I have read quite a few threads where people describe their SI joint pain and it seems many never fix it. I really I hope I can fix mine somehow! My quality of life right now is worse than before the second op. I get pain nearly any time I walk at the moment. Worse than a couple of months ago. Before the second op, I could walk up to 45 mins, it wasn't pain free but it was nothing like this... I guess I need to give it some time to calm down, probably a month or two at least. Maybe the osteopath can help deal with it, but it's a depressing to realise that the second op was maybe a mistake. I will never know for sure, but if I am right, then seeing an osteopath 9 months ago might have been the better course of action. 20/20 hindsight as usual...
Guest
Posted
I saw my surgeon yesterday. My new X-rays were really good with the screws well placed and well integrated, but the surgeon was concerned about the ongoing SI joint issues. He did some examination of me and the usual tests reconfirmed the SI joint as the problem very clearly.
We agreed that I should stop doing any activity that loads on the joint, which is pretty much everything. As the inflammation is so long standing (about 3 months before it started to overtake my post op pain, and 2 months when it has been really debilitating) it has likely spread to all the surrounding muscles, ligaments, tendon and even maybe parts of the hip joint. So now the schedule is bed rest for 6 weeks. The logic is that the inflammation is in a cycle. The joint is so sore that even the slightest load or motion just adds to the inflammation over and over. So the first job is to stop adding inflammation and let my body do what it needs to do to calm the joint down to the point that it can be used a tiny bit without provoking inflammation. Only then can I get back to any activity or physio.
I will have one or two more steroid injections to help things along. I have also stopped bothering with the osteopath as that was not helping. Aside from the injections I am taking as much ibuprofen as I can take without my guts rebelling. That is currently 2.4g per day (4x600mg). I am also on Lexotanil as a muscle relaxant.
One concerning thing that the surgeon said was that maybe the remnants of the L5 S1 disc were still a problem and that I might still need fusion if I still have problems in 6-8 months. We had a difference of opinion on this. As far as I can work it out, the stiffening of the lower spine segments is what triggered the SI joint to deteriorate. He agreed with me that fusion causes SI joint problems, so I could not understand why he was trying to convince me that in my case, having a fusion would FIX an SI joint issue! He said that the root cause of the SI problems could be the neighboring disc... but my disc shows no signs of inflammation so we could not see eye to eye. He suggested it was just something to keep in the back of my mind... I will take some convincing though if it comes to that.
As an aside, at the weekend I spoke to a long lost friend of my wife's. She had two surgeries. First a disc replacement at L5 S1, then 3 years later, an even bigger op on her hip which was damaged in a car accident. She recovered well from both though it took time. She says that after her hip op, her surgeon confined her to crutches for over 4 months. He said that any stress on the healing joint would cause inflammation that would take months to fix. Given what I have now is extensive inflammation in my SI joint and surrounding tissue, she recommended I do the same thing. Forget physio or building up muscles and just let the joint calm down and heal, then once it is ready, return to activity very slowly, starting with very gentle retraining of the core muscles that I will need to keep the joint in the right position and stop re injuring it. Anyway, funny how things work out. We had not heard from this friend in years, and really, we never knew any details of her ops as we live in different countries, but it was nice to talk to someone who had had major surgery of both the back and hip and came away from it pretty much fully fit. She was a grave woman to have a disc replacement in 2006, but she says she had pretty much the best surgeon in the country (UK), very pioneering and used to fixing up soldiers after battlefield injuries and getting them back to, literally, fighting fitness!
Anyway, I have tried everything except doing nothing and treating with anti-inflammatory meds, So that's now my current plan.
Guest
Posted
So I tried doing (pretty much) nothing. That was utterly miserable and did no good. I just ended up even more feeble and muscles wasted away alarmingly. My surgeon then changed tack after a month and told me to take stronger painkillers (Oxycodone) and get back to activity. So I tried this for a while and restarted physio (which mainly consisted of stretches of the muscles around my SI joint and a bit of gentle massage and trigger point therapy on the muscles above by pelvis on my side) . This was just about OK but I was still spending most of the time in bed. I was walking with sticks and gradually building up the length of the walk I would do each couple of hours. I got up to about 18 minutes, then out of no where got a massive reaction in my SI joint area and leg and felt generally miserable, again.
So then I saw the surgeon again on 28/11/17. I was booked for an X-ray first but when I got to the clinic I was told I was having an X-ray and MRI. So I had those and took the CD to the surgeon.
He looked at the pictures and then poked and prodded me a bit and said that although the L5S1 disc was better hydrated and better contained after the dynamic stabilisation, it had lost a bit more height and was evidently not working. So he said it was time for a fusion at L5S1. I asked how that would be done given I have screws in L4 L5 and S1 and semi flexible rods connecting them already. He said he would leave them as they are as the stabilisation at L4L5 would protect that disc in future and that that disc was actually also looking better since the stabilisation. He said he would take out my disc, put in a tantalum cage, some of my bone, some donor bone and the bone growth hormone, clean up the S1 nerve a bit and then close me up. I asked the prognosis. He said he should be able to reduce the pain by 2/3. Hmm.
So while not a big surprise this still came as a shock. I was very concerned that the fusion would exacerbate the SI joint pain. He said this was possible but hat it was also possible that the diseased disc was contributing to the SI joint pain, though he did not say how. So I signed the consent and was told to expect an appointment for surgery in January.
Once I got home I decided that I had nothing to lose and to see what I was capable of if I was prepared to get more active and push through a bit more pain. So the next day I put myself on a regime of a short walk (6 mins) then 15 mins sitting then bed for the rest of the hour, doing this from 8AM to 8PM. This was utterly exhausting at first but by doing very short walks I avoided the SI joint flaring up. I kept up the stretches from the physio as well. Over the next 2 weeks I went to 12 min “power walks” up and down the hill I live on and 20-25 mins of sitting. This created lots of muscle pain (which I was happy to completely ignore), some SI pain but not much and some pain in my central back, in the disc, but again this was tolerable and not persistent. So I was starting to feel a bit more human. The sitting was still pretty constrained and going over 25 mins was not good but I thought some perseverance might pay off given a while longer.
Then I tried swimming... that is where my optimism was shattered. For a bit of background, in January this year (before my second op) I managed to go from nothing to swimming 1500m every day over about 3-4 months. This was a huge achievement for me and I was really hoping I could replicate it. So I went back to the pool and tried swimming 10 mins crawl slowly. Now after 4 months in the spring I had developed a nice smooth crawl stroke but it did involve rotation in my torso which I had built up very slowly - I was swimming 500m in about 9 mins. Going back to swimming now, it was very hard to not swim my normal style so I swam with proper rotation. And BANG. I made it to the end of the swim but knew something was wrong. I got home and by back hurt more and more. When I woke up this morning my left calf felt like a lump of concrete and was aching hard.
Now this did actually remind me of starting swimming in January. That was also very hard at first. But it also made me realise that the exercise was pointless. I spent 4 months getting good at swimming but it did nothing to help me sit down or anything else that put stress on my disc. So I knew the game was truly up and that my L5S1 is beyond rescue. Cue very unsmiley face.
Meanwhile I have been trying to confirm the date for my operation. And to add insult to disappointment, the surgeon had not bothered to book my op as he was not prepared to do so while I was trying to fix myself. So when I called up yesterday asking again for this op date in January, the secretary said, “oh no, it won’t be January. It might be some time in February”!
Anyway, that’s about all I can report now.
I read recently that Tiger Woods made a good recovery from his L5S1 fusion and is back to competition. I am hoping with everything I have that I finally get lucky and I am in the percentage of patients for whom fusion works well. So far I have managed to be in the 10% for whom microdiscectomy fails and 15% for whom dynamic stabilisation fails....
I know I am asking in the wrong place but did anyone out there have a fusion that actually worked?