Spinal decompression L4/L5 UK?

Hi Paul,

Your situation mirrors mine almost exactly.  I had the same operation in May 2010.  Like you I was taking increasing amounts of opiates, and various epidural steroid injections only worked for very brief times.  While the regular pain was bad, I lived in fear of breakthrough events, which could leave me in agony for 2-3 days and take weeks to subside.  It was no way to live, as I'm sure you felt too.

Following the surgery I experienced what is often called the "Glory Week," which is the first week after surgery in which you feel like you've been cured completely.  Much of that is due to the leftover anesthetic and the newness of incisions and the fact that scarring and healing haven't begun.  After that first week I became concerned because the pains came back, although not quite as bad. Like you I was able to reduce my meds after the surgery but I remained concerned that there was still pain - I was frustrated by the fact that I thought going through surgery, with all the pain and inconvenience it leads to, would at least cure me.  And like you, at the five month point I was still in some pain and on meds.  And I would also add that by that point I had even started to develop anxieties about how even a slight onset of pain might be a signal of the onset of one those serious, unbearable breakthrough pain events. I never did, post-surgery, have another breakthrough pain event like the ones pre-surgery, but I had developed a full-on anxiety reaction to them, including panic attacks.  I spent several months in behavioral therapy to overcome that anxiety.

At the back surgeon's insistence I really devoted myself to going to physical therapy after surgery (when the time was right of course), and I made sure to choose a therapist that was experienced in dealing with post-lumbar surgery patients.  I worked hard at it for months.  And I can tell you that by about month 13 or 14 I realized I was completely off my meds on a regular basis.  I was able to go running and be active. There was almost no pain. All that remained was a numbness from about mid-calf out to my big toe - it wasn't pain it was just slightly numb, and as with you my doctor said that would be permanent.

Following that point I probably had 2 and half to three years where life was good, and I was off the meds completely. I even did some distance running like when I was much younger.  But then the pain came back.  When I went back to the surgeon to complain the surgery had failed, he said his surgery HAD cured the decompression and that it was still gone, but once your spine starts to weaken there is a "degenerative cascade" that starts to happen.  I had now developed a new and different condition, "facet arthritis," which is different from nerve compression and sadly has no surgical cure.

I don't say this to scare you but to motivate you to work hard at physical therapy because you WILL get off the meds, somewhere in the 9 to 16 month range.  After that you will hopefully have as long a period of relief as possible, just be aware that you basically have, and will always have, a "bad back," and other problems may occur down the road.  But for now do everything you can and enjoy the time you have in relief.

Hi Paul,

Glad to hear my comments were helpful.  If I could add one more thing - I don't know exactly what all pain meds you might be taking, but I would recommend you not vary them at this point on an "as needed" basis, simply because you have had a surgery.  Your pre-existing pain will go down slowly over time as a result of the surgery, and as such I would recommend that your pain medication regimen follow suit.  Stay on a regular amount of medication every day, and just reduce it down to a slightly smaller level after a while, stay at that level for another while, then make another small reduction, etc. 

Jumping around on medications - especially serious pain medications - is never a good idea, whether it be pre-surgery or post-surgery.  Just yesterday my doctor was advising me on how to reduce my pain medication (due to a procedure I had recently that should hopefully reduce my pain).  He advised me to stay on a regular amount, he advised me of the specific size of the initial drop to make, and he said "when you lower a regularly-taken pain med, your body will actually throw a little fit for a few days, perhaps a fit of pain, and you need to push through that."

I think that is good advice, and applies also to what can happen when you raise and lower your medications in response to pain levels.  You may actually be chasing not just your existing pain but also levels of pain your body is throwing off BECAUSE you are varying medications.  Better to just stay on them, even if some days you think you might not need them, and reduce the meds gradually, slowly over time.

Oh and also I STRONGLY recommend going to physical therapy, regularly - at least 2 to 3 times a week for the next 4 - 6 months.  It will help greatly.

I had the exact same thing about 5 years ago.  Mine involved a bone spur that was crushing the sciatic nerve.  The residual nerve inflammation was completely gone in about 10 days...like it never happened.  However...

I got this taken care of rather quickly so I did not suffer with it for years...and that could be the difference.  I had an LLIF (lateral) fusion of L2/L3 in March of '16 and then started to feel lower back pain in the Fall.  Neuro found that the bone growth was waaaay more than expected so I needed a laminectomy of L2 through L4 to fix that.  Got rid of most of the pain but some remained...uncomfortable.

So he now has me seeing a particularly skilled physical therapist who does "nerve flossing".  What?  Me too...never heard of it.  Seems that scar tissue can form around the nerves and cause the kind of pain I (and probably you) am experiencing.  After 4 sessions, the pain is 50-60% gone.  You might want to look into it.

The technique involves stretching out the right muscle group containing the nerves in question and then, while in that position, flexing the muscles and nerves simultaneously.  In my case, she puts my leg on her shoulder and stretches out the quads and hamstrings.  With this full extension, then I have to press my heel out 10 times.  HURTS LIKE HELL!!!  This is supposed to rid the nerves of any caked-on scar tissue.  I am progressing rapidly and the pain is significantly less than before.  You may want to check it out.