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Hey All:

Finally got a copy of my CT results but haven't talked to my doc about it yet. I've been trying to figure out why I have so much tushie/hip/leg pain post an L5-S1 fusion, which I had considered mostly successful the first year after it. My back is fine, just stiff and a little achey, which I can totally deal with. It's the legs I feel like sawing off!

Anybody have this problem post-fusion? I won't bore you with typing the report here, but it says that I have four levels of mild disc bulges (not a big deal, right?), including a disc bulge at L5-S1 where I had a discectomy and fusion (um...how can I have a bulge of a disc that's not there?!)

What concerns me about the report is that it says I have moderate bilateral facet osteoarthritis it at 2 levels (L4-S1) with spondylotic bony ridging and mild stenosis at those levels. It says my neural formamen are patent, which I think means no nerve impingement. Then why do my legs hurt so badly?

I guess the really good news I can take out of this is that it says it sees evidence of fusion and the equipment is all in tact, so I won't have to go under the knife again, thank heavens.

I read up on facet joint problems and health sites recommend injections. God help the next doc who wants to inject something in my back. I have done way too many ESI injections over the years with no success so it seems a waste of time and money to bother with any more. I've never had a facet joint one though.

Anyone have this problem? What symptoms do you have? I didn't have this before my fusion -- is it one of those problems you get after a fusion? Has anyone had successful treatment?

I wish I could buy a package of new facet joints at Home Depot (((sigh))).

Schragie-girl
Hi! I have facet joint degeneration due to arthritis. I had an injection into the facet joint and developed increased pain that did not go away. It was awful!

The pain you are having could be nerve pain. You should try icing your back as any inflammation in your lower back can cause the sciatic nerve pain.

Also, go back to doing your stretches and if it continues, ask your doc if it could be nerve pain , if it is you can try lyrica, a med used for nerve pain and it works pretty good for my sciatic pain.

Good Luck! Hope you are feeling better soon.
Jen
Schraige - stand up, face forward, put your feet together, hands at your side, lean back - What happens?

If you truly have arthritis of the facet joints, it makes sense that you have pain that increases as you move around during the day. You have a mechanical problem - the movement of the facet joint - increases your pain. It is very possible that your facet joint is somehow rocking on the nerve when you move - it is being crunched. This is what was happening to me and one of the reasons I had my fusion in Feb of last year.

I had my fusion also due to stenosis. With this, it is common to have horrible cramping in your legs. You might want to do an advanced search on my user id....there is a thread entitled [B]Baybreeze....Neurogenic Claudiication Anyone?[/B] The thread is dated 01-20-2007, 07:59 AM

Baybreeze and I discussed this stenosis in great detail. Hope it helps you some.
Hi, it's Baybreeze chiming in LOL. Pep, thanks for directing Shragie to my thread about stenosis/claudication, of course I thought of that too when I read the first post here. Schragie, I'm glad that you are able to stretch and not having pain bending backwards or forwards. However, keep an eye on that over time, as I did not have those pains at first either. From the start of my lower back pains, it took maybe 2 yrs or so until I started having bad problems bending and walking. At first my pains were intermittent & I wasted alot of money buying things thinking it was due to a bad mattress or drafts or muscle strains.

I also have facet arthritis in L2 through S1, plus I keep getting herniations & bulges & problems with scar tissue. My last 3 episodes I had all the nerve pain radiating into both my outer hip areas. ON Thanksgiving night it was horrid, somethign happened & i could not even put weight on my left leg, felt like I was being electrocuted. Everytime this happens, I also get bad spasms across my back PLUS the last time I got them in my legs. So whatever your pain is might be nerve pain or maybe spasms, i dont know. Either way I do know how painful & frustrating it is!

Right now i'm having deep achiness in my entire lumbar spine area (& some other parts), my rear end right where the back ends, going across both sides kind of along the bone area. And I have this outer hip pain all the time (though it has lessened since Thanksgiving). It's the worst when I stand or try to walk around for too long. It feels as if someone put a heavy weight or cement block in there and it's pressing down on everything. However, I am having problems bending backwards, forwards, and sideways. I do have more narrowing and hypertrophy in my facets & lateral recesses since my surgery....though I am no longer having that claudication pain I had before surgery. And one doesnt necessarily get claudication right away, sometimes it can take years to develop. If you already have some stenosis from bony overgrowth, I hate to say this, but it might get worse over time. And standing makes things worse b/c it puts more pressure on your entire spine...when you have MRIS or CTs, your'e not standing up, your laying down which relieves some spinal pressure. So its also possible the imaging doesnt show the whole picture.

LOL ...im in line right behind you at the hardware store!
Shragie,
we all after age 25 start to get problems like DDD, osteo, stenosis, etc.
I had my surgery a year ago and 10 month later when i had my first MRI after all my surgical area and higher was re-herniated again, plus "same old" arthrities, stenosis... did not have to wait a long time for it to come back.

Arthrities means inflammation. Inflammation can cause on a near by nerves and that is why you get your legs pain. I have mine severe but my problem is on a top of all the above is nerve damage during surgery.
Ice, some stretches, yoga, meditation, hot tob - this all may help you to coope with your pain.
Best of luck to you.:angel:
Thank you Ladies!

I read through your claudication post Bay/Pep and it was helpful. I still haven't talked to my surgeon about my CT results because he hasn't returned my call yet. Weirdly he did not want to schedule another appt with me and instead said we should talk on the phone. My pain doc said I should see someone else for meds if I want opiates because he doesn't like to prescribe them and basically told me to go back to the surgeon and think about getting a spinal cord stimulator, which I am not prepared to do after reading about it. So I feel doctor-less right now and will ask the surgeon for a recommendation of who to see next -- a different pain doc, an orthopedist, a rheumatologist -- who knows?

I must say I am very frustrated but since my insurance is changing in January it's an opportunity to find some new docs. After I speak to my surgeon I will probably call Moldova's pain guy at HSS fin Manhattan for a consult (thanks, Moldova!) It's worth the $ just to have a doc listen to me for a change.

In the meantime, I'm just trying my best to cope. I took two Vicoden 7.5s tonight, because the first didn't help, but neither did the second. The pain is sciatic down both legs, in the outer hips, both fronts of my thighs and tonight it's in one of my feet too. Nothing is really helping me these days, but I may switch to warm heat (from my old standby, ice) and see if that makes a difference. I took a really long hot shower after work, but no help. I do have spasms in one leg, but they're not too bad so I didn't think it warranted taking an anti-spasmodic. I get feelings of warm water running through my legs sometimes (like when you get an epidural) but it doesn't hurt, just feels funny. All I know for sure is that something is definitely WRONG!

I've gone from docs telling me it's nerve pain (I had an enlarged S1 nerve on my last MRI) to now having a CT tell me I have other problems. I saw one bulging disc on my MRI in March when I looked at the film myself, but the report didn't note them and both my surgeon and pain doc didn't think it was a big deal when I pointed it out to them. Now the CT 9 months later says there are four, albeit mild. I wish science were a more exact science!
I don't know what to believe anymore. Surgeon says he saw facet problem on my X-ray and now CT appears to confirm it.

I'm willing to try just about anything to feel better and if another course of PT will help I will go (I had 6 months of it already this year!) In the past I have been on NSAIDS but saw no difference in my pain level and stopped after about 4-5 months on them. I am about 30-40lbs overweight, and am losing weight, but even at my thinnest the pain doesn't disappear. I also do tons of walking, which helps with the weight loss, but not so much with the pain.

I think I am venting right now (thanks for reading, but feel free to skip!), but I am tired of feeling like this. Before I had my fusion, it was very clear where the pain came from (bad disc) and even then I had a hard time getting good pain management. In fact, once I told my jerky pain doc I was having the fusion, he changed his tune and gave me enough meds to sedate an elephant for the two weeks before the surgery so I wouldn't have to suffer. I've only seen him twice since the surgery, but both times I had to argue with him to get Vicoden. The crazy thing is I haven't missed a day of work with all this pain but sometimes I feel like murdering my coworkers because I am irritable and get impatient with them.

I guess it doesn't matter if I get Vicoden anymore because it doesn't help anyway. I might as well bite on a bullet or something! Maybe there's an arthritis medicine that would help me. Or maybe something long-acting that will help manage my pain while I'm working without making me feel groggy.

But enough about me. Thank you all so much for listening and being so supportive. With the exception of my husband who is amazing, my friends and family don't really want to hear or can't understand what I'm going through. Moldova, I'm counting down till your surgery....and Pepper, I hope each day brings you closer to a successful outcome from yours. Bay, thanks for chiming in with your experience and I hope XMAS is a MUCH better holiday than Thanksgiving was for you.

Schragie-girl
Schragie - I've been reading some of your posts. So sorry you're having such a rough go. That's about all I can say about that. :(

I'm a thoracic person - so take what I say after this for what it's worth - I had a facet injection this summer and it did bring relief for about 2-3 days and then it wore right off. My PM and NS believed it was diagnostically relevant at least. It indicated that it was indeed the right nerve that was grumpy. It is very difficult to contain the cortisone in that area because it is not a closed space like a disc is. I opted not to have another (and another!) injection because I, too, am fed up with the cost, pain, and all too short relief they bring. The long term impact of cortisone creeps me out a little bit, too.

On your doctor search, Moldova's group sure sounds enviable! I'd take Diet's parents and Moldova's medical team, ok? Back to reality now, have you looked to see if there is a "Spine Center" anywhere near you? They're becoming more popular. I'm now in San Francisco and I've been going to one as part of my care (still getting 2nd and 3rd opinions other places and went with the 3rd opinion for my upcoming surgery - that's another story). But the Spine Centers are nice because they have doctors and testing resources all in one. Just a thought.

I know it's so hard to advocate for yourself and look ahead when you're feeling crummy. Do your best to be kind to yourself.

My best to you,
Margaret
Hey Spine Sisters!

Thanks for your support and sharing your stories. Although my surgeon didn't want me to come in for an appt (weird!) he did answer my email.

He wants me to get a facet joint injection (surprise surprise) and also possibly a selective nerve root block because the stenosis could be causing leg pain. As for other treatments, he said there is experimental facet replacement only in europe (my wish to buy a package of facet joints at the hardware store was more like a premonition!) and that spondyltic bony ridging means I have bone spurs from degeneration.

He wants me to get a sport model corset from a durable surgical supply store
and is sending me to a pain management guy who is on my new health plan and conveniently located to my office. Not too shabby, eh?

I'm trying to keep a good attitude these past few days and try not to focus on the pain While I certainly can't ignore it, I had a much better day today pain-wise.

Bay, it's so nice that your boss is so supportive. I just got a new boss at work and the company I work for is going through a merger so I'm working like a dog to prove myself to new management. My new boss knows I have a back problem and need to take time for doc appts, but I work a million hours anyway so she doesn't mind. My work suffered for a few weeks while I was trying out dopey pills (Lyrica) but I must be an excellent faker because no one seemed to notice but me. I really push myself at work but I am also supporting my husband and me and I think I have real issues about being perceived as disabled in any way. Pre-surgery I had to use a cane and needed help getting out of chairs at work and I was mortified. Now I am outwardly fine, slight limp on bad days when I have shooting pain, but no one knows what I'm going through and I don't want them to.

My coworkers and friends are supportive so I think my issues are mine and not theirs. The truth is people ask me how I feel all the time and I just say that I'm coping or "hanging in there". I do get angry though when people ask me if I've tried herbal remedies or have been to a chiro or acupuncturist. I've done all those things and I wouldn't let a chiro near me now with a ten foot pole.

Chatter -- baked alaskan pain management didn't work for me, but ice does so I'm staying chilly these days!

Carol -- everyone's different with pain and I suspect that many on this board are in far more pain than I am. I have taken a couple of leaves from work -- one doc had me on bed rest for a month and I worked from home lying down, which was no picnic. If I asked for it, I could probably get permission to work from home one or two days a week but I get really sad not being a part of the world. Some weekends I barely leave the house because I feel like i have to recover from the workweek, but hey, I need to put food on the table and kibble in the dog and cat dishes. I have 3 dogs, 2 cats and a parrot and they keep me in good spirits just watching them when I don't feel well. Plus my puppy is always trying to lick my ice pack.

I hope everyone has a good day tomorrow and thanks again for cheering me up!

Schragie-girl
Schragie - Sounds like you're at least moving forward with getting some help on the medical front and it sounds like you're a champ in your home/professional life! Wow! I hope this PM is a winner. The injections can make a real difference, so hopefully they'll do the trick for you. I've tried to take each suggestion and recommendation with a fresh perspective. So, injections didn't help before surgery, but maybe they would for nerve pain afterwards.

I totally hear you on the "helpful" suggestions from folks not in the know. I think my favorites are stretching and massage. Um... yeah. I've learned to appreciate their intent. ;)

OK - cookies to bake and decorate. Back is screaming but I don't care. I love it too much! I have surgery on Jan 11 and I'm partying it up. I figure I'll have plenty of time to rest. (hear my inner adolescent coming out? It drives my DH *nuts!*)





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