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Back Problems Message Board

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Hi All,
Looking for some advice and empathy! I am a 56 year old male. I have had trouble with my back ever since I was a young volunteer firefighter that was involved in a building collapse about 1975. Things got bad in 1997 with a disc herniation. I have had ups and downs and survived using meds and chiropractic care. Last October things went downhill bad. I managed to get out of it with a couple epidurals and did lots of core workouts. However, in April this year, I went downhill and the epidurals would help for a week or so and then I would get bad again. So my problem was bad stenosis at L4/L5. My luck had run out. I needed to get a handicap placard as I could hardly walk (tough for an extremely active person). So after much research I had a laminectomy 7/11 of this year. The Orthopedic Spine Surgeon said that once he got in there it was much worse then what the MRI showed. So both the left and right sides were cleaned out, I had a discectomy, the foramins were enlarged, and the facets were trimmed. Lots of work. All my leg symptoms have disappeared and I can walk upright. The problem appears to be the muscles (and maybe ligaments) in my back. They are still very unhappy. My surgeon says that with the 5 inch incision and the ligaments being lifted off the spine, it takes anywhere from 4 to 6 months to recover. He also said that since bone was removed from the spine, that the muscles and brain must relearn how to support the spine. He tells me that he does not believe he removed enough bone to cause instability.

So here I am, 2 months plus out of surgery. If it was not for the muscle pain, I would be a very happy camper. The pain can get intense, especially if I do something dumb like ride my lawn tractor! I can not handle nsaids so if tylonol does not work, I must use percocet to make things bearable. I do use a tens unit, which takes me from pain to nothing almost as soon as I put it on. I can feel the soreness in my muscles, so I believe it is muscle and not nerve. Must of the problem is lower back and into the butt. I have been doing physical therapy for about 6 weeks now and am getting frustrated.

So with the vast knowledge that exist here, am I in a somewhat normal path of recovery? It seems I am moving forward, but extremely slowly. What have others experience been? Is there anything else I can try to get the pain level down (my GP thinks I should try gabapentin)? My back can go from feeling pretty good to really painful quite easily. Of course that means I have been doing stuff. Also, sitting can still cause problems. Anyway, is there hope still with time? It seems to me that I still get some small spasms going on in the back muscles sometimes which then causes soreness and pain. I usually feel better after PT which would lead me to think muscular. Anyway, I have rambled enough. Comments and/or suggestions?
Your recovery sounds very normal to me. Recovery is always slower than patients feel it should be. And, you've already answered your own question. If you know something is going to increase your pain, and you go ahead and do it, you experience more pain. To keep this from happening, you have to avoid those activities until you are completely healed. If you are unable to restrain yourself from doing things that are ill-advised, you will increase your level of pain and you might just wreck what your surgeon has accomplished at the same time.

There is no such thing as a small spine procedure. As surgeries go, a laminectomy is not as invasive as other procedures, but it can still take months for the body to recover. But, you had a discectomy and foraminotomy in addition to the laminectomy. Depending on how badly the nerves were compressed, it can take even longer than six months to heal completely.

What you want to avoid are any activities that will cause a flare of the nerves and that may cause inflammation. It is very difficult to get inflammation under control once it gets going, and this can cause a surgery to be less than successful.

You don't mention that the disc was herniated, but indicate you had a discectomy. This leaves the remaining disc weak and more susceptible to injury until you are fully healed...which can be at least six months.

I would guess that the muscle that runs along the spine had to be bisected so the surgeon could get in to work on the facets, etc. That may be what you are having the most problem with at the moment. The muscles are just laid back into position, and they have to grow back together. Added to this is all the soft tissue, muscle and nerves that have been stretched and jostled, traumatized, really. So, it's no wonder we hurt after spine surgery.

Try to be patient and look at the big picture. You want to do what you can to make this surgery a success. You do not want to be sitting for an extended period of time. Sitting puts 30% more stress on the discs than either standing or lying down. So try to get up after a half hour and walk around a bit. Be sure you are walking and are careful to use good body mechanics, good posture and structural alignment. Avoid activities that involve repetitious bending or twisting at the waist.

Hopefully it will make you feel better knowing that we're all in the same boat...and cannot avoid the fact that it takes a long time to recovery from most spinal procedures. ;)
Thank you very much for the reply. You helped to lift my spirits. To be clear, I had my first herniation at L4/L5 that I know of in 1997. This progressed to DDD which had been confirmed by a discogram. After that point I had two additional herniations in that disc. Usually within 6 to 8 weeks the worse of the pain would go down after an "event". Epidurals were extremely effective then also since my muscles would completely lock up my back when an event would happen. The epidural would get me walking again. The epidurals became less effective as I had said above this past year. The MRIs always showed a herniation, but the doctors said it was not severe (including my spine surgeon back in the past - I have seen him for years). They were wise to keep me away from the knife for as long as was possible. However, once inside, the surgeon said that the herniation was pressing on the nerves pretty good and thus that is why he did a discectomy along with the other work. He actually said the nerves were very compressed and he was surprised it was not causing me more pain and symptoms. So yes, all the nerves at L4/L5 were disturbed during the surgery. The surgeon did say that he did not believe a fusion was called for and thus the laminectomy.

Besides PT I am biking and walking and yes have been taught proper form by the physical therapist. The biking is stationary of course. I loved using the elliptical machine for cardio work, but find it intensifies my pain if I use it right now. Again, the motion must overwork the muscles trying to stabilize my back. So I have laid off of that until I can tolerate it better. I try to stay away from activities that aggravate the back muscles, but sometimes just trying to keep up with the family does it.

I really appreciate your response as it does help my mental state. Too much thinking about whether you did the right thing or not can put you into the blues. Although I was not walking more then 100 feet before the surgery.

As for the pain, if it is muscular, any recommendations for someone whose intestinal tract does not tolerate NSAIDs? I suspect that the Gabapentin will help with any nerve pain I have which may be enough to make things more tolerable. Well it may or may not work, just need to see. Anything else that can help with the muscular issues? I do use heat and ice, but while they both work, the effect is short lived.

Again I really appreciate your response. And most importatntly it sounds like I am progressing as would be expected.
Wow thanks for the excellent reply tetonterri66!!

Yes the MRI is going to be interesting. I just plan to dump a bunch of narcotics into the system and hope I can make it! Yes I have discussed with my doc. I suspect the cervical issue is from laying down and trying to watch TV and the laptop. But it has gone on for about 3 months now and its time to be sure nothing bad is going on. Trigger point injections help for a week or two.

As for the back pain. I had a Laminectomy, Discectomy, Foraminotomy, and The Facets were cut. All at l4/l5. When walking I get pain in the upper buttocks. I could deal with that. When sitting the pain is originating right at the incision over L4/L5. It starts as a dull ache and will intensify to an unbearable ache. When the latter happens, if I touch the area over and around the l4/l5 area it is very sore. Rubbing it lightly will make the pain subside some as long as you rub it. Tens can bring the pain down to a tolerable level for a period of time sometimes.. I really suspect this is muscle spasms, but could be wrong. Vicodin is very effective in helping with the pain. But in order to bring the pain to a tolerable level, I have to go to La La land with it - that is take a lot. The pain doc wants me to try Nucynta? I have tried Flexeril and Skelaxed, but both were like elephant tranquilizers for me.

So the question really is, what is causing that area to be so sensitive to sitting. I can go from tolerable pain to all out I need to lay down for hours pain. I can lay on my side with very little pain (this it is my rescue position).


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