Groin Pain after L4/L5 Fusion

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csalmon731

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I would like to say something on my behalf. In my last post when I listed the two links, I honestly was just trying to explain examples of what I think is wrong with my leg. I did not intentionally put those there to "advertise" or anything else. I was hoping someone would see what I was talking about and offer some input.
Thank you.
 
I had fusion l-4-5 pedicle screws bone graft in 1995 when i woke up terrible groin pain ls left leg could not straighten, what happened was i have nerve damage from pedicle screws when they removed screws fusion crurabled been in pain since take percocet 3 a day,flexeril 2 at night,
you should walk as much as you can also let the dr know there is something wrong,i would call him every day if you have to. Rick in pa
 
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Hi, I'm new here. Short description of history, then my question. ;) I had XLIF procedure done with fusion of L4/L5 on Deceraber 22, 2010. I did not have a bone graft, dr. used synthetic bone. He went in through my right side. About a week or two after surgery I started having a lot of pain in my right groin area, along with hip pain. I can't even stand up straight or walk without being on my toes. My right leg won't straighten out. I had my post op visit yesterday and he said everything looks normal for 4 weeks out. He told me to rest and not to be up walking, other than household chores, which I can't even do. From what I have researched, it sounRAB like the PSOAS muscle. Does this EVER heal? Even after time, I just want to know if I have something to look forward to.


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My question is, should I rest it or try to walk as much as I can? If it is a contracted PSOAS, shouldn't I stretch it out? If so, why would he tell me to rest it? Today has been bad, but yesterday and the day before it hasn't been as bad. I went to the store two days ago to try to walk around and it seemed to help a little, but today it's just bad. Sitting down doesn't bother me at all, only walking and trying to spread my right let out. It also hurts some on the left, but nothing like the right muscle.

Also, I was on Hydrocodone 10 and Soma, but he said I don't have to take the Soma anymore and lowered the Hydrocodone to 5mg, which I have only taken one of today. I've just been aying around and sitting up.

Any advice is greatly appreciated.
 
Thanks for your reply. My dr. used the Aspen clamp thing in my back so I didn't have any screws or roRAB, but I never thought about that being the reason. I am just so confused. Sometimes it hurts but is pretty manageable, other times like in the morning, I can't even walk at all without a lot of pain. I am taking only 1-2 hyrocodone a day and 1 Soma. I guess because I am laying around a lot. I do get out and try to walk some, I sure hope it helps. I still am having a lot of pain at night. I toss and turn constantly. Does nerve pain cause this kind of pain, like a strained muscle achey feeling?
 
Welcome to the board. I'm sorry to hear that you are experiencing one of the main problems with the XLIF procedure. Damage to the psoas muscle seems to be more common than doctors or Nuvasive like to acknowledge. As I understand it, the probe has to be threaded through the psoas, which can end up temporarily splitting the muscle. This can cause the muscle to hurt after surgery, but it can also cause lateral femoral neuropathy or genito-femeral neuropathy.

This is a temporary situation, in most cases, and is often treated with one of the "nerve" drugs like neurontin or Lyrica. Sometimes surgeons prescribe a round of prednisone in an attempt to get any inflammation to go down. If that provides little relief, there are injections that can be tried.

I know of several people that had this sort of pain immediately after their XLIF, but none of them were told to discontinue their walking. That would make me a little nervous, and I think I would ask the surgeon about it again. I can't imagine he wants you lying around 24/7. You should follow your surgeon's instructions....but if I were you I would do a little walking several times per day just to keep the spinal muscles stretched out, and the blood circulating.

I can relate to what you are going through. My femoral nerve was damaged in my PLIF I had in 2008, and it took a long time to recover. Mine was damaged simply by the way I was positioned on the operating table...or so they say! Who really knows what goes on while we're sleeping?m I found that icing the area was more successful than any medication in helping with the pain. Also, try wearing baggy clothes. You'll be more comfortable if you don't have something tight pressing on the skin.

I would suggest you keep calling your surgeon so he is aware of the amount of pain you are in, and can hopefully keep trying to find something that will help to control the pain. If he will not or cannot, consider switching to an interventional pain management doctor.

I wish you luck and hope you can get this under control soon. Please let us know how you are doing and feel free to post with all your questions and comments.
 
Thank you for your reply. It really worries me because I walk around my house some, but it hurts really bad. I can't straighten my leg out at all, even when I lay down. I'm scared that if it stays contracted (if that's what it is) that my pelvis or back will heal crooked. Do I just keep forcing it to straighten out, walking on it even though it hurts really bad? Or is this doing more damage than good? My back doesn't hurt as bad as my leg, though it does tighten up when I'm up too long.

By the way I did the steroid pack, but it did not help. Does anyone know if it will work itself out over time? I am so sick of it hurting even though it's only been 4 weeks. :(
 
I don't really have anything further to add...but I wanted to mention that different "branRAB" of muscle relaxers work better on some patients than on others. I really think you need to call your surgeon back and tell him you are not getting any relief from your medications. Perhaps he could try you on something other than soma. Also, sometimes surgeons give a second round of prednisone if the first round doesn't do the trick. You could inquire about that possibility, or even getting a steroid injection into that area....You're almost six weeks post-surgery, right? Surgeons sometimes order them at this point if they suspect there is inflammation that is just not clearing up.

Are you feeling any changes in the psoas muscle or is it as bad as ever?

So, there's the possibility of a different muscle relaxer, more steroiRAB, either injected or oral, and, finally, patients are often given a "nerve medication" like neurontin, or Lyrica, or Cyrabalta....so maybe you could ask the surgeon if one of those might help you.

I hope you're getting sufficient rest, even though I understand you are very uncomfortable. Have you tried icing the area? Or alternating ice with heat?? I'm just trying to think of some things for you to try. Maybe it's just a matter of needing time to heal...hopefully that will come soon.

Oh, forgot to try to answer your question about nerve pain...it can be of just about any quality -- it can feel like an electrical current, a buzzing, sharp, stabbing, dull, achy, change in temperature, sometimes burning hot, other times cold and dead feeling....it can feel several ways at one time, or change quickly, or you might just have one particular feeling that seems to last forever. I'm sure I have forgotten some adjectives that are commonly used to describe the pain, but you get the general idea.
 
I understand why you are concerned, and wish that I had some suggestions to offer you. I am not clear what you mean when you say you cannot straighten your leg out...could you elaborate?

It would concern me to be told to not walk....that is just so counter-intuitive to what we are told today regarding any lurabar injury. At most rest is recommended for a day or two, but now they say it is better to be active.

Has your surgeon indicated if you will have physical therapy or do you have a PT you've worked with previously? If so, I would call and describe your problem to the PT to see if they have any ideas. I think I would also call the doctor back, ask to speak with the nurse and describe your pain in detail. I wouldn't think that a month later you would still be having this pain...and I think your surgeon neeRAB to try to explain to you what is going on.
 
Thanks for all of your help and advice. Yeah I have been using ice some and some heat, but not that often. Last year when I had the two Discectomy/Laminectomies, he put me on Flexaril. It seemed to help then, but I didn't have this leg pain then. I am 4 1/2 weeks post-op now and it feels better sometimes than others. In the morning it seems worse. I don't know if it's the walking making it better, or just maybe, hopefully, it is just getting better on its own. I will watch and see how it feels over the next week or so, if I don't see a bigger differance, I will contact my dr. again. Thanks again for your help.

Some information I didn't provide in the beginning:

I am 32
1997--L4/L5 Disc ruptured (age 19) causing siatica down left leg
1998--Set of 3 nerve blocks (worked well until 2009)
1/2009--Diagnosed with DDD and mild scoliosis
1/2009--Set of 3 nerve blocks (did not work)
2009--PT (did not help)
7/3/2009--Discectomy/Laminectomy
7/16/2009--2nd Discectomy (to remove more disc that had moved out)
12/22/10--L4/L5 fusion--XLIF with Aspen spinous process fixaction system
 
Hi. Yes, when I say that I cannot straighten my leg out, I really can't without a LOT of pain. It's like my muscle is contracted, the right leg is shorter than the other right now. I have to limp on my toes. It feels like a tear in my groin muscle and around my right hip.

I never had this problem before surgery.
If this is what it is, it recommenRAB 2-3 weeks of rest.

My neurologist said he would set me up for PT after I go back in Feb, but I don't have insurance now so I'm not sure what I'm going to do about that.
 
yes i take 2 flexeril 1 hr before bed to keep from tossing and turning,my legs get so weak when trying to walk during the day its terrible i always have to sit,you call dr let him know, Rick in pa
 
Thanks for the advice. Believe it or not, my leg is feeling better today, about 80% better. I'm just scared that I am getting my hopes up and it's going to get bad again. If I keep having pain, I may ask him for Flexaril. I wish the best for you too. : )
 
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