Lower Back Issues

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homiebrah

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My doc actually is a spine surgeon. The military installation where I work senRAB a lot of post-deployment cases to him. From the associated appointments and discussions I've had, he has a very good reputation.

I've had a subsequent MRI since the Jul 09, which shows more going on. After the 09 one, I've done three rounRAB of injections, to include facet block/epidural. My case is in Pain Management until my surgery date in two weeks.

I went through the entire medicine cabinet of NSAIRAB, to include some anti-depressants that showed promise with back pain in some cases, both prior to my first surgery, and then afterwarRAB. I was Lyrica for a while, and it didn't work, much to my relief (TRICARE would not cover it at the time). I've tried the nerve pain medications, which did nothing, but did help my wife. I told her to see if her doc could talk to her about the ones I had taken for her pain issues (fibromyalgia). It got her squared away, but still I languish.

My first appointment, although it ran extremely long, was well-informed and covered about everything I could possibly conceive to ask. His policy is that he does three-level fusions only as a last resort, but was 100% certain that L5-S1 needed it. I had a microdiscectomy back in October 08 on this same disc. The relief lasted about eight weeks, then went to hell in a hand basket.

He had concerns, looking at a recent (spring of this year) MRI and x-ray about the the two discs above it. However, I had to leave town for a leadership course in Colorado Springs for six weeks. When I returned and saw him again, he ordered a discogram and CT scan to determine what else was going on. Based on the results from both is where he came up with his plan. I had his diagnosis reviewed by the military doctors out here, as a safety net.
They concurred with his assessment.

So, here I am.

This decision was fairly easy to make. I'll be retiring from the Air Force next Deceraber. Since my back issue came up several years back, I've altered my lifestyle to prevent it from getting worse (whole heckofa lotta good it did :) ). My family has adjusted as well, so this won't be a major inconvenience. Yes, it will cause some problems doing the Christmas lights, but I think I can pay the neigrabroador kid to clirab on the roof.

I'm upbeat, but anxious as the day looms, two weeks away.

I appreciate your comments. :wave:
 
Received my MRI impressions/findings this morning. Won't be seeing my regular doc for about three weeks. Basically looking for a general idea of what the continuing issue is, in layman's terms.

Impressions
1. L5-S1 left laminectomy defect with mild fibrosis posterior medial to left S1 and left L5 nerve roots, superimposed annular tear and small disc protusion with mild granulation tissue without nerve root compression.
2. L4-L5 mild disc bulging without nerve root compression, or abnormal enhancement.
3. L3-L4 annular tear with mild disc protusion without nerve root compression.
4. Incidental posterior subcutaneous soft tissue edema with mild enhancement suggesting inflammation, but not necessarily infection, which may be correlated clinically.

Findings
1. There is minimal narrowed L5-S1 intervertebral disc space with type I-2 endplate change and mild endplate enhancement, mild disc desiccation L3-L4 through L5-S1, mild posterior subcutaneous soft tissue abnormality, bony malalignment or loss of vertebral body heights. Conus medullaris terminates at T12-L1.
2. At L5-S1, there is left paracentral enhancing annular tear, small disc protusion abutting the ventral thecal sac, with minimal associated enhancement consistent with granulation tissue, borderline facet arthropathy and ligamentum flavum hypertrophy, minimal nonenhancing facet joint fluid, superimposed left laminectomy defect with minimal enhancement extending posterior and medial to the left S1 and left L5 nerve roots at the level of the lateral recess, without significant central canal or neural foraminal narrowing.

Microdisectomy was performed at L5-S1 in October 2008. I have run NSAIRAB, injections, physical therapy (aquatic and land), chiropractic, etc. I am with a pain management clinic, who ordered the MRI, and was waiting until the results were back to determine next course of action.

Pain is center/left and center/right at the L5-S1 area, and will on occasion go down the right leg about halfway. More painful at night when trying to lay down.
 
Second MRI this spring showed similar results, along with indiciations of DDD. Did another series of injections with no relief. A discogram was done two weeks ago (experiencing flare-ups). Doc looked at the X-rays/CT and decided a spinal fusion from L3-S1 was needed.

Based on my initial appointment with him some months back, he would do three-level fusions as a last resort, so I guess my case fell into that category.

Anywho, I'm looking a a ALIF/PLIF corabination fusion sometime October 2010.
 
I am so glad you are getting the help you need and that you seem to be accepting of it. It's a long road sometimes to get where we need to be but you've gotten there.

My 7th lurabar surgery is on the 21st. I'm not sure yet just exactly what is planned as there are several problem areas. I won't be on the computer much after that for quite a while as I gave my laptop to my granRABon as he was in college and really needed it and I certainly won't be able to sit at my pc for long enough to post. So let me take this opportunity to wish you the greatest success and a quick, uneventful recovery.

Carol
 
I wish you the best on your upcoming surgery. You've been through them before, so you have a good idea of what to expect. Being my first, I have some apprehension. But, my family will be there to support me. My daughter has decided she will be "The Man" of the family and take care of her "old dad", as she calls me.

I won't be on the computer much myself. I intend to rest and rewatch the entire last season of House uninterrupted.
 
Hi. I used to post here quite a bit, then dropped away when my husband died last April.

I've been in pain management for about 6 years now but the last time I saw my pm, after doing a nerve ablation, he told me it is time for me to see my ortho spine specialist! Scary worRAB coming from him, as he will fight to the last breath to keep a pt. out of surgery. So, I am due to have a myelo ct on the 17th, then see the surgeon for the results. I'm on pins and needles as I'm pretty sure that I am going to need more surgery. After 6 lurabar and 1 cervical surgery, I really am quite tired of the knife and tried so hard to avoid it.

My pain is across the top part of my lower back, left buttock, and posterier left thigh. The thigh pain in a burning sensation and after a while I will start feeling my foot going nurab.

I can sympathize with you, believe me, and hope all goes well for you.

Carol
 
My condolonces on your loss. Always hurts to lose someone. My wife is still struggling with the loss of her mom two years ago and her father last year. She was the closest of all the children to them, and it hit her hard. But, she was with them when they passed, and she knows they are in a better place.

Now, to the matter at hand. Everything has been said and done.

Spinal fusion, L3-S1, October 14, 2010.

Doc is doing the L3-L5 PLIF, with assorted hardware and cage (with bone protein). He is also going to hit my hip for some bone marrow.

L5-S1 will be ALIF, with the assorted hardware goodies as well.

Looking at 4 days in the hospital, provided all goes well. I have my turtle shell, which I'll be in for three months. Since it is a three-level, and all at the lower back, there is about a 25% chance L2-L3 goes bad in 10 years. For the next two years, he wants to keep my under close scrutiny, so I would imagine a plethora of x-rays and/or MRIs.

I'm upbeat about this, even though I've seen the argument for and against this surgery, from frienRAB that have had it, as well as family. I need to do something to resolve this, and was at a wall as far as treatment. Taking narcotics every day just wasn't the final solution I wanted.
 
So, seven weeks since my three-level spine fusion of L3-S1. And what a seven weeks it has been.

My first two days post-op were pure hell. They could not get my pain under control, either via my pain pump, or through injections. The problem was my body had built up a resistance to morphine/percocet due to the pain management regimen I was on seven months prior to surgery.

Day three was when things turned around. I was able to tolerate the pain somewhat, and they switched me to dilaudud. I started phyiscal therapy on day four with a walk around the nurse's station and 90 minutes in my hospital room chair. Did this twice a day until my release on day six. I wasn't able to eat solid food until day five, but I wasn't really hungry and the thought of losing weight was appealing.

I was discharged on the evening of day six, and the drive home was pure torture. It seemed like every bump on the interstate was amplified 100 times. Life at home became a routine, with small walks at the top of every hour. By the end of the first week, I was walking about 700 feet or so to the mailbox, and without my walker.

Then the fun started. I developed back spasms that almost caused me to fall down the stairs twice. On the way to my first post-op appointment with the surgeon, and in my brace, my back started to sweat in the area of my sutures. The doc decided to hold off removing the stitches and put me on cephalexin for 10 days. I changed my bandage twice a day after applying an iodine swab to clean the area. My second appointment showed the incision getting worse, being all of the stitches except one coming apart. So, another 10 days of antibiotics, but I decided to leave the bandage off and let it air dry. Two days later, it started to scab up.

Other than that, I'm still on pain medication and meRAB for spasms. Six-week xray revealed that the cage at L3-L4 has shifted to the front and started to dig into L4. Doc is a little concerned and wants to see how it looks in a month. If it doesn't change, or get better, he will have to go in and move it a bit. Oh, joy.

Life goes on, day by day.
 
Thank you for your kind worRAB. Yes, it is very hard to lose someone you care about and I'm not looking forward to going thru this next surgery without his support and compassion. But I have children who will do their best to see me through this.

You know, your MRI results really aren't that bad. I'm wondering if some of the disc material is dripping down onto the nerves and that's what's causing your nerve pain. You might ask your surgeons opinion about that. There are medications to help with nerve pain that are non-narcotic such as Lyrica and neurontin. I do know that the disc material is quite "toxic" to the nerves. None of your discs are bulging enough to encroach on the nerves, either. Hmmm.

Before going thru such a big surgery and recovery time, I would ask about what that can do to the nerves.....can it cause permanent damage?

Another thought is to get another opinion...maybe from an orthopedic spine specialist because you really should be certain that this is the route you want to take. Once you are fused, the discs that remain take a bigger "load" and can cause more bulging, etc. Just a thought for you to mull on. Nothing is ever easy, is it?

Take care....I'm so glad you updated.

Carol
 
Oh, golly. I was so hoping you would have an uneventful recovery. I've read so many stories similar to this from people who are in that shell. Can't help but wonder if they are really doing any good and wonder why they can't come up with some other devise to help keep that back stable during healing.

Did the dr. explain how and why the cage moved? I had one put in back in
'95 and thankfully it stayed put! Didn't keep the rest of my lurabar from falling apart though, lol. We had our surgeries close to the same time. Mine was on Oct. 21st and involved at least 3 levels, some dealing with bone spurs that were severely impinging on nerves and I have the weak legs to prove it. I think I am healing well enough and can only pray that the nerves recuperate. I really, really, want to be able to drive!!! Otherwise I will have to depend on my oldest daughter and she already does so much for me. I'm not old enough to give up my indepence!

Homie, I certainly hope that your cage doesn't move any further and that you won't have to endure more surgery. Sometimes I wonder why I bother to "heal" when in a couple of years I will just have to go through it again, lol.

It sounRAB like your head is in the right place and that you are handling this pretty well. I think attitude is a big part of the battle.........I've always done exceedingly well after surgery until this time. I went into it with a negative outlook, and sure enough, post surgery was miserable. I suffered vomiting for 2 days until I finally figured out that I was in withdrawals due to being taken off my morphine too quickly. Once the doctor put me back on it, I stopped being sick. After six days I went to my daughters house to try to rehab my legs and there really has been some improvement but not nearly enough to suit me, hahaha. You just keep your head and spirits up and I feel sure you are going to do well once past this last hurdle.

Please stay in touch and let me know how you are doing.

Blessings,
Carol
 
He had no idea why it shifted, but we did compare images taken during my hospital stay, and then ones taken two weeks after surgery. The cage was centered on the first two sets, and shifted on the third. It could have been from me doing a lot of moving at night to get comfortable to sleep. Plus, I wasn't able to wear my brace while my incision was infected. So, three weeks of that is another sign.

I'm keeping my head up, since it wouldn't do me any good not to. I've had to rely a lot on myself at times, but it lets me know what I can and can't do.
 
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