Epidural Injection Post Op PLIF with Instrumentation - Risk vs Benefit Question

[Jan P]

I am 11 months post fusion and still having some back pain, but more often lower right leg nerve pain. I am alot better than pre surgery, but still not able to string more than 3-5 days without pain/discomfort.

Still seeing my PT and he has suggested (twice) that I should consider an Epidural. I talked with my NS regarding this, and he was very clear that he did not want this done - the risk of infection is to great!

I have been conversing with a few of you on my other post - "9 months Post PLIF and Looking for Answers", and the opinions are mixed, with Tuliptoday just having an injection a few days ago.

So, dear spine patients does someone have thoughts on this subject. If so, perhaps it will make my decision clearer and help others in the process.

After reading Rob's post about having his hardware removed, I am wondering if that will be something to consider in a few months.

Thank you for your continued help and support - Jan

[Justin]

Hi Jan,

In regard to the epidural (steroid) injection: did your NS spell out why he did not want you to have one due to the risk of infection? I ask this because the risk of infection is extremely low even with pre-existing hardware, as epidural injections are performed using sterile technique with sterile instruments (that are single use and then thrown away). However, if your surgeon is against an injection, there must be a specific reason in your case (I know he is concerned about the fusion instrumentation). Maybe he just doesn't inject patients with hardware (I know some docs don't, but I've personally helped inject patients that have hardware--it is very much physician dependent).

After reading Rob's post about having his hardware removed, I am wondering if that will be something to consider in a few months.

Thank you for your continued help and support - Jan

I'm sorry that you are experiencing pain a couple days a week. However, I would like to stress that you are only 11 months post-op--there is still time to see improvements in your pain. The reparative process post-op takes quite a while (the remodeling of tissues is an inherent process that progresses in a calculated, step-wise fashion).

Also, I would not entertain hardware removal at 11 months post-op. You still have (potentially) a lot of healing ahead of you.

Good luck--keep up the physical therapy and keep us posted.

[Jan P]

Thanks Justin for your insight and thoughts.

The NS, as I recalled just said, "absolutely no epidural there is to much risk" - period so we did not discuss further. I suppose I should have questioned more, but apparently, he did not seem to feel there was need for further discussion. I should have have pressed it - live and learn!

I appreciate your encourgement that I may still be healing. It makes alot of sense and I know in my heart I need to give myself alittle more time. But, it does get frustrating when I can not sit and visit with friends and stay seated for more than a little bit. Or when most days do not go by without some amount of discomfort/pain. It's just hard when my PT thinks I may have hit a plateau in my recovery and his ability to help me. I am not ready to give up!!!!! I am sure I'm not alone in the conflict about what should be the next step for me or if there is one.

I will investigate further with a few pain management doc's about having the epidural and try to come up with the right decision.

Thank you Jan

[Gilbert P]

Hi Jan

I am three months out and having the same issues. I have Coflex at the lower spine and L5-S1 with bony material for fusion

A quick question: R U still on pain meds?

I am not but sometimes I will take some.

Slow and steady wins the race

Gil

[Jan P]

Hi Gilbert -

I am currently on 1800mg of Gabapentin for the right leg nerve pain. Several months ago, I tried to step down but unable to tolerate the pain. So back up I went. I still have to take the Tramadol, not daily but seems like a few times a week and if really really bad with resort to a Vicodin (but seldom).

Pain Management Nurse Pract. says I may likely need to take Gabapentin for life. My PT and my NS both (at different times) say I should not still need these. Soooooooooooo, who do you believe. I guess it comes down to how you feel, not the way they think you should feel. I would rather take what I am and be able to keep the pain level down to a nil - than deal with how it feels with the pain! I am sure you and others feel the same.

I was suppose to have PT yesterday but he feels I have reached a plateau and nothing more he can offer me. Great feeling not!

Sorry you are still having issues. Hang in there and hopefully it will get better for you as time goes on.

Jan