[Spinal Fusion / Lumbar] Cervical & Lumbar Spine Problems (L5/S1 Spinal Fusion)

[dena1972]

My name is Dena and I have been fighting pain for years without much relief. My problems began in March of 1998 after a car accident and have been on again off again for years afterwards now. I have:
C4-5 disc protrusion narrowing the left central spinal canal
C5-6 posterolateral disc protrusion narrowing the left central spinal canal, left intervertebral foramen in narrowed
C6-7 let paramedian disc protrusion narrowing the left central spinal canal in the proximal left ntervertebral foramen
T11-12 disc protrusion narrowing the central spinal canal and minimally flattens the ventral aspect of the spinal cord w/o compression
now here is where it gets tricky: I had an XLIF surgery (10-2009) on what I thought was L4-5, but I just had an MRI with and with out contrast that says that I have:
L4-5 disc desiccation, disc bulge asymmetrically toward the right. Mild facet degeneration, right intervertebral foramen is narrowed.
L5-S1 intervertebral fusion, residual right far lateral disc protrusion impinging on the right exiting nerve root sleeve.
Now my question is how can I have a disc protrusion in an area where there is no disc? And my next question is to the doctor, why does the MRI show my surgery in the L5-S1 region and not the L4-5 region? Can anyone answer the first question I have?
Oh and if you are wondering if surgery was a success, No, it wasn't I am currently in pain everyday seeing pain doctors and now another back doctor since the one who did my surgery said the pain was in my head and wouldn't help me anymore, even though one of my complaints was very real: my left foot is always hotter to the touch than my right no matter what I do, no relief! Thanks Doc!

[Hooch]

I'm sorry to hear that, sounds like an awful surgeon (and a tit to boot). I hope there is something more that can be done, plenty of pathology there.

You sound quite educated about your condition. The hotness in one leg, I thought this could happen in anterior approach when nerve is damaged? I know a bloke who has this, unfortunately nothing can be done to rectify that specifically.

Welcome.

[Cindylou]

Hi Dena, That is definitely a question for your surgeon, as you can't have a disc protrusion if it has been fused. Is there any outside chance you have an extra vertebral disc and this second doc just counted wrong from the MRI image? Just a thought that would explain it, but you definitely need to address this question to the original surgeon. Did he operate on the wrong level, God forbid? Hopefully not. Meanwhile, I hope you get answers to these questions soon and sorry for this doc being such a jerk. Some just are. Hang in there. Cindylou

[Justin]

Hi Dena,

Welcome to the Spine Patient Society.

now here is where it gets tricky: I had an XLIF surgery (10-2009) on what I thought was L4-5, but I just had an MRI with and with out contrast that says that I have: L4-5 disc desiccation, disc bulge asymmetrically toward the right. Mild facet degeneration, right intervertebral foramen is narrowed. L5-S1 intervertebral fusion, residual right far lateral disc protrusion impinging on the right exiting nerve root sleeve.

Based on the bolded, quoted text above, it looks like you had your surgery at L5-S1.

Now my question is how can I have a disc protrusion in an area where there is no disc? And my next question is to the doctor, why does the MRI show my surgery in the L5-S1 region and not the L4-5 region? Can anyone answer the first question I have?

Based on your MRI report, your surgery was at L5-S1 and not L4-L5.

[dogmattic]

Hi Dena, I had scanned your post - and noted you have the same sympathetic issues with your foot that my wife has.
Note - we went through about a dozen course of HBO (Hyperbaric Oxygen Treatment), which was pretty much the only treatment we could find for 'vasodialiation'. We used one of the single-person chambers with, I think, 2.0 atmospheres and oxygen pumped in.

Although this article refers to Circumferential Fusion, the complications mentioned apply as well to lateral access of any kind (ie, Prodisc revision).

http://www.medscape.com/viewarticle/439167_6

Retraction and mobilization of the psoas muscle can injure important surrounding neural structures. These include the genitofemoral nerves, the sympathetic plexus, and the exiting nerve roots that form the lumbar plexus. Retrograde ejaculation has been reported in up to 10% of patients undergoing anterior lumbar approaches. Genitofemoral neurapraxia can result in perineal anesthesia or dysesthesia. Sympathetic plexus injury can result in vasodilation and hyperemia of the ipsilateral lower extremity (paradoxical "ischemia" of the normal contralateral side).

wishing you well

[Cindylou]

Hi Dena, I had scanned your post - and noted you have the same sympathetic issues with your foot that my wife has.
Note - we went through about a dozen course of HBO (Hyperbaric Oxygen Treatment), which was pretty much the only treatment we could find for 'vasodialiation'. We used one of the single-person chambers with, I think, 2.0 atmospheres and oxygen pumped in.

Although this article refers to Circumferential Fusion, the complications mentioned apply as well to lateral access of any kind (ie, Prodisc revision).

http://www.medscape.com/viewarticle/439167_6


Retraction and mobilization of the psoas muscle can injure important surrounding neural structures. These include the genitofemoral nerves, the sympathetic plexus, and the exiting nerve roots that form the lumbar plexus. Retrograde ejaculation has been reported in up to 10% of patients undergoing anterior lumbar approaches. Genitofemoral neurapraxia can result in perineal anesthesia or dysesthesia. Sympathetic plexus injury can result in vasodilation and hyperemia of the ipsilateral lower extremity (paradoxical "ischemia" of the normal contralateral side).

wishing you well

Wow, dogmatic. Vasodilation. Hyperemia. Neurapraxia. A lot of big words. I researched the ones unfamiliar to me, but it would be nice if you could translate what you said into layman's terms, so everyone could better grasp what you're trying to say. Just my CL

[dogmattic]

Hi Cindy, thank you for the flattery, but those are not my words - they come from the referenced article (section: Complications). I suppose I should have 'quoted' the paragraph' - but did not foresee anyone actually thinking that I penned that. I wont attempt to simplify it, as I am sure those who are afflicted, are sufficiently motivated to understand it at their own level ... and I barely understand it myself.

Dena states: " my left foot is always hotter to the touch than my right no matter what I do, no relief! Thanks Doc!"

I believe this is classic 'vasodialation' typical of Sympathetic plexus injury ... or at least, that's what our Prodisc Revision surgeon said. Find the 'Female Anatomy' illustration near the bottom here. To the right of this graphic, is an except from the article 'Endoscopic Lateral Transpsoas Approach to the Lumbar Spine: Discussion'

Our surgeon suggested a 'sympathectomy'. Yeah - right ... another surgery to find microscopic sympathetic nerves that he could'nt see in the first place to avoid damaging? The (non-invasive) idea of HBO therapy was shared with us by another forum member - which we are more than happy to pass forward. The condition resolved ... perhaps due to the HBO Therapy.

If anyone really wants to dig in on this subject of HBO Therapy, check out:
Richmond Hyperbaric in Canada_Research on RSD/CRPS
Reflex Sympathetic Dystrophy Treatment - RSD & Complex Regional Pain Syndrome

• Hyperbaric Oxygen Therapy forces oxygen into oxygen-starved tissues
• It reduces swelling and inflammation
• It increases the growth of new blood vessels
• It improves white blood cell function
• It provides antibacterial effects

[kbeebo]

Hi Dena, Welcome to a great place for comfort and learning. I too, had an accident that contributed to my back(lumbar)problems. So sorry that you have had to endure so much pain,worse yet, the struggles ahead since it sounds like a more thorough job could have been done at the time of your surgery. My previous surgery left me with more nerve pain than before and the knee pain is the worst w/shooting into the ankle/foot area different places different times on left side.
However, maybe somebody qualified could correct me, but isn't the foot as related to nerve pain corresponding to the L-5, S-1? I would think the L4-5 nerve pain would be higher on the leg, also. If u live anywhere near the San Diego County area, if u need a good pain Dr I might be able help. I hope that statement is within the rules of the Forums. Good Luck! I am new also, great people here. Keith