[Spinal Fusion / Lumbar] L5/S1 plif

[Matt]

Hi-
Just wondering what some other members think and what their experience has been after a L5/S1 PLIF.

I had the procedure done 7/30/10 and I am reaching out to anyone who will listen/respond as I really have not had much feedback from my doctor, other that 'you will be fine'. I will first start off by saying that I am not taking any meds - even Tylenol or Advil now, as I want to get a really good idea of what my pain levels really are. I had a pretty bad herniation between L5/S1 and had two orthopedic doctors and the longtime chairman of the neurological surgery department at a major teaching hospital all independently agree on the diagnosis and treatment (PLIF). I was in a lot of pain and lost feeling in my left leg to the point that I was unresponsive to the reflex tests and had been on pain medicine on and off for several years.

I was about a month behind in my recovery by the doctors standards, but I seem to be doing better now and the feeling is back in my leg. I had an in home nurse and in home PT for six weeks and, due to financial restraints, was unable to go to regular PT. Upon my return to work after 9 weeks, I began walking regularly on a treadmill and got completely off the pain meds by mid-late November. Last week, I began to jog again on the treadmill and actually got through a 5k in 31minutes this week

Some people think I am crazy to do this, but, my doctor keeps telling me that everything should be set and that I can not hurt my back at this point, so I figure WTH - I will give it a shot. I was running 10-12 miles a week up until of March 2010. I am also doing some strength training on my upper body. I stop whatever I am doing when I feel that it might be too much and am very calculated in my movements as I don't want to cause any other problems.

I am still in pain - regardless of what I do. It is not unbearable, but my main problems are that it takes me a while to get up after laying down on the floor (I have a young child, so this is common). It is actually quite painful to get up from this position. Getting out of bed is not an issue as it is a completely different motion. Also, it is very painful to move after laying on my stomach. I called the doctor and they recommended that I go to PT, so I am going to do that. If that doesn't help, I will have to go back to see the Dr.

Now on to my questions..

1. My neurosurgeon tells me that everything is fine, although no follow up imaging has been done post surgery. The pain doctor that I went to told me that it takes up to a year to recover from this. I am wondering what other people have experienced. Is my doctors ego possibly getting in the way here? Do doctors usually take another look after the surgery?

2. Is this pain going to be with me from now on? Do I just need to learn to move differently and build up different muscles?

3. Has anyone had a full recovery and been able to return to their normal activities without pain? Am I expecting too much? Am I doing too much too soon?

I greatly appreciate any feedback or links to other posts that may answer any of these questions.

[KBear]

Matt- I think a year recovery is very reasonable. I had adr at L4/5 and it took a year to see marked improvement and I didn't become pain free until 18 months. I can't even fathom being out running 6 months after surgery, I wasn't close to that. As far as imaging, not sure what is normal for fusions, but with mine I have xrays at every visit (2 weeks, 1 month, 3 months, 6 months, 1 year and etc.)

[Matt]

KBear,
Wow - 18 months. It looks like I need to change my expectations. Thank you for your input!! I am worried about causing problems with the running, such as nonunion, but hopefully the upcoming PT will address that. Congratulations on being off the pain meds - I took myself off in November. It wasn't fun, but I am happy to have my mind back! In hindsight, do you think any of the pain medicine (narcotic) made you feel pain that wasn't really there?

[KBear]

I think the pain medicine definitely made me feel pain that wasn't there to an extent. Once I got down to 1-2 Hydrocodone a day is when I think it most had this effect. A little before my one year mark I began weaning off of medications (was on Kadian (morphine), hydrocodone, Lyrica, Cymbalta and Zanaflex). I weaned off of hydrocodone first, then Kadian, then Lyrica, then Cymbalta. The Cymbalta was by far the worse withdrawal of all of them and it's only an anti-depressant that helps with pain. I had to go back on the hydrocodone because I started having pain everywhere. Once I got off of the Cymbalta, I quit the zanaflex, but continued the hydrocodone. I then started feeling much better and was able to wean off the hydrocodone. I took tylenol in place of it, but the withdrawal wasn't bad.

I think there are two main reasons it took me so long to heal. The first being that I was in pain for over 3 years before surgery, so I think my body 'remembered' the pain for longer than some do. I think that the less time you are in pain prior to surgery, the faster you heal. Secondly, I started weaning off medication really quickly after surgery and ended up being in so much pain that I just laid on the couch all day and wasn't doing my therapy exercises. I think I should have stayed on the higher doses for a longer time and did the therapy and stayed active, then I would have probably have healed quicker. I noticed as I was weaning off the medications that when I wasn't active I hurt more than when I was.

I'm one of the slower healers on here, as there are others who are doing great a lot sooner than I was, but we each heal differently and it's always best to err on the side of caution and give your body the best chance to heal correctly. You only get one shot at recovery.

[Hooch]

Hi,

I don't think you're crazy to run.

It is not uncommon for improvements to occur right up to years out, tho the bulk tends to happen by 6 months.

It is imperative you do physio, your multifidus espescially would have take a beating with the posterior instrumentation. If it's not working properly you will be in pain.

Resources - Exercise Practice - Lumbopelvic Core Muscle Training - Diane Lee & Associates - Consultants in Physiotherapy

[Cindylou]

Welcome Matt. I don't understand your neurosurgeon not performing post-surgery imaging. I believe you need to bring that up to him/her at your next appointment, and if one isn't on the books, than call and get one scheduled. This is, of course, just my layman opinion, but that's my 2 cents. Good luck. Cindylou

[Matt]

KBear,
I am happy to hear that I am not the only one to experience that. I stayed on a pretty high dosage of Oxycodone (125mg/day) for the first 3 weeks, then I seemed to get down to about 60mg/day until I went back to work, then cut back further. I know from experience that the side effects of withdrawal from anti-depressants can be quite nasty.

Thank you for your input and I wish you the best of luck with your pregnancy

[Matt]

Hi,

I don't think you're crazy to run.

It is not uncommon for improvements to occur right up to years out, tho the bulk tends to happen by 6 months.

It is imperative you do physio, your multifidus espescially would have take a beating with the posterior instrumentation. If it's not working properly you will be in pain.

Resources - Exercise Practice - Lumbopelvic Core Muscle Training - Diane Lee & Associates - Consultants in Physiotherapy

Hooch - Thank you for your input. I have never heard of the multifidus muscle. I did some exercises this evening based on your site and some youtube videos and I really felt it (in a good way). That makes a lot of sense. I will definitely make sure my upcoming PT includes focusing on that.

[Matt]

Welcome Matt. I don't understand your neurosurgeon not performing post-surgery imaging. I believe you need to bring that up to him/her at your next appointment, and if one isn't on the books, than call and get one scheduled. This is, of course, just my layman opinion, but that's my 2 cents. Good luck. Cindylou

Cindylou,
I agree - I think it is really odd. That is why I am wondering if his ego might be getting in the way. I have seen that with surgeons in the past. I did ask about it the last appointment I had and he didn't think it was necessary. In fact, he discharged me and told me the only reason I needed to follow up was if I had problems. I am going to follow through with the PT to see if that helps - if not, I will definitely insist on imaging. He is a very good and well respected doctor, which is why I am a bit surprised.

Thanks for your input!

[Cindylou]

Matt, wow, I cannot believe he discharged you at 5-6 months out. That, is definitely not normal practice after a major surgery such as that. Maybe his ego is getting in the way, or God forbid, what if there is something he doesn't want you to see on the imaging? Hopefully, it's not that. But I definitely have a red flag with the premature discharge and no imaging together. Good luck with this and with your pt! Cindylou