[Spinal Fusion / Lumbar] TLIF at L4/L5 & L5/S1

[BRUTUS]

Hello everyone,
My name is Andy (Brutus is our 8 yr old Jack Russel Terrier). I am 59 yrs old and underwent a TLIF on Sept 3rd 2009 for 2 bulging and 1 torn disc, spondylothesis, stenosis and arthiritus. I was in pain before surgery which had increased and tried physical therapy, accupuncture and a chiropractor without success. I consulted with 2 neurosurgeons (one recommended a triple fusion of L4, L5, & S1. The other surgeon recommended dynamic stabilization with fusion of S1 and L5, a spacer and clearing out the root canals for the stenosis. I went with dynamic stabilization and and my 3 week follow up was instructed to not wear my brace and to start physical therapy. I was doing great up until about the 3d month when I tried to wean myself off of oxycodin 5/325 to vicadin. My pain level increased dramatically. I was then back on oxycodin which did not work as well so my surgeon increased the oxycoin to 10/325. I was then put on opana 15 once every 12 hours and used the oxy for pain spikes. These also did not work. I then went to a pain mgt doctor who put me on oxy 15 every 12 hours. I am also scheduled for a facette block on the 15 of this month and possibly a nerve-deading procedure which I can't recall the name. I was advised to stop physical therapy because it would increase the pain.
I am now confined to our house, do ball exercises, a walk a block when I can. I am extremely depressed and spend alot of time in bed because of the pain. I am taking antidepressants twice a day and these have helped a little. I am deeply concerned as to whether the surgery failed or if I just pushed myself to hard to soon. I have had 2 post surgery x-rays and a CT scan and all were normal. I am going to try to go back to my surgeon this week to see if he can determine what is wrong. I have lower back pain with pain radiating down both legs which is more on the left side. I am a retired military officer who was extremely physically active before this. Please help me with any advice and info. This is the most difficult challange I have ever faced in my life.
R/
Andy

[trkdoc714]

Hi Andy. I hope you feel better than normal today. It wasn't that long ago that I was in the same boat as you find yourself in now. You've found the right place to garner as much information as you can stand. The good people here are also very supportive and can give you some ideas for making life a bit easier to deal with while you go through the trials and tribulations of your ailment(s).

Everyone here has "been there". We understand you more than family members in most cases. We know the types of pain you feel and the severity of the pain. Although I'm now an irregular (in more ways than one), all of the members will give you hope and support.

Good luck on your journey,

Bob

[BRUTUS]

Thanks for replying Bob...it is nice to know that you are not alone-
R/
Andy

[Justin]

Hello everyone,
My name is Andy (Brutus is our 8 yr old Jack Russel Terrier). I am 59 yrs old and underwent a TLIF on Sept 3rd 2009 for 2 bulging and 1 torn disc, spondylothesis, stenosis and arthiritus. I was in pain before surgery which had increased and tried physical therapy, accupuncture and a chiropractor without success. I consulted with 2 neurosurgeons (one recommended a triple fusion of L4, L5, & S1. The other surgeon recommended dynamic stabilization with fusion of S1 and L5, a spacer and clearing out the root canals for the stenosis. I went with dynamic stabilization and and my 3 week follow up was instructed to not wear my brace and to start physical therapy.

Hi Andy,

Welcome to the Spine Patient Society. What device(s) did you have implanted? Also, was your spacer an "interspinous spacer?" Sorry, I'm just trying to wrap my head around what you had done.

I was doing great up until about the 3d month when I tried to wean myself off of oxycodin 5/325 to vicadin. My pain level increased dramatically. I was then back on oxycodin which did not work as well so my surgeon increased the oxycoin to 10/325. I was then put on opana 15 once every 12 hours and used the oxy for pain spikes. These also did not work. I then went to a pain mgt doctor who put me on oxy 15 every 12 hours.

Tapering off of medications can cause an increase in pain. Also, tapering off of narcotics at three months post-op is pretty ambitious, especially with a lumbar fusion. I just tapered off of my narcotics at 7 months post-op (I know how rough it can be--it was very painful).

I am also scheduled for a facette block on the 15 of this month and possibly a nerve-deading procedure which I can't recall the name. I was advised to stop physical therapy because it would increase the pain.

The facet block should help. The "nerve-deading" procedure is called Radiofrequency Denervation (Facet Rhizotomy) (click on the link for a recent discussion on Facet Rhizotomy that you might find helpful).

I am now confined to our house, do ball exercises, a walk a block when I can.

Gosh, I am sorry to read this. It is good to see that you are still doing exercises and walking despite your increased pain -- this will ultimately serve you well during your recovery. Personally, I found it really easy to go a couple days without walking and doing my exercises when I was experiencing pain post-op. The inactivity ended up setting me back even more and it created a vicious cycle of being in pain --> not doing much physically (walking and exercises) --> weakened muscles due to inactivity --> more pain --> start cycle all over again.

I am extremely depressed and spend alot of time in bed because of the pain. I am taking antidepressants twice a day and these have helped a little.

Unfortunately, depression and spine-related disorders & pain go hand in hand. Medication and behavioral therapy are extremely helpful.

I am deeply concerned as to whether the surgery failed or if I just pushed myself to hard to soon. I have had 2 post surgery x-rays and a CT scan and all were normal.

Just my two cents here , but I would venture to say that you pushed yourself too hard too soon. Recovery from invasive spine surgery can take quite a long time. After 3 spine surgeries, I can say that it took me a good year to start feeling like myself again (mentally and physically). It's great that the x-rays and CT scan were normal--this really stacks the odds in your favor.

I am going to try to go back to my surgeon this week to see if he can determine what is wrong. I have lower back pain with pain radiating down both legs which is more on the left side. I am a retired military officer who was extremely physically active before this. Please help me with any advice and info. This is the most difficult challange I have ever faced in my life.
R/
Andy

Please let us know how your appointment with your surgeon goes and what he / she has to say. Is the pain that you are currently experiencing the same as before surgery or is it different?

I do hope that you "turn the corner" soon and that you make steady progress daily. BTW, thank you for your service.

[Katie]

Welcome Brutus!

While I haven't been fortunate enough to have my surgery yet, I have to agree 100% with what Justin has said, especially about how soon you went off the pain medication and started therapy. It goes against almost everything I have read about the recovery period.

And thank you for your service as well. My husband's whole family is military based, and I am newly married into it. It certainly is a very different and precious network that I am appreciating even more than before.

I sincerely hope that you can resolve your pain issues soon. By the way, the only pain medication that worked on me was both long and short acting morphine. All others either caused bad reactions or had no effect at all. I'm not sure how yours compares, but I am using ~340 mg of short acting morphine as well as 60 mg of long acting morning and evening, and am fairly comfortable now, after struggling for several years for relief.

[jss]

Andy,

First, what a terrible story.

Second, thank you for your service. My oldest is in the US Army (CI) and is shipping to Afghanistan in February. I, and those like me who never served, owe a debt of gratitude to all service members that can never be repaid.

Finally, I've had three cervical surgeries, the last being a double ADR. I have had symptoms such as paralysis from the neck down, to tingling in an extremity, to extended periods of pain confining me to the couch. I've experienced frustration and depression. Like you I was (am) very active (marathon runner). Though my left hand is still numb, I am currently free of all pain, and short of things like standing on my head and UFC, I have no physical restrictions.

In my decade long quest to get where I am (mostly symptom free), I have read dozens of terrible stories like yours. A great many of them resolved over time; sometimes years. For some it just took time (months and even years) for symptoms to resolve post-surgery. Others finally found a doctor or procedure that resolved their symptoms. The only pattern I've observed in successful outcomes was perseverance.

Good luck, Jeff

[Cindylou]

Welcome Andy, Thank-you too, for your service to our country. My Father served in World War II, his Father in World War I, my brother served two tours in Vietnam, and my step-son is headed back to Afganistan in March, having already spent a year serving in Iraq. So God bless you all for your sacrifice on our behalf.

I do have to agree with what most are saying: coming off the pain meds too soon, and starting physical therapy too soon as well, as being the likely culprits for your current condition. I am so sorry for this, but I do think you can slowly turn this around. Justin was right on with breaking that cycle of pain, by easing into some physical activity like walking, but just taking it slow. I have had numerous back surgeries myself, and I like what Jeff said about perseverance. Take it very slow, never give up, and you should begin to see some improvement by and by. Most of us who get discouraged after our surgeries are "movers" not "sitters." We don't "wait well." This has been my biggest life lesson since my bicycle accident 8 1/2 years ago.......persevering and never giving up on myself and my condition.

Good luck! We are here for you.

[BRUTUS]

Thank you so much everyone for your replies... as my wife and I both read them I was overwhelmed with emotion. All of you were so kind to respond and share your experiences with me. In the back of my mind I was thinking that maybe I pushed myself too hard but being the "bonehead" Marine I just looked at this as another physical challange and with my "surgeons guidance" pressed forward. This last week has been hell as I had been on Opana 15ER and Opana 10ER both once a day plus Oxy 10/325 for breakthru pain. I am now taking Oxy 15 Imm every 6 hrs and it is just not working... (the Opana caused me severe digestion problems if you catch my drift). I think I need to go back to the pain mgt Dr. also. Any suggestions??

[BRUTUS]

Thanks for replying Bob...it is nice to know that you are not alone-
R/
Andy

Thanks Justin,
I had 4 screws and a spacer of some inert material that the surgeon packed bone fragments around. The hardware is Dynesis Dynamic Stabilization. The last Xray showed hardware correctly placed and L5 and S1 fused.

[BRUTUS]

Welcome Brutus!

While I haven't been fortunate enough to have my surgery yet, I have to agree 100% with what Justin has said, especially about how soon you went off the pain medication and started therapy. It goes against almost everything I have read about the recovery period.

And thank you for your service as well. My husband's whole family is military based, and I am newly married into it. It certainly is a very different and precious network that I am appreciating even more than before.

I sincerely hope that you can resolve your pain issues soon. By the way, the only pain medication that worked on me was both long and short acting morphine. All others either caused bad reactions or had no effect at all. I'm not sure how yours compares, but I am using ~340 mg of short acting morphine as well as 60 mg of long acting morning and evening, and am fairly comfortable now, after struggling for several years for relief.

Thanks Katie,
Have you had any side-effects from the morphine and are you able to do normal activities like drive etc...?