Back Pain Community

maybe you could address this question/problem to Dr.Minchew?

Porter1971

Unfortunately, your post has limited information on your prior history. However, I assume that you had an L5-S1 fusion at some time in the past for back pain or some type of instability. It is clear that you are either having a recurrence of your pain or have continued to have pain since the time of your surgery. That is actually a critical distinction as to whether you had a period of pain improvement or not. If you had a significant period of improvement (more than 6 months), then it is possible that changes at L4-5 could causing pain. This is a described phenomenon called "adjacent segment degeneration" and is accelerated deterioration at a level above or below a prior fusion. However, it would seem that there has not been significant degeneration at L4-5 if your x-ray and MRI "came back clean" with no abnormalities for you. Having said that, it may be the case that your L4-5 level already demonstrated some degenerative changes at the time of your surgery and no apparent changes were noted on the new studies. You can develop increased mobility at a level above a fusion but this really can not be "diagnosed" with any type of physical examination maneuver or test. The "test" performed by the therapist could have placed stress on any number of structures that can cause pain including your pelvis and lumbar facet joints (small joints of the spine). It is not specific for any type of abnormal motion of the vertebra. Furthermore, the therapists' definition of "instability" or "hypermobility" is not the same as used by physicians. I have discovered this fact by participating in journal clubs (meetings to discuss scientific studies of back pain) with our therapists at Duke who teach in the PT school. If there is any instability or abnormal motion of your L4-5, this would be demonstrated on x-rays with you bending forward or backward (flexion-extension) x-rays. This may be something to discuss with your surgeon. In reality, there are a multitude of things that could cause new pain and there is no test where a flashing red light goes off at the source of the pain. I know this is frustrating for you as a patient but trust me; it is also frustrating for your doctors that would truly like to help you.

If your pain never improved after surgery, it would not be logical to attribute the pain to a new problem. Possible causes of pain after surgery include a failure of the surgery to heal, additional problems that were not addressed at the time of surgery, and simply a poor outcome that is not explainable. I assume that your surgeon has assessed you for a possible non-healing of the fusion if there is any question on the x-rays. This is most often done with a CT scan as it demonstrates the bone much better than an MRI.

Good luck!

JTM

Thanks for the reply Dr. Minchew. And yes, my surgery was a extreme success as I call it. In fact I had no pain at all for the last 2 years post surgery. This pain started out of no where and accelerated quickly. And as I know the therapist may have caused a problem outside of the norm it did help at least give possibilities to what may be the cause where as up to that point the doctors that were seeing me were basically scratching their heads saying the test came back normal yet there are all these symptoms. I hope to have more information when I see my actual surgeon next week who did the first surgery. He was unable to see me while in the hospital due to an apparent heavy surgery load. It happens, I understand that, but doesn't help with the frustration of spending four days in the hospital and coming out with no real relief or plan of relief. And the therapist was the one that mentioned doing the flexion xray, something which my doctors have never done even on my prior surgery. So my hope with that information is nothing more then hopes of it helping the surgeon narrow down the problem quickly so as hopefully to eliminate any nerve damage. I have alot of "symptoms" that I never had at any point with the other disk problem and the way this one came on really concerned me. My previous one was a work related injury and grew in intensity over several years so it was sort of expected. This one came on with no "known" cause and pain has been at an extreme the entire time. And then the loss of feeling in the one leg with the temperature changes between legs, not to mention the lack of reflexes in both legs, just all add up to poor out look for "we'll do some therapy and you will be back to normal in a few weeks."Which is what I am hoping to get. My surgeon is very big on avoiding surgery which is one of the things I liked about him. So I know if he tells me I need it then its going to have to be done. But it was one of those things where I knew there was another surgery in my future based on his finding from the first surgery, I just figured it would be alot further down the road. So again I do appreciate the input its nice to have some profesional input once in awhile , and I am very glad you give us your time.