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Disappointed after surgery
yoyoming posted:
I am a 57 year old woman who has always been active, until recently. 9 months ago, I had a lower lumbar decompressive laminectomy with a spinal fusion using a titanium implant. This was done after many years of lower back pain that was also starting to limit my ability to walk any distance at all and of course exhausting all other non-invasive treatments to no avail. My back is better -- most of the pain is gone, unless I sit in a chair without proper support for too long. But the weakness and pain in my outer hips and upper thigh areas after walking even a couple of blocks has not improved. My surgeon says it can take a long time for nerve damage to the legs to get better, but won't be more specific. Am I expecting too much too soon? Is it realistic to hope that this condition will improve? Any advice others can offer, I'd really appreciate.
Rafael Levin, MD, MSc responded:
More typically patients who had a lumbar decompressive laminectomy with fusion report improvement in their lower extremity symptoms before they report improvement in their back pain. I therefore tell my patients that the predictability for success with this operation is higher for relief of lower extremity pain with standing and walking than it is for relief of back pain. In your case your experience is somewhat atypically the opposite. Though I am pleased to hear your back pain is much improved, it appears that you are still having significant claudication symptoms affecting both your lower extremities. I agree with your surgeon that nerves may take long to recover after chronic compression, and unfortunately, sometimes permanent nerve demage can presist despite an otherwise successful decompression. Nevertheless, at 9 months post surgery consideration can be given to obtaining updated images (MRI and/or CT) to look for compression at the operated and possibly other levels. Other underlying causes of lower extremity claudication should also be reconsidered such as vascular causes, for example. I am confident your surgeon will perform the appropriate workup. Don't be discouraged and I hope you will continue to progressively improve.
bj1208 responded:
hi and welcome to the support group - Dr. Levin has given u great advise, as he always does!!

I had just a single fusion lumbar L5-S1 3 years ago- I too was extremely active (Martial Arts Instructor for 10 years) and had always had lower back pains that were mild.

Talk to your surgeon and let him/her know that you are concerned with the walking issues. MRI's, CT Scan's can show if there is any problems. Other tests, like EMG with NERVE CONDUCTION TEST can see if there is permanent nerve damage.

Unfortunately, 5 years ago, I was at the grocery store and bent over to get a bag of sugar and my disc ruptured - it wasn't until a year after my surgery that I was released from the surgeon and requested that I see a PHYSIATRIST Pain Management treatment center - they did go deeper into my pain complaints as I still have chronic low back pain and also both legs were hurting. they did the EMG Nerve conduction test and it confirmed that I had nerve damage in both legs. It seems that when my disc ruptured the disc actually splintered and was pressing on the nerve root on both sides.

But as your surgeon and Dr. Levin have stated - it can take up to a year or possibly longer for those nerve roots to heal.

I am happy that your surgery was a success and you are healing very well. My surgery, too, was a success - I fused 100% but they could not do anything about the chronic low back pains or the nerve damage - but I am happy with my choice to have the surgery.

Keep us posted as to what you find out - take care - Joy

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