Pain after 5 disc Fusion

Welcome to the forum, but sorry you had to find us.

What kind of doctor are you seeing? A pain doctor? Family doctor?

I would suggest a second opinion before making any decision. Do a search on this forum, the box at the top of the page, and see what others have said. I'm not going to get a stimulator implanted even though I have pretty bad pain. But I didn't jump into lumbar fusion either. (I did get one cervical fusion when I broke my neck.)

Wecome to the forum Rgsafety. Instead of going the implanted stimulator route, has anyone (one of your Doctors) suggested the possibility of seeing if you might be a good canidate for an implanted pain pump? I got mine implanted in June of 2014 and I have nothing but good things to say about it! It really has been a Godsend for me. Mine gives a continuous but very minute infusion of morphine directly into my lumbar spine. For the most part it controls my lower back and leg pain extremely well but sometimes when I have break through pain, I also have a device called a PTM (it came with my pain pump) it's a small electronic device (about half the size of a pack of cigarettes) that I cary with me. If I have break through pain I put this device on the skin directly on top of my implanted pain pump, and press a couple of button on the device and it will make the pain pump infuse a preprogrammed bolus infusion into my spine to controll the pain. The PTM is programmed by my pain Doctor and it only allows me to give my self so many bolus doses in a 24 hour period and mine is set by my doctor that I have to wait at least one hour between each bolus dose. I rarely have to use it more that just a few times a day depending on what I am doing. Other wise the normal constant infusion controls my pain quite well! I got mine put in at the University of Indiana pain management clinic. I go there approximately every 6 months to get the pump refilled and checked. Depending on the infusion rate and other factors that will determine how often you need to get the pump refilled.

Anyway just thought it might be something worth considering if you haven't already? I wish well and good luck to you!

White Beard

I just wanted to thank the people who have responded to my original posting.

I have no new news. I had the CT Scan I mentioned in my posting. It has been over a week and still haven't heard anything from my doctor concerning what it showed, if anyhting, that might be done to lessen my pain.

I called the doctor's office, today, and left word for someone to get back to me.

I'll see what happens!

Rgsafety

I finally heard back from my surgeon concerning my extreme pain one year following L2-L5 disc fusion.

The CAT Scan, that I had done, answered some of my questions. The fusion between L4 and L5 didnt take and I need to have it done again.

My lower spine at L5-S1, according to my surgeon, has completely deteriorated and is basically a bone on bone situation. The surgery will be anterior/posterior.

I'm in the process of getting the two surgeries scheduled. Since it involves workers compensation, it'll be months before I actually get it done.

I'll check back when I know anything else.

Rgsafety:
I completely understand the desperation in wanting r-e-l-i-e-f from high intensity pain, but I have to wonder if the surgery proposed (repeated fusion L4-L5and likely smoothing of articulations surfaces and fusion L5-S1) will provide you with a post-operative life without pain.

The bony degeneration of L5-S1 is likely due to the extensive lumbar fusion, itself, and increased mechanical forces translated to the L5-S1 articulation.

The failure of the L4-L5 fusion is also likely a reflection of these same mechanical forces. The imposed rigidity of the fused vertebrae higher up (L1 through L4) lended to extreme biomechanical forces at the lowest lumbar level, causing movement and impeding a solid bony union.

A repeated fusion at L4-L5 and a new fusion at L5-S1 will be at risk for a similar scenario - micro-movement due to altered biomechanics from an unnaturally long rigid lumbar spine and pseudoarthrosis.

You report your current pain level, too, as high with significant effect on daily functioning such as walking and sleep quality. It seems highly impacting for two involved lumbar levels (with degeneration of vertebral body and failed bony union) but without nerve root impingement.

What has the surgeon discussed in terms of realistic surgical expectations?

I wonder if an approach involving targeted direct drug therapy (i.e. an implanted intrathecal pain pump) would give you the desired goal of pain relief without additional invasive surgery and the unknown sequela that can accompany surgery.
I would consider an implanted pain pump as an alternative first consideration to additional surgery.
Karen

Just an update:

My workers compensation Insurance company is now denying my two new surgeries. They've designated them "unnecessary".

I guess it will soon be "Lawyer Time."

I'm actually, also, pursuing possible benefit of a morphene pump.

We'll see!

Rick

RG:
Maybe, just maybe, the insurance hesitation in authorizing the added lumbar surgeries is a blessing and a way of highlighting prospects for an intra-thecal pump (pain pump).

That a lengthy fusion was initially performed (L1-L5) is at play with your current lumbar dysfunction and pain. The lumbar spine is meant to move. The biomechanics of the lower spine are forever disrupted with a full segmental lumbar fusion. The degenerative changes noted on your recent imaging and failed fusion at L5 are likely due to the altered biomechanics from the initial fusion.

The fusion may have been what you needed at the time, but added surgery to restore the fusion at L1 may not give you pain relief nor a long-term solution. Altered biomechanical forces will continue to be in play, as the body will have to continue to shift forces of weight bearing, gravity, and translational forces of the body in motion. Think of Tiger Woods and tremendous forces at play when he unleashes a long drive with a 9 iron on the fair way, and you can appreciate the lumbar spine at work.

All to say . . . An intra-thecal pump (pain pump) may be the better option for you than additional surgery. In that pain and the secondary effects of pain are your primary presenting issues (no neurological deficits) the intra-thecal pump may be the wiser option.

It certainly would be worth trying an intrathecal pump before pursing a more intrusive surgical remedy.

Failed back syndrome is real. I cannot tell you how many individuals I saw when I was practicing as a physical therapist who underwent repeated back surgeries, thinking that the next surgery would be the Holy Grail that would bring pain relief . . . And wasn’t. Each surgery brought a higher level of pain and a higher degree of impaired daily function/self care. The final blow would come as the surgeon would remark, “There is nothing more that can be done.” These patients unexpectently were dismissed and tossed to the side - with lumbar nerve roots that had been overly traumatized with repeated surgeries and resulting pain hypersensitivity. It was heartbreaking to see.

In that you have no neurological deficits (a positive finding, to be sure), an intra-thecal pump may be the better means of giving you pain relief and a renewed quality of life.

Every surgery has risks. No surgery should be taken lightly.

Give the intra-thecal pump extra thought.
Karen

RG,
I just reread your initial post, and while I agree that other opinions need vetting and a discussion about a pain pump: I had a nonfusion in after a C4-7 neck fusion (ACDF). The pain was beyond words. I endured it for 5 years. Eleven days ago I had it fixed, that is they went in posterior and fused C5-T1 with rods and screws. The minute I woke that awful pain was gone! Making the post op pain feel like nothing, that is how bad my pain was! I was so scared to have the surgery since the first one was awful. This has been manageable. A nonfusion or pseudoarthrosis is torturous pain. A revision will fix it. BUT THERE ARE RISKS.

The first one is if you get it fixed it is your last chance at fusion. Mine too. Which means you have to be extra careful for a long time to let your bones heal. Diet, exercise, limitations, a bone fuser in my case etc. I am very worried I will not fuse again. My neurosurgeon said my bones were soft and they complicated my surgery. He wasn’t able to get the anchors in like he wanted because of my soft bones. So in one spot he even used a smaller screw, but it went through the bone and now sits on a nerve making my finger completely numb and my arm pain worse. We don’t know if this will get better, worse or stay the same. I don’t care if my finger becomes paralyzed because the awful pain is gone. If I fuse and it gets worse they can go back in and take out my hardware. If I don’t completely fuse I will be looking at an external brace the rest of my life. So surgery is not without risk. I am hoping I fuse, I guess I will know more as I heal.

So make this decision carefully. I feel your pain (or did). Get the best neurosurgeon you can if you make the decision, I can say it will stop that broken back pain, but the question is at what potential risk?

My heart goes out to you. TN