Life after a lumbar fusion.

I had a Lumbar Fusion from L1 Thur S1 about 3 years ago and I haven't been able to stand straight up for more than 1 to 2 hours a day. As the day goes on the more I hunch over. Very hard to walk any distances. I can't lay flat on my back on a hard floor. My physical abilities are less every day. I have been to Chronic Pain Clinics and Physiatrists and get no Help. Anybody out there have any suggestions? Thanks.

Post Edited (Sorry Charlie) : 4/4/2019 8:40:52 AM (GMT-6)

I’m fused from T12 to S1. I would go to a good neurosurgeon and see if you’ve developed or are developing degenerative scoliosis. I was fine and straight for 3 yrs after my first fusion, but when the pain returned, I had another fusion up to T12. The pain was reduced, but then I started hunching over with a curve to the right. My neurosurgeon said I’ve developed degenerative scoliosis and ruled out more surgery, so I had a Medtronic spinal cord stimulator implanted 7-8 yrs ago. I had a program updated (free) to help with the pain where my upper body is turning. I now walk with a cane and teach line dancing using it, to prevent falls. I’ve had a broken ankle and a broken foot and don’t want anything else. Please see your neurosurgeon or another one to find out exactly what’s going on. Your titanium rods, screws and cages are allowable for an MRI, which would show what’s going on in ther. Good luck!

It sounds to me that you have a malpractice claim against the surgeon, unless you're past the statute of limitations.

Sorry Charlie, I would go back to my PCP and ask him for a referral for water therapy. I am not going to say this will make the nerves better, but what it can do is help strengthen up muscles & this can help. If you could attend for a few weeks, then switch to a gym or YMCA that has a heated pool.

What meds have you tried for the nerve issue? I am going to guess perhaps Gabapentin, Lyrica & perhaps Cymbalta? If you have tried these meds without success, consider discussing trying Amitriptiline. It's older medication used off label to treat a variety of issues. Drs use to prescribe it a lot, but when the newer medications came out it pretty much dried up. The only thing about Amitriptiline is it can be sedating, so many people take it at bedtime & it also helps with their sleep.Your dr is correct about nerves having to regenerate on their own & it is a slow long recovery. Treating nerves is a completely different ballgame as you have found out.

You can always obtain a copy of your operative records from the hospital where you had your surgery to see what happened. Unfortunately, this is a possibility with spine surgery. We have had a few members over the years that this has happen.

WIf you don’t have lots of severe pain, the CBD oils should help, but unfortunately there’s not much that can be done for nerve regeneration. They are researching stem cell, but nothings been approved by the FDA. A neurologist might have some ideas, but if it’s really nerves cut during surgery, you may have trouble getting someone to see you. I’m fused from T12-S1 and have never had a problem like this - degenerative scoliosis yes, but I’m holding myself up with a slight curve to the right and a slight hunch over. I still line dance and teach line dancing! You really need to find out exactly what is wrong before you can helped. Have you tried wearing the back brace that you had to wear after your fusion? It won’t make you become straight, but might allow you to walk farther.

Charlie:
There are published clinical papers and research reports on the difficulties you are describing - paraspinal muscle denervation following lumbar surgery/fusion, especially as involved lumbar stenosis as the prior primary etiology.

It is not that any nerves are inappropriately cut or severed during surgery. Rather, the mechanism of paraspinal musculature denervation is a result of altered biomechanics of the lumbar spine as a result of the bony fusion and rigidity that, in turn, cause repeated stretch/traction injury to the affected nerve root(s) and associated posterior primary ramus(i).

Each vertebral nerve root has a posterior primary ramus that exits along the vertebral foramen. The posterior primary ramus then bifurcated into three branches. One branch innervates the immediate neighboring paraspinal musculature (but with no accountable innervation of any lower extremity leg musculature). This explains how people can have focal vertebral muscle weakness without accompanied lower extremity muscle deficits.

It is the altered lumbar biomechanics owing from the fusion and segmental rigidity that are the source of stretch/traction injury to the posterior primary ramus. Stretch injury of the posterior primary rami predisposes the vertebrae above and below the fusion to instability, which exacerbates the original stretch injury - lending to a spiral of further stretch injury, denervation, and joint degregation.

MRI is not a good diagnostic tool. Symptoms often change with position. Symptoms may dissipate in supine and exacerbate in standing.

Electro diagnostics of the paraspinal muscles are the best diagnostic tools. EMG is a highly specific diagnostic tool for paraspinal dennervation due to stretch injury of the posterior primary rami. The study looks for muscle fiber fibrillation(s) and can accurately assess for the degree and depth of denervation.

The National Institute of Health on-line library has several articles on the subject. Type in key words: Paraspinal denervation, lumbar fusion, posterior primary rami, stretch injury. You can read and browse and see if any of the information applies to what you have experienced or are experiencing. Knowledge is power.
Karen