L2 – S1 spinal fusion pain questions

@drxtract
Hi, there. I am about 4 months post L3-L5 decompression and fusion surgery. I was told it could take a full year to recover and see where my symptoms stand. Before surgery, I had severe central stenosis and neurogenic claudication caused by degenerative disc disease and congenitally narrow spinal canal. The pain/weakness/numbness in my lower back, hips, buttocks, legs and feet was really bad and affected standing, walking, stairs, etc. Post surgery, pain was 11/12 out of 10 off the charts! It started to get better over several weeks and my numbness improved noticeably.

After 2 months, it seemed I was getting better and then all of a sudden I started to get significant pain in my hips/hip flexors which made standing, bending over, walking and stairs very difficult. It feels like severe nerve pain. I have been taking NSAIDs that don’t really help, use Voltaren pain gel, capsaicin nerve pain cream and lidocaine pain patches. They help a little but not much.

My primary doctor finally prescribed me Lyrica 25 mg once per day for nerve pain. I tried gabapentin in the past but that made me too dizzy/sleepy. It took me a while to adjust to Lyrica but now I am less dizzy and it helps numb the nerve pain a bit. I see my doctor tomorrow and she may increase me from 25 mg to 50 mg. I also take antidepressants and antipsychotics to help me deal with major depression due to chronic pain.

You may want to see if you could go to a pain management center to help you manage pain now that you are 3 months the out from surgery. Surgeons don’t really do much for long term pain management post surgery/follow-up so don’t suffer in silence. You may want to try the Salonpas large pain patches on your lower back above your left buttock to see if that helps you when standing/walking to minimize the nerve pain. You may also want to try ice to relieve any inflammation that irritates your nerves when walking. If you had any neurogenic claudication before surgery, I understand nerves may regenerate after surgery and cause nerve pain while healing.

Hopefully, you will start to feel some relief over the next few months. A big milestone is 6 months and then you will see where you are with symptoms compared to pre-surgery symptoms. I reach the 6 month mark in February.

I feel your pain!….. I have had several back surgeries. The first one was years ago & went well. The second two were “ back to back”:( cruel joke) & I haven’t been the same since. A lot of hardware put in & I am in excruciating pain every day! …..nothing helps….I have a hard time sleeping….the hardware is pressing on my ribs…& if I try to straighten my back….it is very painful….this is getting pretty old!!!
God bless us all!

@drxtract I’ve spoken with @dlydailyhope quite a bit and will agree with her see pain management surgeons are just there to FIX the problem . The Salon Pas patches will be your best friend and you can even try the roll- on it’s easier to do if you’re alone. Since your fused to S1 be careful twisting or bending I was twisted at 3 weeks after an L4-S1 fusion and then told by my surgeons np I could start bending and twisting at 4 weeks , that night I bent to dry my lower legs and there was a burning that has never improved since May 2023. The anal and groin pain got worse, it started feeling like bottle rockets being launched in my legs! I just found out a few weeks ago at Mayo Clinic I have a screw loose at L5 and leave it alone and get a pain stimulator which I just finally had the trial put in Tuesday and it has helped! Good luck and don’t ever be afraid to ask questions even if they sound silly odds are others have been there and have great advice!

For me 25mg of Lyrica/PreGabalin would be those lowest taper dose before stopping it altogether.

You can still have post op swelling. But honestly you need to talk to your surgeon or the triage nurses. You should be having a 3 month post op anyway. Everyone is different. We would have to know every detail of age, your condition before and after, if you are in physcial therapy, etc. Please contact your doctor and get necessary help and pain management. people should be coming to your home if you are not mobile. it is available to get home health. You MUST do the exercises in conjunction with assessment. I've had many surgeries and it sounds like you are reaching out to us and void of the help which is mandated during these kinds of surgeries for you! good luck!

There are many factors here to cause this post fusion pain. Was this a “Harrington Bar” type fusion? Or other? Did you have an epidural to help locate the root cause or an X-ray was obvious to reason why? I am bone fused S1-L5-L4, the Brackets-Rods L4-L3-L2. Two epidural’s lasted 1 1/2 day and where 100% relief, they just didn’t last. A Spinal Cord Stimulator was 60-70% relief and went for implant. They use new leads but tried for 90-100% but instead, went down legs into my feet. 5 months passed and Dr tried again claiming 1 lead wouldn’t come out but still installed two more. Now useless as nothing on the left and 2” away from the right side. They gave up not me. Now a new Dr was shock I never had the sacrum-iliac joint injected. Ok! He did ($375 more) but it gave me the ability to walk up stairs or get up from sitting and lasted 5 weeks. Unfortunately, it was only the bottom 1/3 of my pain. Lidocaine & corticosteroid is injected to reduce inflammation between two vetibral joints. If on target, the right level, it works. How long is the issue. Tell us more…

Yes I have that through an accident 10 yrs ago ,I find an osteopath once a month for treatment helps so much ,

@drxtract sorry to hear about your experience. You didn’t say why you had the fusion whether acute injury or chronic gradual issue? I had my fusion S4-S1 in 1990 after falling down a flight of stairs during an earthquake and my films look a little similar. Due to the amount of work our lower spines do I’m not surprised you’re in pain. I’ve never been out of pain since but not to the degree I was in prior to surgery. Depending on how debilitated were before surgery may pinpoint your problem. You haven’t started PT yet I presume and possibly your expectations are unrealistic? Consider you had major surgery on the I-beam of your body. You need to give your body more time to heal and become one with your new hardware. Your muscles are still sore from being cut and you were most likely in a static position for a long time post-op too. Be gentle on yourself and give it time.

For those who have had multiple 4-5 [or more] lower back surgeries how did you manage to get your surgeon to perform so many? I had the typical L1-L5 fusion 3 years ago. When I talked with the doc about S-1 and/or S2 he was somewhat loathe to do more surgery because of the amount of scar tissue that he said that he would have to go through.

@bajjerfan I can’t even get the surgeon to fix an L5 loose screw after my surgeon refusing to do anything and seeing 3 other local surgeons I went to Mayo clinic in Rochester . I was told rather than have another surgery to go have a stimulator put in. It was great finally having some relief last week from the trial stimulator after 18 months now to wait on the permanent one. My fusion was L4-S1 April 2023 and L3-L5 in 2002