Sciatic pain after a laminectomy and L4/L5 fusion

@jlssurplus
Sciatic pain can result from a number of factors, not the least of which is stenosis, which can be congenital (In my case) or due to age or damage, etc.

Treatment depends on a number of things--but if the Surgeon wants you to wait, and you have persistent sciatica, ask for a detailed explanation using MRI and x-ray imaging. Why?

What is the probability of success (reducing persistent sciatica with surgery, fusion?). What are the treatment alternatives? If you do not schedule surgery, what PT are you going to use? Spinal injections? Prolonged use of drugs is something you should be very cautious about! How confident are you that your surgical practitioner has the know-how and has a hospital to perform the surgery you contemplated?

I am likely needing to do an L3-4, L 2-3 fusion later this month because although the L 4-5 fusion in 2017 was successful, my aging body eventually deteriorated more. I can't turn in bed, without significant pain; and usually cannot walk straight until Noon, and with Aleve or Advil. Consequently, I am developing scoliosis.

Ask lots of questions. Life is difficult if you have persistent pain and or cannot move well or be active. It will impact your attitude and clarity of thought.

Good luck.

@loriesco hi! I am new to this group! 53 y o female, active, fit, had L5-S1 discectomy in my 20's, now having spinal fusion L4-L5. My biggest complaint is nerve pain down left side of leg. Surgeon is confident the surgery will alleviate it. I am walking 10,000 steps a day and doing pilates to strengthen my core prior to surgery. Would love to hear some positive stories!

@thankful1
I was told the ablation does not work for stenosis (At least mine).
It targets the facet joints and that is not where my pain is.
I very rarely have any back pain just the down the leg nerve pain.

@rstaunton my pain stopped because the disc fell out and the vertebrae did its own fusion by growing together! The nerves were completely crushed. Same thing with the left leg. Do you have no back pain? In any case I got my life back! Waking up from surgery was an immediate improvement without question I could turn over without the imposing weight on my back. You will do GREAT going in as athletic and strong as you are in your recovery will be GREAT. You do have to give it time. I have had multiple joint replacements and they all take the same amount of time to recover. There is no getting around that you are having major surgery and your body experiences that trauma and needs a couple months to heal itself and get back in shape. The opioid was very helpful for overcoming the surgical pain and being mobile, doing my exercises and rehab and getting back into the swing of things. I am a street artist doing Chalk large Chalk arts in the street and after all of my surgeries (except the cervical spine fusion surgery because I had TWO in one month!)) fusion I was back in the street doing Art at 5 months from age ages 55 to 67. Without my surgery, I would’ve had to end my street painting career. My only advice is to have an orthopedic surgeon who you trust and love. Because I have degenerative disc disease and we agreed to do only a small part (L3 to L5) so I can get up and down in the street. I knew I was going to have to go back for more eventually. I’m probably about at that juncture again 8 years later at 69. What I inherited is genetic. So when I look at my ancestors, I am breaking all the rules and living my best life. I wouldn’t take back my surgery for anything! I just wish I could’ve gotten there faster. I hope that’s positive enough. It’s honest. I am no longer afraid of surgeries because I know the outcomes are liberating. They are a pain in the ass though! Hey, that’s almost a pun!
Oh, I forgot to mention the pain in my leg – yes the pain was gone, but the nerves in my case didn’t completely heal properly. They were crushed beyond the capability of getting back to 100%. I take iron and B12 and a lot of it, and it gets rid of the neuropathy pain. And exercise. It’ll take a couple years at least to figure out what you can expect from nerve damage as nerves regenerate over 10 years. So if your doctor thinks that the pain in your leg is caused by the compression and that’s what he’s going to alleviate I’m sure you’ll get 100% relief but if there’s the kind of numbness and tingling and itching that goes down to your foot, that might be a different kind of situation. Yes all my pain was gone, but the dysfunction might be due to other things in addition to the lumbar release you experience from surgery. Good luck if you have any further questions you can always ask.

@thankful1 It sounds like a decision when there can be variables. One source you may be interest in is a website called mskneurology.com. If you look at the articles section for low back and pelvis, there are some conditions that cause pain that mimic spine conditions. Those are related to muscles causing tight compression of nerves. It maybe worth a physical therapy evaluation. PT may be able to help calm things down or buy some time before surgery. If you do have surgery, there will probably be a lot of rehab afterward.

@jlssurplus Thank you for such a GREAT perspective and information...I had a L4-L5 Laminectomy back in 2017. I am now experiencing a totally different pain this go round. My pain is in my right thigh and it's EXCRUCIATING at it's worse (standing for more than about 5-10 minutes)...When I cook, I cannot even stand anymore, I have to sit on a stool. My neurosurgeon says I need a Fusion now and I'm quite honestly TERRIFIED because of all the stories I'm reading. You've definitely shed some light on what to ask and possibly expect. I too would like to get back to somewhat normalcy and back to swinging my golf clubs and cooking and working in the yard without the excruciating pain radiating down my thigh and leg. In your opinion what kind of recovery am I looking into as far as realistically getting back to work and just being post-surgery pain free?
Again, thank you!

@albertlc13
What levels are they planning to fuse?

I believe it will be L3-L4...I go Tuesday for MRI on Lumbar, Thoracic Spine, Cervical Spine and CT Lumbar.

@albertlc13
If you don't undergo the fusion, how will you go forward in pain? I have found that reviewing the MRI with the Surgeon provides the knowledge about the body that is essential for any "buy in" to undergo surgery. have them show you the pressure point(s) and any degenerative changes in your spine that is causing the pain.

I am facing same very soon. The pain in lower back and down the top of the thigh is a classic symptom. Ask the surgeon to tell you the difference between treating "symptomatic pain" and the cause of the pain. Two different things with often very different outcomes.

Deciding on surgery is a big decision. I have done it 3X. Hope this perspective helps...

@jlssurplus
The restriction period is generally 3 months lifting no more than 8-10 pounds.
No Bending, Lifting, Twisting (So you get a vacation from housework)
Everybodies recovery is different. Usually 3-4 days in the hospital unless the are doing a minimally invasive then it would be less.
You will need someone to help you probably 1st week or go to a skilled nursing facility.
If I remember right my wife used a walker for a couple days.
2-4 weeks and off narcotics for driving
I was told about 3 weeks before I could even go back to work and bark orders.

I have the same issue about standing, its pretty typical nerve pain from Stenosis. One you stand the weight compresses down on the nerve root. A chair with wheels is my friend.