Three Level Lumbar Spine Fusion

@sarcher 5/10/17

I am sorry to hear you are going through such pain. This may that may take a while. I have had back pain for 32 years and solved it by 80% recently and over 95% nerve pain is gone - 4 months post-op. A key message here is you need to be your own best advocate to become more knowledgeable and be forward thinking on your approach. Its been my personal experience from a double level fusion performed from the back, (posterior) that this is a major event. If what I am reading is accurate, you indicate a double level "disc replacement" was implanted - which is commonly done from the front, (anterior approach) - next to the belly button. I had a double level fusion 12 years ago and that wears out the disc above and I had an artificial disc replacement (ADR) on top of the old fusion in December 2017 and I am doing very well. My point is posterior surgery is a major event and that may be the major source of inflammatory pain. Also in perspective, most ADR's add 1/2" each, so you may be 1" taller. This causes muscles to be stretched. I read in an international ADR blog that a 3 level ADR case, it took six months for hamstrings to finally adapt.

A discussion with your Doctor about the necessity of ongoing Physical Therapy (PT) (which will include stretching) and medications like an anti-inflammatory (I.E. prescriptions Daypro 600mg x 2 a day) and pain medication (like Lyrica starter dost 50mg x 3 a day, may need to be increased to 75mg dose), perhaps muscle relaxers like Baclofen (use very limited and cautiously) and also 12 hour patches like *Lidoderm 5% (helps tame and dull the pain surface area) or *Flector (very effective in area specific treatment). You may also find relief from Biofreeze - a cool gel that helps trick the nerve receptors to pay more attention to the cool sensation than the pain, especially helpful at night. I definitely prefer the aerosol spray so you can reach around to apply easier - and you avoid getting it on your hands - avoids inadvertently getting it in your eye by rubbing. You can get the aerosol on line at Amazon for $12. Lidoderm 4% cream and roll on is available at the pain section at the pharmacy - the roll on is easier to apply. Off the shelf IcyHot has a cream that is both Lidoderm 4% and a tinge of hot (I like this). If appropriate, CVS has a Capsaicin (pepper plant hot) and I recommend only the roll on.

A key point here is stiffness and tightness WILL cause pain and PT approved daily stretching are important mitigation techniques - again as agreed and prescribed by your PT. Exercises to ask your PT about would be use of a gym recumbent bike may help circulation and pain relief. You might be surprised how effective this could be - but I sat down with my surgeon with a list of activities I wanted to do and asked when it was okay to do them. Walking was his number #1 recommendation - daily. I went to Barcelona for my surgery - was up and walking in 3 days, walked 15 miles the two weeks post-op literally as a tourist. #2 was daily stretching - I have a rope with a loop end that pops over the top of a door and a foot sleeve (like a kink-shop product) that allows me to easily stretch instantly and its easy to travel with. #3 Bosu ball - stand on top and stretch back and fourth (have something solid to hold on to), #4 PT; and #5 recumbent bike. In ending, every patient must be their own best advocate and asking questions off a list and writing down the answers is wise. I refer back to these notes often in those first few months.

The fact is this is going to take time. The good news is that ARD's give you a major advantage in recovery. One last comment is that 'at some point' - as PT approved) stomach and back muscles should be strengthened - for various reasons, but specifically because most ADR's can allow hyper extension of facet joints as the ADR is like a ball bearing and moves faster - not like a regular 'tension in turning' natural disc. So when your torso turns left or right the facet joints at the ADR level move first and may suffer arthritic friction. Good muscle health in the torso core help mitigate that effect. Back surgery is not a solution, its an attempt at mitigation. In most instances, you will need to stay on your game in exercise. If the pain is disruptive to your life, there are procedures like RF Ablation that burn the nerves. This can last for around a year - and allow a cut back of meds. Right now at only 4 1/2 weeks, you are suffering post surgical pain and have a road ahead. RF Ablation is a consideration a good bit down the road "if" its even appropriate. One other consideration is when on so many meds, consideration of liver help supplements Silymarin are likely wise.

My final comment to back pain suffering folks also reading this is that are consideration treatment is to stay on line and dig. After 32 years of pain and every treatment I could find, I spent $29k and went to Barcelona to Dr. Clavel a world top spine surgeon because I wanted a specific model ADR from Spinal Kinetics M6-L. In my situation, it was best. Whether by appeal I will get any money back is unknown. Most cant or wont do that. Places like Mayo are a consideration. What I found out was that the artificial disc (ADR) was invented in Germany in the mid-80s for a professional athlete. Since then its the epicenter of excellence on the subject. My neurosurgeon had performed over 1700 of these procedures (1200 neck 70% double level and 550 lumbar).

Meds: *The Lidoderm and Flector patches may be refused by your insurer. I found that having a doctor willing to appeal this to the insurer for me worked. I did not go to my surgeon for this, I went to my regular internist. There is a difference in liquid and roll ons mentioned above and the patches are what I prefer to get all night long - good night sleep - protection. Creams and roll on's seem to last around 4 hours or so.

You went through a major double procedure. The procedure to remove the hardware was a major event. I hope you fell better with more knowledge to consider. The probability to heal well is in your hands. Be your own best advocate first.

Peace.

JR Chicago

I see him on Thursday. I'm just sure at this point if the pain level is where it should be. The last surgery I had no back pain afterwards just nerve pain for thirteen weeks.

Thanks for your input.