Having Decompression Hemi Laminectomy and possible Diskectomy
I have been having radiating pain through my hip, buttocks, leg into my big toe off and on several years. Physical therapy and a round of oral prednisone would take care of the issue. This past December the pain returned with a vengeance. I tired the normal PT, oral prednisone, three different chiropractors, massage therapy, dry needling, etc with no relief whatsoever. Having been a Mayo gastro patient in the past, I contacted the Spine Center at Mayo Jax. I got in for an assessment with the Physical Medicine Dept. on March 20 – which happened to be the last day for non-essential appointments/procedures due to Covid 19. They were able to add me to the MRI schedule before I left that day. (Yet another example of Mayo going above and beyond. Folks stayed late so I could have that done before returning to my home 400 miles away.) They called me within a couple of days and gave me the findings. They recommended that I try epidural steroid injections before considering surgery. Due to Covid 19, I had to have these near my home but it was late April before I could get that scheduled. The first injection helped my pain for 5-6 days. My second injection which was two weeks after the first gave me relief for 7-8 weeks. I thought I was on my way. The pain then began to come back and gradually worsened. At that point the Physical Medicine Dept referred me to Dr. Selby Chen. Since it was going to be a month before Dr. Chen had an opening, he recommended a third injection to try to help the pain. The injection itself was very painful – totally unlike the first two. I didn’t not get any relief from the third injection and I fact the pain is getting worse. After my appointment with Dr. Chen (I am so thankful for telemedicine), he recommended decompression surgery and a possible diskectomy at L4-L5. Due to Covid 19 they are very backed up so my surgery isn’t until Oct. 8. Has anyone had this surgery and if so, what can I expect? Dr. Chen said I should be able to leave the hospital the day of the surgery or the next day. I’m one that likes to know exactly what to expect with medical procedures. I handle it a lot better that way. If this surgery doesn’t work, my only option will be a fusion which I want to avoid if at all possible. I am very active and have just retired after 35 years teaching, coaching and serving as a school counselor in a public high school. I want to get my lifestyle back. My pain is when I stand or walk. Thankfully I get about 90% relief when sitting. I would appreciate anyone that could share experiences, what to expect, etc.
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@ktrammell1 Yes, Mayo is the best I had a big back surgery at Rochester Mayo. I had the best surgeon. I had some complications, but it was due to one of the medicines, I had low blood pressure till I would almost pass out. The surgeon had to go from T10 to my pelvis, because degeneration had caused a scoliosis and at L 4 & 5 I had stenosis, where the doctor told my husband I must have been in a lot of pain. The surgery was 9 hours long. The anesthesia made me confused and then I ended up having to have a red blood cell infusion. I wasn't impressed with the hospital. I don't think they had enough nurses. I never hardly had fresh ice water and warm water to take my pills and then they would not cover me up if I had gotten up from voiding or sitting in the chair. I am recovering now wearing a brace and cannot bend, twist, or lift anything heavy. It's a rough surgery, but I don't have the sciatic pain down my back, butt and leg. I had a fusion, but feel since yours is at L4 & 5 that I also had a Diskectomy. My nerves very very pinched down there. Stay with Mayo they are rated #1. The surgery and recovery is not fun, but worth it. I have rods and screws in my back. I think you should have the surgery, but I'm not a doctor. My bones are soft and I'm on Tymlos injection to increase my bone mass. Let me Know how things go with you. Blessings. Jeanie
Hi @ktrammell1, welcome to Mayo Clinic Connect. @lilypaws, I was just going to bring you into this discussion. Thanks for your post. @jenniferhunter will also have some great info and experience to share.
Karen, waiting until October will be a challenge. Jeannie and Jennifer and other members know about that too. See this discussion that @lilypaws started when she was waiting for her surgery:
– Waiting for surgery: How to manage the pain while I wait? https://connect.mayoclinic.org/discussion/waiting-for-surgery-1/
@ktrammell1 Hi Karen. It is hard to wait for surgery when you are in pain. I waited 2 years, not because I wanted to, but because surgeons did not want to help me until I came to Mayo. After I got my 6th surgical consult at Mayo, I was offered discetomy and fusion surgery for my cervical spine. I had spinal cord compression, and all kinds of weird radiating pain. I was seeing a physical therapist at the time, and she was buying time by realigning my spine which kept shifting due to muscle spasms. She also used a Dolphin Neurostimulator on my neck which passes a current between 2 hand held devices. That blocks the neurotransmitters for pain signal transmission between nerve cells and it reduced my pain for about a week. She also did myofascial release work to loosen tight tissue and that helped during surgery because it was easier to retract the muscles in my neck. Arnica gel used topically can help pain and reduce inflammation. Ice might help. I imagine you are sitting a lot because there is less pain for you then and every time you need to get up, you have have pain. I've been going through some of that recently too for a different reason, I dislocated and broke my ankle in mid May and only now am starting to weight bear and walk. My leg is much smaller with atrophied weak muscles, and the sprain that happened during the injury is still not healed. It gives me pain in my ankle, foot, knee, leg and hip. I know now what happens when people sit too much, even if it was necessary. Recovery takes patience and the will to do it right.
My experience at Mayo Rochester as a spine surgery patient was excellent. I had a wonderful surgeon and a complete recovery that resolved all the spine generated pain that I had. Waking up from surgery, the pain was gone, and I had the pain from the incision and surgical path instead. I did wait about a month from the time of my consult until my surgery and I did everything to relax and get ready. I listened to music and did deep breathing. That helps with pain if you can reduce anxiety. I was measuring my blood pressure and dropping it 10 to 15 points doing this. Get lost in music that you love. I am told that spine surgery in the lumbar area is a tougher recovery because you are bearing most of your body weight there. My surgeon also told me the best thing I could do was to build core strength to protect my spine. I did that with trail riding my horse at a walk which did wonders for me and helped my recovery. This is kind of what they do at therapeutic riding centers, but they also use people as spotters next to the horse. Kayaking was good for me too, but there will be lifting restrictions at first after surgery and your situation is completely different. I got clearance from my surgeon before I did any of that.
Right now I can't do either of those, and I did return to Mayo for surgery to place internal fixation on my ankle. This has been a lot more painful than my spine surgery and for a lot longer, but that's also because I wasn't able to walk at all. 6 weeks after my spine procedure, most of my pain and incision pain was gone; I just had fatigue and weakness because of wearing a neck brace for 3 months. I chose not to have hardware on my spine and agreed to stay in the brace until fused which is possible to do on a single level cervical fusion.
Get everything organized in your home now to prepare for your recovery and that will keep your busy. I folded all my clean laundry and put it in bins next to the bed and cleaned the house. I put elastic laces in my athletic shoes which kept me from having to bend over to tie my shoes. I could just slip them on and I still use them now even 4 years later. Pack your pantry and freezer with meals that are easy to prepare. You may want a collapsible wagon to pull to carry things in the house (like laundry) as you recover to keep the weight off your back. Get a shower chair or bench and mechanical grabbers so you can pick things up without leaning or getting up. You might want DVDs to watch. After major surgery, you'll be pretty tired and sleep a lot. You body needs that as it is directing all your energy toward healing. A lot of patients sleep in recliners. I slept on the couch a lot since my ankle surgery with my leg propped up on pillows. I have a 2 story house and the bedrooms are upstairs, and I did have a walker on the first floor, and a rolator walker on the 2nd floor. I had to crab-walk myself up and down the stairs on my good leg and arms, stand up and grab the walker. Now I'm able to use crutches and am doing some weight bearing, so it's gotten easier even though things still hurt, but that has slowly improved since the beginning. My surgeon wants me to be able to walk unassisted at my next follow up, so I'm working on it.
As for spinal injections, I had one and will never do another because I had a bad reaction to it, and it gave me a new sharp electric shock pain because the injected fluid had nowhere to go and just created pressure. It was done as a diagnostic procedure before I was a Mayo patient. It took 2 months for those pains to stop altogether, and I had cold sensitivity in my hand from that for a year and a half. These carry some bad risks too.
You will be in great hands at Mayo, and I found everyone there to be very kind and compassionate and you've already experienced that. That helps a lot when you don't feel good. Mayo also has a great art collection at all the campuses, so take a little time to enjoy that before your procedure. I was very impressed with both of my experiences as a Mayo surgical patient. Here is my patient story. Good luck to you.
@ktrammell1 It's the pits when you have to wait. My surgeon told my husband I must of been in a lot of Pain. I had a back fusion from T-10 to t-5. I had stenosis at L4 & 5. While I was waiting I did puzzles on my computer. I tried to keep busy, Still did laundry , but didn't cook much. My daughter would come just to get me out of the house. Wore a mask and felt safe. We would stop at Star Bucks and get a Macha Green tea Latte. Yum. Just getting out of the house helps a lot. I also have an low immune. I'm going to see the immune doctor this month. Like I said, I had to wait a long time before surgery. I had to see a (can't think the type of doctor) to put me on to help my bones get stronger.. He put me on Tymlos, which is an injection, with a very small fine needle into my stomach, but it's very expensive , but the cost is going down. I think it was an endocrinologist. I had to wait 3 months to get into him.
The pain doctor had an ablation done on me, that just help little while. Had to go for a bunch of test at Mayo for the surgery. It was a whole year from the first Year I saw the surgeon, but at that time I did not know whether I would have the surgery or not. Prayed to God and he said Yes. My doctor said I needed the surgery and so did my husband. Like I said I just kept busy before the surgery. My right leg would drag. That's the leg I had sciatic down. From your first sentence I can tell you need the surgery. I also rested, because I was very tired. You have so much more wrong with than I did. You must be in A LOT of pain. My neck is bad too, but now sciatic down my arm. Try to think positive.
I also had epidurals that didn't work. I still have pain from my surgery fusion in my back, but it was a a 9 hour surgery and very big. I wish I c ould tell you more how to wait for your surgery. Like I said I kept busy and did puzzles on the computer, plus did some entering on our spread sheet. Think positive and all is well, but I know it's hard. I had to wait a year for my surgery. Jeanie lilypaws
Does anyone have any suggestions for dealing with this excruciating sciatic pain while awaiting surgery? I refuse to take opioids. I’ve had no relief at all with Neurontin, Nabumetone, Tramadol, Advil, Tylenol, Muscle relaxers, ice, heat, Tens, massage, PT or Chiro. Due to two previous GI ulcer bleeds, I have to be very cautious with NSAIDS.
As a nurse (and patient who has taken opioids and never gotten addicted), if none of those things you listed help…why do you refuse to take them? Look, you may have a very valid reason – family history of dependency, they made you feel sick when you took them before, whatever. That is your call and I respect it. But IF you refuse because you are frightened of becoming addicted, then I think you need to have an honest talk with your MD. If you need some quality of life, consider trying them. I can honestly say I would not have made it to my jaw joint replacement surgery (a 9 year period of pain) without using them, especially the last six months. By then I was using slow release morphine and hydrocodone, latter for break through pain. Muscle relaxers, aspirin, ice. I would NOT HAVE SURVIVED. The only other thing I can think of is if you have access to medical marijuana? Worth a try. Thing is, the more pain you are in, the more tense your muscles become, it’s a never ending cycle. Ugh. Good luck. I hope you can find some relief! How long do you need to wait for surgery.
Good afternoon Karen. May I welcome you to Connect even though I am a little late in doing so. You have been through the wringer, so to speak. Waiting and wondering is a mentally exhaustive state of being. I have read all of the replies to your request and there is a lot of experience in those responses to similar situations. None of the options mentioned were available to me. I didn't live where there were surgeons like you require. I thought the sciatica was just a hip or leg issue.
When I learned it was my lower back, I succumbed to a laminectomy. Post-surgery, I was hospitalized for 2 weeks because something just wasn't right. I remember that it was dark and dreary and depressive. PT twice a day and ice. When I returned home things just didn't work out. I found another surgeon who told me that the recent surgery had been done poorly. I needed a fusion. For some reason, he told me to wait until I was in pain 99% of the time and then he would do the fusion. As I waited for quite a while, I decided to stay working. I made some adjustments. When it was my week to drive in the carpool, everyone met at my house. I lay in the back and someone else drove.
My main responsibility at that time was as a college counselor. So…..when my clients arrived, I lay on the floor and they sat in my chair. Another "get-a-round". Finally, It came time for the fusion. It was done beautifully and to this day I use the healing exercises given to me to prevent any further issues.
Karen, I noticed that @wisco50 suggested medical cannabis. My life today can only be called life because of my commitment to medical cannabis and its ability to keep pain and discomfort under control. If you would like more information about medical cannabis options, I am happy to share what I have learned and experiences. The industry is moving quickly and the products, although confusing at first, deliver on their promise.
Stay in touch with Connect. There are always new folks becoming members and sharing knowledge that is often in the best interest of everyone's quality of life.
May you be free and protected from inner and outer harm.
I would like to learn more about medical cannabis. It is not legal where I live. But is sold in neighboring states. I having pretty bad insomnia. Only thing that works are medications though I think they make me feel tired the next day. My insomnia is related to neck discomfort (long story, detailed elsewhere, I believe) and anxiety related to diagnosis of PTSD related to when I had terrible jaw pain for so long. Last year while in a marijuana legal state I tried some and slept well, woke up well. Hmmmm….!
I don't have any suggestions on alleviating sciatica pain–I'm on that journey myself and have experienced some relief with a series of two epidural steroid injections. (Both of these injections hurt. The second worse than the first.) My physiatrist can approve patients for medical marijuana here in PA, and he said he thought I was an excellent candidate and should try it. I began using cannabis tinctures about two weeks ago. I take Wellbutrin for anxiety, but the cannabis has been more effective and I'm going to discontinue the Wellbutrin. I have trouble sleeping, and the cannabis has also helped with that. The pharmacist at the dispensary I go to suggested a 10:1 CBD:THC product. I'm not certain of the pain relief. I am going to try a 19:1 tincture and see how it goes. I am very new to cannabis, and I am learning to read the ingredient list and check mg/ml, not just rely on ratios. I would welcome learning about others' experiences with medical cannabis. My physiatrist feels I will definitely need surgery at some time, and he and I are both waiting to see if this second cortisone shot provides enough relief that I can feel "normal." I injured my back in early March, and was diagnosed with endplate compression fractures of L4 and L5, a bulging disc at L4-L5, and (icing on the cake) severe stenosis at L4-L5 and mild stenosis at L3-L4. And until this happened, I had no back trouble at all! Ah, life. If I do have to go the surgery route, because we're in Pittsburgh, I will need to remain local with a neurosurgeon. We do have two large teaching medical centers and neurosurgery practices associated with both.
@jellycats Out of curiosity, I looked at rankings in Pittsburg and UPMC Shadyside is ranked #24 in the nation for neurosurgery by US news. I also found a surgeon listed from there in the Becker Spine Review as a surgeon to know. https://www.beckersspine.com/spine-leaders/item/13640-spine-surgeon-leader-to-know-dr-david-okonkwo-of-the-university-of-pittsburgh.html When I was searching for a neurosurgeon for my cervical surgery, I looked up everything I could find about a doctor I was interested in, and looked for online videos. By doing that, I found presentations by surgeons at conferences and I learned a lot about spine surgery and I read medical literature. That helped me evaluate surgeons who were evaluating me because I knew what their answers should be and I knew if they didn't understand my case or suggested other medical issues, that they were not interested in me as a patient. Another thing I tried to assess was how happy was a doctor in their career life balance. Physician burnout is high among spine surgeons. I felt like I would get better care if my surgeon was focused and interested in his work and happy in his life and I asked other providers I saw at the same place about the surgeon. When I met the surgeon face to face, I knew he was calm, intelligent, and had a great sense of humor. Some of the surgeons I saw previously were arrogant and unwilling to spend time to answer my questions and all of them missed connecting my symptoms to my spine problem, until I got to Mayo. I had my surgery with that calm doctor who loves his job and who knew the right answer about my symptoms. I knew the answer too because I found medical literature with cases like mine and sent that in with my request for an appointment. I watched a video interview I found with Dr. Joseph Maroon at UPMC talking about his life and what he did to overcome his own physician burnout and he is highly regarded there. He said he actually quit neurosurgery for awhile and turned his life around with proper exercise and nutrition which gave him back a better outlook and family life. It's a high stress job. As patients, we don't always think about how much a doctor sacrifices in their own life to be there for us. I want a doctor who wants to be there and will not be distracted by other issues. The spine trauma you have with end plate fractures needs a highly qualified trauma spine specialist. You should get several opinions on how surgery should address that. I would also ask doctors you respect who they would choose if they were the patient with your injuries. It will be a long recovery, and do what you can to insure it will be a success.
I found a Seattle science Foundation video of a surgeon explaining classifications and treatment goals for spine fractures, and he just happens to be at UPMC. That's good news that their doctors are out teaching other surgeons at conferences. The video also mentions other health conditions that are not good for spine surgery. This may not be exactly like your case, but it's interesting to see how doctors think and talk about solving cases. I don't know if there are any surgical photos as I didn't watch all of it. There are x rays, and power point slides. Here is the link.