TLIF Spine Surgery w MRSA - what next to do?

Posted by india65 @india65, Jan 20, 2022

I've had 3 fusion-related surgeries, the last an 8hr minimally invasive TLIF (Trans Liminal Interbody Fusion). This done 11 mo ago at Mayo Jacksonville, but lower back pain is still there in spite of all the PT, walking, etc. IF MRSA again, where from here?. If not, a continued nerve issue, where/what to do? Steroids?, pain pumps? What?

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Hello @india65. Have you contacted your surgical team about your ongoing pain? Some pain can come from surgical scar tissue in the fascial layers. I have done extensive work with my physical therapist who does myofascial release to get things moving properly and I am a cervical spine surgery patient. Here is our discussion on MFR.

Myofascial Release Therapy (MFR) for treating compression and pain: https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

Does MFR sound like something you would be interested in trying?

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@jenniferhunter

Hello @india65. Have you contacted your surgical team about your ongoing pain? Some pain can come from surgical scar tissue in the fascial layers. I have done extensive work with my physical therapist who does myofascial release to get things moving properly and I am a cervical spine surgery patient. Here is our discussion on MFR.

Myofascial Release Therapy (MFR) for treating compression and pain: https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

Does MFR sound like something you would be interested in trying?

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Tnx Jennifer Interestingly, aware that after 11+ mo of low back pain, b/c, as a 3X MRSA surgical loser, I'm uber-concerned the source of my pain is MRSA or FAR less so, my surgically related L4 nerve tweak and/or the common, posterior incision damage to related deep back muscles/tendons. Recently, my experienced PT/massage person has focused on this deep tissue, low back/buttocks area…I think – without naming it or saying this may be the cause. I will pass this on to her with the hope hope…before I go back to Mayo/Jax for my 1 yr check – this time predicated by all three imagery diagnostic tools.
BTW Is your connection thru MAYO JAX or ??? Neal B.

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@india65

Tnx Jennifer Interestingly, aware that after 11+ mo of low back pain, b/c, as a 3X MRSA surgical loser, I'm uber-concerned the source of my pain is MRSA or FAR less so, my surgically related L4 nerve tweak and/or the common, posterior incision damage to related deep back muscles/tendons. Recently, my experienced PT/massage person has focused on this deep tissue, low back/buttocks area…I think – without naming it or saying this may be the cause. I will pass this on to her with the hope hope…before I go back to Mayo/Jax for my 1 yr check – this time predicated by all three imagery diagnostic tools.
BTW Is your connection thru MAYO JAX or ??? Neal B.

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@india65 Neal, I am a Mayo Rochester patient. I had a cervical spinal fusion 5 years ago there, and I returned to Mayo Rochester for surgeries for an ankle fracture in the last 2 years. I started myofascial release with my physical therapist probably ten years ago for thoracic outlet syndrome and I have done it on and off since then and it really helps me. MFR has helped me recover from my surgeries by releasing the tight scar tissue. Infections and surgeries will both cause inflammation. That's a good question to ask if MRSA can leave scar tissue in the body. Surgery will create scar tissue that also affects the fascial layers, and when that gets stuck and can't move, it can cause pain as well as dehydrated tissue. You could also ask your surgeon about myofascial release. They may not be familiar with it, but if they are you would be able to ask if they thought it could benefit you.

How did you like Mayo Jacksonville?

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Hello, I am reading your comments re: back fusion at Mayo Jax, I went there as well for my L4-5 fusion one year ago last week. I hope you get some relief soon.
I went back for a check in December, also experiencing lower back pain, below the surgical area though it’s in the left buttock. My NS advice was it hasn’t fully fused and to give it another 6-12 months. I hope he is right. Perhaps I should ask about myofascial release therapy? I’ve been to PT and it did increase my strength but caused more pain quite often.
I also wonder if you’re having an allergic reaction to something. I had a strong reaction to the adhesive used to hold the drapes on during surgery.
All the best, hoping for a reduction in your pain!

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@jenniferhunter

@india65 Neal, I am a Mayo Rochester patient. I had a cervical spinal fusion 5 years ago there, and I returned to Mayo Rochester for surgeries for an ankle fracture in the last 2 years. I started myofascial release with my physical therapist probably ten years ago for thoracic outlet syndrome and I have done it on and off since then and it really helps me. MFR has helped me recover from my surgeries by releasing the tight scar tissue. Infections and surgeries will both cause inflammation. That's a good question to ask if MRSA can leave scar tissue in the body. Surgery will create scar tissue that also affects the fascial layers, and when that gets stuck and can't move, it can cause pain as well as dehydrated tissue. You could also ask your surgeon about myofascial release. They may not be familiar with it, but if they are you would be able to ask if they thought it could benefit you.

How did you like Mayo Jacksonville?

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MAYO/JAX is great..with a top-rated neuro-doc. …& very responsive on the portal but short appointments. Re: Pain I will be asking about the back's multifidus muscles along w L4 nerve, perhaps also tweaked during surgery as well as scar tissue. Maybe all the scheduled imagery may reveal something – hopefully anything!.. other than MRSA! Perhaps too more MFRelease may help.

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UPDATE Hi Jennifer & everyone. Since my Jan. posts I am now quite debilitated, now in pain after 10 min on my feet, limiting my formally very active life…after surgeries, MRSA etc.
My 1 yr, post op exam for my L2 to L5/S1 Trans Laminal Interbody Fusion at Mayo Jax back in Feb. my neurodoc defined one of my pain sources as SI joint – it likely due to "ADD" Adjacent Disk Disorder. (Lower S I joint problems (43%?) are quite common with fusions – it's the physics of the spine's structural aspects).
After no pain relief from a cortisone shot, I will likely (hopefully!) get Step 1 at Mayo's Pain Management Dept – an SI ablation. There may be other investigations because, the cortisone shot was ineffective and I said "one" source of pain. Hidden MRSA return? Surgical stress on ilium/sacrum nerves? MF tear? Who knows? Any comments appreciated.

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@india65 , thank you for your update. I'm sorry you are in so much pain. When we were communicating back in January, you talked about being in physical therapy. Are you still doing that now?

I am guessing that you don't do very much standing or walking because your pain limits you. The problem with sitting all the time (and this happens to me too) is that the hip flexor muscles get too tight, and those are pulling on your lumbar spine. Your pelvis can be pulled out of alignment which also adds pain, and you can have an upslip of your thigh in it's socket, or the illium (hip) bones can be inflared or have a slight twist. I speak from experience here because I have some laxity in my SI joints and when that happens, it causes low back pain for me. This is something a physical therapist would address. I know for myself, there is an easy maneuver to get my pelvis back in alignment. I have overly tight fascia on my left side through my rib cage and connecting to the hip bone as part of the thoracic outlet syndrome that I have. My PT works on that with myofascial release. When my hip flexors are too tight, I can lay on 2 small balls placed just inside the hip bones to release it. A PT can also use their hands to do that if you are laying on your back.

I realize that you have a fused lumbar spine, and I don't know what you can safely do. It is possible that other issues like pelvis alignment or tight scar tissue is creating a lot of pressure that is causing pain. I know we talked about myofacial release before, and I wanted to share this video with you explaining lumbosacral decompression. There is a lot of other information in that discussion and there is a provider search at http://mfrtherapists.com/

Video:
https://connect.mayoclinic.org/comment/247117/
Spine surgeons also do procedures to fuse the SI joints. That is something that you cannot undo, so it is worth exploring all other options before you consider that. I do know someone who had the SI fusion. She also has lumbar fusions that were done first, and had the SI fusion because she was still in pain. I think surgeons tend to think in terms of their procedures, and don't think a lot about scar tissue or tight fascial scar tissue caused by their surgery. They study on cadavers and it doesn't have the same properties or suppleness as live tissue. Your surgeon's comment about adjacent disc disease in your SI joint is a theory at this point. It could be out of alignment which also causes pain. Surgeons do explain that surgery can cause ongoing pain, but usually without an explanation of why that can happen. Let that be, without assigning a cause, and you will be better able to focus on getting better without having a road block in your mind.

This link explains a lot about pelvic dysfunction lumbar plexus compression syndrome. Your spine is fused, but your pelvis can move and change position. This link explains how that dysfunction mimics a lumbar spine problem by creating similar pain symptoms. It is a lot to read, but it will help you ask good questions.
https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/
I have had good results with physical therapy so I tend to think of that first to try to solve a problem and it doesn't involve surgery or drugs. Does any of this sound like something you would consider before trying an ablation? Do you have any alignment issues with your ankles or knees? That too, can affect the pelvis and hips. Custom orthotics can help a lot from a podiatrist. I have them, and I just had impressions made for new ones because my ankle changed with an injury when I fractured it 2 years ago. My PT tells me that alignment is key to prevent wear and tear on knees that can lead to joint replacements.

REPLY
@jenniferhunter

@india65 , thank you for your update. I'm sorry you are in so much pain. When we were communicating back in January, you talked about being in physical therapy. Are you still doing that now?

I am guessing that you don't do very much standing or walking because your pain limits you. The problem with sitting all the time (and this happens to me too) is that the hip flexor muscles get too tight, and those are pulling on your lumbar spine. Your pelvis can be pulled out of alignment which also adds pain, and you can have an upslip of your thigh in it's socket, or the illium (hip) bones can be inflared or have a slight twist. I speak from experience here because I have some laxity in my SI joints and when that happens, it causes low back pain for me. This is something a physical therapist would address. I know for myself, there is an easy maneuver to get my pelvis back in alignment. I have overly tight fascia on my left side through my rib cage and connecting to the hip bone as part of the thoracic outlet syndrome that I have. My PT works on that with myofascial release. When my hip flexors are too tight, I can lay on 2 small balls placed just inside the hip bones to release it. A PT can also use their hands to do that if you are laying on your back.

I realize that you have a fused lumbar spine, and I don't know what you can safely do. It is possible that other issues like pelvis alignment or tight scar tissue is creating a lot of pressure that is causing pain. I know we talked about myofacial release before, and I wanted to share this video with you explaining lumbosacral decompression. There is a lot of other information in that discussion and there is a provider search at http://mfrtherapists.com/

Video:
https://connect.mayoclinic.org/comment/247117/
Spine surgeons also do procedures to fuse the SI joints. That is something that you cannot undo, so it is worth exploring all other options before you consider that. I do know someone who had the SI fusion. She also has lumbar fusions that were done first, and had the SI fusion because she was still in pain. I think surgeons tend to think in terms of their procedures, and don't think a lot about scar tissue or tight fascial scar tissue caused by their surgery. They study on cadavers and it doesn't have the same properties or suppleness as live tissue. Your surgeon's comment about adjacent disc disease in your SI joint is a theory at this point. It could be out of alignment which also causes pain. Surgeons do explain that surgery can cause ongoing pain, but usually without an explanation of why that can happen. Let that be, without assigning a cause, and you will be better able to focus on getting better without having a road block in your mind.

This link explains a lot about pelvic dysfunction lumbar plexus compression syndrome. Your spine is fused, but your pelvis can move and change position. This link explains how that dysfunction mimics a lumbar spine problem by creating similar pain symptoms. It is a lot to read, but it will help you ask good questions.
https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/
I have had good results with physical therapy so I tend to think of that first to try to solve a problem and it doesn't involve surgery or drugs. Does any of this sound like something you would consider before trying an ablation? Do you have any alignment issues with your ankles or knees? That too, can affect the pelvis and hips. Custom orthotics can help a lot from a podiatrist. I have them, and I just had impressions made for new ones because my ankle changed with an injury when I fractured it 2 years ago. My PT tells me that alignment is key to prevent wear and tear on knees that can lead to joint replacements.

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Thanks again Jennifer. Know that though I must be near a place to sit in 5-10 min, I hardly sit! And I have been to sooomuch PT and some MFA therapy. I drive, do restaurants, garden but everything… near a seat…always in level 2-3 pain until level 5 pain forces me to sit. I also go occasionally to the gym with non-back sit machines doing light exercises (the sitting bike), and non-swimming self exercises.
After duel SI cortisone shots, both my nerodoc and recently, neuroradiologist docs seem to think – next investigation S I joint. I am not convinced it isn't something else back down there and I have posited several technical questions and investigations to them…some related to the surgical aspects too detailed for this forum. HOPEFULLY not indolent MRSA again.

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In addition to excellent advice from Jennifer, you may want to request MRI with contrast. Determine if there is any arachnoiditis developing.

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