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HannahCP
11-02-2013, 03:38 PM
Hi there all,

I have seen past posts (which I am unable to locate now - figures!) about studies regarding disc degeneration below a fusion within 5 years of spinal fusion surgery.

The reason I ask is that I am 13 months post-op from spinal fusion (t2-l3) for correction of a 90 degree kyphosis. Since surgery, I've had a great deal of pain in my lower back...under the fusion. At first I thought it was SI joint dysfunction, but that was ruled out after a cortisone injection didn't help...They didn't see anything in my x-rays at my 6 month, but said that if my pain continued, they'd do a CT scan. I had a CT scan done before my 1 year post-op appointment, which was two weeks ago. I explained my pain...hurts to sit longer than an hour...dull ache in lower back radiates toward hip and down legs...can't walk farther than a mile without pain and weakness in leg. So...

The Dr. saw some disc desiccation in my l4 and maybe l5 discs and brought up my pre-op MRI, which did show some darkening in those vertebrae, so it was an issue from before surgery (as I did have some of that pain prior to surgery)...but adding 3 lbs. of metal to those vertebrae has definitely aggravated it to the point where I am miserable....

I am scheduled for a new MRI on Nov. 11th and once I do that, Dr. Lenke said that he will most likely be recommending epidural cortisone injections. Which then will take more time to get an appt. with that Dr...so I am bound to be in pain for quite some time. I am also in physical therapy, but at the moment not focusing on low back pain...just shoulder and neck pain.

But I just wanted to see if anyone else has suffered from degenerating discs under their fusions....and if epidural cortisone injections helped? If I'm only one year post-op and I'm having this kind of pain, am I inevitably going to need a revision surgery fusing me all the way to the sacrum?

Thoughts appreciated!

Thanks

Hannah CP

titaniumed
11-02-2013, 04:27 PM
Hannah

Even though its good to see you posting, its not good under these circumstances.

I have had 6 verified herniated discs now, but not under my fusion....its what led me to have my surgeries done years ago. I went for years with 4 lumbar herniation’s, and yes, it’s a royal pain in the disc.....I also had the crippling sciatica that comes with that. Hip and leg pain is an indicator that something is happening in your lumbar region. Those nerves start in that area.

I was offered the shots, but never did them. I was too busy dying out in Hawaii at that time. That’s when I did my ocean therapy, swimming in the ocean all day long, and it worked. (For a while) I also did VAX-D therapy and that worked. (for a while) I took Celebrex and that worked. (for a while)

Last March, I had 2 verified cervical herniation’s in my neck, above my fusion, and took an oral steroid pack(Methylprednisolone) along with diclofenac and that worked. (I hope for a long while) I don’t want to do an ACDF, but am prepared just in case I have to.

NSAID’s and shots seem to be the route, and after seeing how my neck has done, I have hope. I think that stress is an absolute KILLER. Its not worth it. Do whatever you can to avoid any stress.....Be as mellow as you can. Warm water pool therapy helps to let the material retract. Funny how the nucleus will extrude, or protrude, then retract. Pain will reflect on how this action happens. Ask Dr Lenke for an NSAID to tide you over in case you need them.

Be sure to keep us updated on this...

BTW Linda had her revision a few years ago below her fusion mass. I don’t recall if she had herniated discs.......

Hang in there

Ed

briarrose
11-02-2013, 10:06 PM
Hi Hannah,

I have a degenerated disc below my fusion, between L2 and L3 (fused T2-L2). I found this out at my yearly check-up with my spine surgeon back in March (from x-rays). I'm 5.5 years post-op and I've been having low back pain for at least 2 years. My surgeon recommended physical therapy and injections, but I have not done either at this point. My pain is pretty random. Some days I wake up with bad lower back pain that lingers for days. Yesterday I hurt myself moving boxes and had to rest most of the day, yet I feel fine today. I am taking Mobic for possible rheumatoid arthritis and that may help with some of my pain.

Your pain sounds worse than mine. I prefer sitting, but I need to be leaning back at an angle. I don't know if my or your situation will require more surgery. Let's hope not!

Have you lost any of the natural lordosis in your lower back? I have and I think that is partly why my disc is herniated. My surgeon thinks it's the other way around - the herniated disc has caused my posture to change to compensate for the pain.

I hope you can get some answers at your next appointment!

Shell

Pooka1
11-03-2013, 06:09 AM
Briarrose,

Dr. Hey in Raleigh has had a few blog posts about the issue of making sure the alignment below the fusion si good. As I understand it, he thinks this is the key to not needing the fusion extended. He has blogged about the lengths he goes to (osteotomies, etc.) to get that alignment to save the levels. He did this even on a fusion to L4 which I find amazing... he doesn't seem to ever want to give up on preserving the motion segments.

That is my impression of Dr. Hey. I have never met him but would suggest him to my daughters if they ever had trouble wit their fusions in the future. I like him because of his apparent focus on saving levels, his ability to develop new techniques (engineering undergrad), and is amazingly short operation times.

I also like his apparent tentative skepticism towards BrAIST despite the hoopla. People experienced with research know to always be skeptical.

LindaRacine
11-03-2013, 10:51 AM
Briarrose,

Dr. Hey in Raleigh has had a few blog posts about the issue of making sure the alignment below the fusion si good. As I understand it, he thinks this is the key to not needing the fusion extended. He has blogged about the lengths he goes to (osteotomies, etc.) to get that alignment to save the levels. He did this even on a fusion to L4 which I find amazing... he doesn't seem to ever want to give up on preserving the motion segments.

That is my impression of Dr. Hey. I have never met him but would suggest him to my daughters if they ever had trouble wit their fusions in the future. I like him because of his apparent focus on saving levels, his ability to develop new techniques (engineering undergrad), and is amazingly short operation times.

I also like his apparent tentative skepticism towards BrAIST despite the hoopla. People experienced with research know to always be skeptical.
Unfortunately, even with perfect balance below a fusion, some people will have degeneration.


I had a similar issue as Hannah, though mine didn't start until I was about 7 years postop. I held off surgery a long time by doing daily core strengthening exercises. I wasn't pain free, but I was able to keep the pain at a tolerable level. As it worsened (after another 7 plus years) I had some epidural injections. Eventually, I had additional surgery to have the fusion extended to the sacrum.

Epidural injections can be an important part of the treatment plan. Some people get long-term relief from injections. Even when that's not the case, the injections are often diagnostic (as they were in Hannah's case). If the injection works, there's a high likelihood that surgery at that level will be successful. If it doesn't work, there's a high likelihood that surgery at that level won't help.

Linda

Pooka1
11-03-2013, 03:38 PM
Linda I was thinking about this from Boachie...


If you fuse a 13-year-old to L4, 20 to 25 years later, at the most, he or she is going to have problems at L4-5 and L5-S1 levels. So I tell them to take it easy a little bit, and avoid excessive high impact, rotational sports and activities, no other things that will cause early degeneration. But if you fuse them to L1 or T12, they can do very well for the rest of their lives, provided the remaining lumbar spine is properly aligned and has not shifted.

I also think there is a distinction to be made between fusions that end at L1 or L2 because the structural curve ended there or because the patient was young and the surgeon didn't want to fuse the entire structural curve. Maybe the former might be stable for life if the unfused lumbar is perfectly aligned whereas no amount of aligning can overcome not fusing the entire structural curve eventually. Just a guess to explain your observation in light of what Boachie seems to be saying.

HannahCP
11-16-2013, 12:09 PM
So after having my MRI, it looks like everything is normal. It's good to hear that, but is so frustrating that I am still in so much pain. All they recommended was physical therapy (which I'm already doing) and called in a steroid (medrol) Pak. Have oral steroids helped anyone else on here? I am very skeptical that it will do anything but lower my immune system. But gotta try anything...I've been surviving work days with previous hydrocodone that I was prescribed at 6 months post-op and am getting down to the last bit. I know my surgeon will not prescribe me any more and doubt that my GP would give me a Rx for it. I currently take about 1 every other day....since I am so low. Ibuprofen and Tylenol do nothing. Flexeril doesn't help. Just was reassigned into a more stressful and demanding role at work which makes the pain worse. The nurse said that even after surgery some people have pain and that you kind of need to learn to deal with it....very comforting....anyway, the saga continues. Hoping the steroids help a bit nd that PT provides some help....

titaniumed
11-16-2013, 01:54 PM
Have oral steroids helped anyone else on here?

Yes..... I also took an NSAID (Diclofanac) along with it for my cervical herniation’s last April. It was a miracle. Man-o-man! It took about a month, then all of a sudden there was no pain.

Medrol is Methylprednisolone. Follow instructions, do NOT deviate.
http://en.wikipedia.org/wiki/Methylprednisolone

I personally wouldn’t continue taking the opoid. (Hydrocodone) Of course, I am “anti anti” when it comes to taking chemicals, meds and steroids. I have always eventually terminated my meds during my stints, relying on my body to recover on a chemical level trying not to destroy my liver and kidneys. If you have ever heard the term “safe as milk” then you need to understand how safe milk is. (smiley face)

My 4 lumbar herniation’s in a 70 degree (age 49) year old spine were a disaster. I was offered shots and my reply was “Why?” It seems like painting a rusty car. I “could” have taken meds and destroyed my organs through the years. They understood my logic. Surgery was the only answer. I type this so you can understand my history and attitude. I learned that the easy things like diet control, managing stress, laying down, and hot soaks are my “standards” in living with scoliosis. These are the first things I address if something goes wrong.

Once again, and I will repeat myself time and time again, STRESS is no good. It seems that stress is directly related to disc pain.....I don’t know if there are any studies on this, there should be. I have learned to deal with stress on my own personal level in which I try to laugh at it now, and think of it as another “fun” challenge. In other words, if the house is on fire, start laughing. I know this sounds crazy, but it works. When people come in my office with these “the world is falling apart” problems, I simply smile and or laugh now. They are all very simple things really.

Ed

susancook
11-16-2013, 09:52 PM
Hannah, Corticosteroids are awesome for getting LOTS of energy to clean house! Every time that I go on steroids, my house shines! Major energy boost! Take advantage of it!
Susan....boy, does my house need cleaning....

jrnyc
11-17-2013, 12:40 AM
just a word of caution...
steroids are wonderful...especially the injections, as they can target
specific areas of pain...but if given too much, they can cause cortisol
levels to drop...to near zero...and that can be very devastating and
dangerous...
also, oral steroids can be wonderful...but the body tends to get used
to the dose and need more...patients cannot stay on them forever,
unless they are on a very low dose, to treat adrenal disorders...
otherwise, patients must be weaned off the oral steroids...
and it is possible for the symptoms to return to where you started
from, once weaning is complete.

also, always make all your doctors aware of how much steroid or oral
you have been getting...there is a limit to how much steroid is safe to
be injected over a 12 month period of time.

no medication is safe...i had an allergic reaction to Diclofenac...i did
get about 5 months relief from it before the reaction...but i expected
to be allergic, since i am allergic to Vioxx and Celebrex...
of course, not everyone is allergic...i am glad for those who can benefit
from the relief NSAID's have to offer...
now that i am off Diclofecac, i see how much it was really helping with my
pain.

jess...and Sparky

king14
11-21-2013, 06:37 PM
Hi everyone it's been a while. I actually logged in to ask this very question, and here you are Hannah experiencing the Same thing as me.. and we had our surgeries pretty closely together...
I am having a problem sitting, I too have to sit on an angle back. And cant sit on the floor for even 1 min. (fused T4-L1) with residual curve in lumbar at 19 but a rather large lateral shift.
My hip has been giving me the most problems (got a shot in my hip in August, but don't think it was the right spot cause it still hurts everyday)
I'm on the watch and wait game. But here's whats working for me...
exercise. getting STRONG, I lift weights 3-4 times a week. I walk everyday. I do NO impact what so ever (no running, no step aerobics) it all aggrevates my low back. Massage the LOWER half only. I've had some people work my neck... (even though its unfused) and it wreaks havoc on the rest of my body... Water therapy --and watch your sugar intake.. sugar causes inflammation and I noticed a DIRECT correlation when I splurge for a few days I ache EVERYWHERE
And I Still use "props" when I sleep.
Good luck and keep us posted!
xoxo
I'll keep you posted as well... Part of me thinks that if I fuse lower, i'll relieve my back pain... cause I wont' have the side shift... but I might open myself up to a WHOLE new can of worms... So we wait...

HannahCP
11-26-2013, 09:04 PM
Hi everyone it's been a while. I actually logged in to ask this very question, and here you are Hannah experiencing the Same thing as me.. and we had our surgeries pretty closely together...
I am having a problem sitting, I too have to sit on an angle back. And cant sit on the floor for even 1 min. (fused T4-L1) with residual curve in lumbar at 19 but a rather large lateral shift.
My hip has been giving me the most problems (got a shot in my hip in August, but don't think it was the right spot cause it still hurts everyday)
I'm on the watch and wait game. But here's whats working for me...
exercise. getting STRONG, I lift weights 3-4 times a week. I walk everyday. I do NO impact what so ever (no running, no step aerobics) it all aggrevates my low back. Massage the LOWER half only. I've had some people work my neck... (even though its unfused) and it wreaks havoc on the rest of my body... Water therapy --and watch your sugar intake.. sugar causes inflammation and I noticed a DIRECT correlation when I splurge for a few days I ache EVERYWHERE
And I Still use "props" when I sleep.
Good luck and keep us posted!
xoxo
I'll keep you posted as well... Part of me thinks that if I fuse lower, i'll relieve my back pain... cause I wont' have the side shift... but I might open myself up to a WHOLE new can of worms... So we wait...

That is so strange that we are having similar issues. It's nice to know that someone else out there is trying to find answers as well. I took the weeks worth of the Methylprednisolone pack and I haven't noticed any changes in pain levels. I walk daily but not more than a mile because it hurts across my hip and down my knee and sometimes in my hamstring. I need to try water therapy, but just going to the pool to swim laps doesn't really work for me, as I'm not a great swimmer...I think I'll have to sign up for an actually class or something when the next session at the YMCA starts...I am currently in PT and I am hoping that strengthening my core and rebuilding my back muscles will help...But I feel like its going to be a long road with a lot of soreness to go along with it. I still sleep with my "props" too.

I guess the wait and see answer is the one we have to settle with for now. I hope your pain is relieved a bit! Happy Thanksgiving!!!

And Ed - I'm working on trying to get a less stressful job for the sake of my body! Fingers crossed :) How long did it take for you to feel the effects of the steroid? Was it immediate or does it take time???

Hannah

titaniumed
11-26-2013, 11:25 PM
And Ed - I'm working on trying to get a less stressful job for the sake of my body! Fingers crossed :) How long did it take for you to feel the effects of the steroid? Was it immediate or does it take time???

Hannah

Hannah, and King, you know, this is probably a good idea......and I like those words “For the sake of my body” Maybe, I will tattoo those words next to one of my scars.

“When it comes to making money, its easier NOT to spend it than it is to make it”.....Was that Confucius, or Twain? LOL

Like I mentioned in post #8, I “also” took Diclofenac with the steroid pack and it took around a month..... It wasn’t the fastest thing in the world but sometimes these things take time. When our soft tissues end up inflamed, its like cooling off hot coals in a fire. Try to take it real easy for a while. Don’t bend over, squat with your spine erect like in immediate recovery.

I’m surprised you don’t have an NSAID handy.....Maybe they don’t like handing these out to the younger crowd as they are hard on the body, but work quite well on controlling 90% of the pain. I guess you could ask your doctor. Many of us older scolis have experience with NSAID’s, they are our fire extinguishers. Maybe Linda can elaborate on this subject of NSAID’s and younger folks. Abuse of these meds can promote heart attack. You don’t pop these to add a little sparkle to your day, if you know what I mean. (smiley face)

Hot tubs also work well for pain relief, drink plenty of water as you can lose a few pounds in 20 minutes. Don’t get too excited as this isn’t fat loss, its water loss, and needs to be replaced right away. I found that boiling at 106 degrees F which is about 4 degrees higher than usual hot tub temps is effective at handling 9-10 level nerve and disc pain. In hot tubs, don’t sit, try to keep the body extended straight in a floating position.

Patience and deep breaths...

Keep us posted on how this pans out.....

Happy Thanksgiving.....BTW, go easy on the boxed stuffing....I have read that its bad news. Yams yes, boxed stuffing, no.

Ed