Do Laminectomies Always Work

[Matthew]

Hello everyone,

On the 8th of Feb this year i damaged my back lifting a milk crate full of milk - approx 18kg whilst at work. This resulted in severe back pain and burning/lump feeling in the right buttock and pins and needles feeling/numbness in right calf and foot.
I have had mild forms of sciatica but never to this level
On the 8th April i had a nerve block on the L5 nerve
On the 14th May i had L5-S1 Laminectomy + R) Forminal Disectomy and Rhizolysis and L5 nerve root release.

I made sure i concentrated on moving as soon as i could post surgery. I concentrated on small amounts of walking, trying to do 4 sets of as many minutes i could bare. In addition to a series of light exercises i was hoping to make reasonable recovery a month after surgery. By reasonable i mean, able to sit more or less pain free, walk with a posture i had pre injury and lay down comfortably.

I can only manage 3x 15-17 min sets of walking. The pain just gets too much for me to go longer and it just exhausts me. Sitting gives me a burn in my right buttock and dis comfort in my right leg. A burn in my lower back and an arthritic type ache in my pelvis. I have trouble sleeping as i am unable to lay on my back from the pain. Constantly i have a sharp pain in the base of my spine - cocyx. Physio has not provided with much relief - except traction in the right leg. My medication is Tramal 150mg, Endone 5mg and Celebrex 200mg and Panamex 500mg.

I would have to say on a whole i am in the same pain that i was pre surgery. I am trying to find out as much as i can about this procedure and its rehab. Some people say they were fine after a month, some say they were still in pain 6-8 months later. I was in reasonable health before the injury. I was in off season mode when the injury occured from my low league football club.

Has anyone had this procedure and what was their recovery time. My GP and Physio seem to think that it taking a bit longer than normal. Did anyone do anything particular in their rehab that they found helped. Or was their surgery unsuccesfull, what options were they presented with.

I have an appointment with my surgeon next week and i would like to know what my options i can consider, frustration is well and truely setting in. I understand that putting the boots on is out this season, i just thought i would have been able to walk normally by now, at least sit and sleep pain free.

Thanks

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[gcoe]

Hi Matthew

Yes it does sound like things are taking a long time to settle. However given that you are 5-6 weeks post surgery it is too early to say if the surgery has failed. Things may settle yet. One would hope that the the leg symptoms should be much better by now and I think that is concerning. You should be able to walk further by now - one would expect some discomfort but you shouldn't be in agony. You have a right to be frustrated and concerned and I would definitely seek a frank discussion with the surgeon at your next review.

In terms of the evidence for laminectomies with discectomies (I couldn't find anything that included Rhizotomies) by far the majority do settle down while 14% of patients go on to have persistent pain. Have a look at this site for a summary of a review of several clinical trials:

Results after lumber discectomy for back/leg pain

This minority that have persistant pain is a well documented problem. Your surgeon should have informed you prior to you giving consent that there is a possibility of ongoing problems.

Targeted exercise along with fitness programmes are generally helpful - particularly when the pain turns chronic as it is in your case. You should have started specific strengthening and endurance exercises, not jiust walking but this needs to be guided by your own surgeon and physiotherapist. Exercise should be aimed at increasing your day-to-day activities rather then reducing your pain. What I mean by that is it may be unrealistic to expect exercise to reduce pain but you should be able to do more before the pain gets worse. If you like I can see if I can find some evidence for specific back rehab post-laminectomy.

With your pain medications there are some heavy duty drugs you are taking. Generally this is appropriate for an acute setting but can create problems for you in the mid to long term. You need to get a review of your pain medications as your pain is now becoming chronic. In chronic pain different regimens of medications are often more effective than the current ones you are taking.