Thanks gcoe,

It's good info for me regarding the nerve cell "function" as apposed to just thinking about the pain pattern. I will ask my surgeon to explain this aspect of my condition next week.

I want to understand how the glutes became so wasted as it certainly wasn't from disuse before this episode! I need to establish that there is no barrier to me being able to rehabilitate this muscle function. There is currently "life" in the glutes, I can contract them now, but I am in a lot of pain in my low lumbar/pelvis from the effects of this latest episode.

The fusion was done 2 years ago due to back pain and instability (hardly any disc left and very slight retrolisthesis) I also had intermittent Right sided nerve pain.

gcoe, from my experience I do agree with what you say about the rate (if any) of adjacent segment degeneration above a fusion. Even tho I am in some trouble now It has to be understood that my L4/5 disc didn't degenerate purely in the 2 years it has been sat above a fusion. It was not in perfect shape before the fusion. It had needed a microdiscectomy for a left sided prolapse 2 years before the fusion to cure L5 nerve pain, this discectomy was 100% successful and I have never had any pain on the left side since. We did "top off" the fusion with an interspinous spacer but I had trouble with the spacer 4 months after op and had to have it removed (unlucky!). Even after all that I was fine doing physio exercises, hill hiking, horse riding etc. for most of last year.

The current pain episode I am dealing with started 7 months ago, I had a lot of pain across the level of my fusion at L5/S1, plus at L4/5, especially on the right where I know the Wikipedia reference-linkfacet joint usually hurts, plus some right leg pain (at that time leg pain was not quite as marked as it is now) plus pain running distal from fusion down to lower sacrum. This is why I had the X-ray taken in December. Since then the nerve pain, leg weakness, glute atrophy etc. developed. All on the Right.

I had an Wikipedia reference-linkMRI more recently to check for nerve impingement etc, nothing obvious from this. (bare in mind the MRI is of me laid flat and motionless and may have limited value) So, after the MRI my surgeon tried out the L5 root block. The nerve root block was done recently as a diagnostic and I did get some pain relief 3 days after block which continued to help over the next few weeks. It also seemed to help with my general muscle function as prior to the block I had an awkward painful gait with my right leg rotated laterally. After the root block my leg straightened up a bit and made walking easier, maybe some muscle spasm eased at the time? or just a coincidence? I'm just guessing

Over the last few weeks I thought it had improved enough after the root block to be able to rehabilitate with physio, but over the last few days the right sided symptoms of nerve pain and leg weakness have returned plus the pain in lower lumbar has increased.

This brings us up to date.

If anyone can suggest relevant questions I should ask my surgeon and physiotherapist next week it would be much appreciated.


Sorry it's a bit of a long message but the more you probe the more history comes out!