Advice Please After Back Surgery

[Nanook]

Hello, I'd welcome and appreciate any advice. I'll try to keep it concise.

I'm female 51, prolapsed L5 22 years ago, no treatment, I was told to go home and lie flat for at least 3 weeks. Over the years I had sciatica and stiffness on and off. I managed with the odd referral to physio otherwise I just worked around the pain and lived with it.

Two years ago I started to have muscle spasms under my (r) shoulder blade, coupled with alot of pain in my left leg and terrible stiffness. I also have a pronounced stoop and waddled when I walked! I finally convinced a GP to send me for an MRI last August and was referred to a neuro surgeon. She diagnosised Spondylothesis at L 3/4 Grade 1, there was also stenosis at L4/5 but not as bad .She also said I had prolapsed L4 and L 3 was partially prolapsed or to use her words" poking it's nose through"

I had surgery mid March, the day after the op (apart from alot of surgical pain) I could stand upright, stoop was gone and so was the pain in my leg. Unfortunately I had problems with the wound, discovered to have MRSA in it, 3 lots of antibiotics seemed to have shifted it.

I started to get pain back in my left leg as well as my right leg and back ache. I was under the impression I would get intensive physio, this turned out to be wrong. I have had 6 sessions in 17 weeks, 3 included actual treatment, which included cycling on a bike for 10 mins twice and sitting on a gym ball raising alternate arms and legs. I have continued on my own buying a wobbleboard gym ball etc and getting a hold of a dvd for pelvic and core exercises.

I still have a fair bit of pain after walking for 10 minutes. Occup Doc suggested I may have failed back surgery! I now have to wait till Sept to see the surgeon for the first follow up after the surgery.

My questions are...is it a bit early for someone to be suggesting failed back surgery? Any suggestions what else I could do to further my recovery? I managed to see a letter detailing what surgery was done.............L3 and L 4 lamina were removed along the thickened ligamentum flavum at the L2/3 L3/4 and L4/5 interspaces. Facet bones were undercut.
I'm willing to try anything acupunture, tamars also pilates which the surgeon recommended before the op.

Any advice would be most welcomed. I was looking forward to a new pain free life and I'm beginning to think I'm never going to be pain free. I was told this op wouldn t do anything for back pain, however I wasn t bother very much it, it was the leg pain that was debilating. thank you

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[alophysio]

Hi,

1. My initial impression is one of sadness. It must have been bad for them to remove the L3 and L4 lamina. This will make you back VERY unstable. If you can find out if the bone removed was partial or complete, it would help - i would pray for partial removal.

2. Your back problem is not isolated to the low back. To get pain between the shoulders would imply a thoracic spine problem as well. I would find a physio who is very proficient at thoracic spine treatment (they are rare, let me assure you. They should have done at least one of LJ Lee's courses - LJ Lee is the world's foremost expert on the thoracic spine in physio treatment and rehab).

3. Your exercises sound too general for my liking. Try to find someone who can be specific and is familiar with the current research on core stability. I can almost guarantee that the DVD you got is inadequate. Getting these exercises right is tough for good physios to do so patients tend to find it even harder!

Acupuncture might help your short term pain but i don't think will be a long term solution.

Don't know what "tamars" are.

Pilates is no good for you unless the person is a highly qualified and experienced physiotherapy. Alot of the pilates repertoire will be dangerous to your back.

The leg pain and back pain can actually be improved a lot. I have personally helped many people with surgery like yours. The trick is to get the right surgeon and the right rehab.

Good luck! There is hope. You will need to look for good people to help you - that is not to say that the people that are helping you aren't good, it is just that i would have done things differently.

BTW, don't be scared to spend money on good advice and treatment. Is it better to go somewhere for free and be no better or spend 500 quid and be pain free?

[Nanook]

Hi,

1. My initial impression is one of sadness. It must have been bad for them to remove the L3 and L4 lamina. This will make you back VERY unstable. If you can find out if the bone removed was partial or complete, it would help - i would pray for partial removal.

2. Your back problem is not isolated to the low back. To get pain between the shoulders would imply a thoracic spine problem as well. I would find a physio who is very proficient at thoracic spine treatment (they are rare, let me assure you. They should have done at least one of LJ Lee's courses - LJ Lee is the world's foremost expert on the thoracic spine in physio treatment and rehab).

3. Your exercises sound too general for my liking. Try to find someone who can be specific and is familiar with the current research on core stability. I can almost guarantee that the DVD you got is inadequate. Getting these exercises right is tough for good physios to do so patients tend to find it even harder!

Acupuncture might help your short term pain but i don't think will be a long term solution.

Don't know what "tamars" are.

Pilates is no good for you unless the person is a highly qualified and experienced physiotherapy. Alot of the pilates repertoire will be dangerous to your back.

The leg pain and back pain can actually be improved a lot. I have personally helped many people with surgery like yours. The trick is to get the right surgeon and the right rehab.

Good luck! There is hope. You will need to look for good people to help you - that is not to say that the people that are helping you aren't good, it is just that i would have done things differently.

BTW, don't be scared to spend money on good advice and treatment. Is it better to go somewhere for free and be no better or spend 500 quid and be pain free?

Thank you for your reply. The surgeon who did the op has a very good reputation, my GP said if she needed an spinal op that is who she would choose. I figured you couldn't get a better recommendation.She did state I had grade 1.

The info re the op that I gave was copied from a letter between the OH doc and surgeon. The surgeon knows I work in nursing and finished the letter saying, " I would have thought she would have returned to work by now".

Could you explain what unstable back means....or at least what this will prevent me from doing?

The pre op and hospital care was great, the post op has been absolutely appalling in my opinion, with GP's OH and physio passing the buck, none can/or will try and answer any of my question..all I have got is "it could be it might be " , " best wait and see the surgeon".

Re the shoulder blade spasm , ( below shoulder blade ) perhaps I didn't explain it well enough. I don't have it now ( it was what made me ask for the MRI last August) I'm assuming, perhaps incorrectly that , that is when I did in the L4.

I will try and find a physio that teaches pilates. The pelvicore dvd I have is by a Swedish? physio professor called Kari Bo and I find it ok to follow.

I forgot to mention, (again no one can tell me what causes this) I get a strange sensation in my right inner thigh, it's a similiar feeling you get if you pull a hair on your arm but feel it else where, referred pain? It comes and goes, I had it before the op. I just get odd looks and a shrug of the shoulders when I ask, if I could be told where they come from and why I keep getting pain and these odd sensations, I would be able to cope better. I get the feeling since I've had the op, I should just be grateful and get on with it
I certainly didn't expect to have the spine of a 20 year old after the op and I've certainly done/doing my bit to make the most of the surgery.Thanks again.

[Canuck Physio]

Don't know what "tamars" are.

Tamar's is an interesting (what I believe is a Chiro treatment) with the use of a spring charged type of pad, that supposedly placed over the facet joints removes 'subluxations'. It is common in US, I have heard of it in UK, but would not recommend it in this case, and there is no research as to its efficacy, but apparently people respond positively to it

[alophysio]

No probs...

The inner thigh is likely to be referred pain. There are different possible sources of the pain. It could be discs, ligaments, muscles or muscles overworking because of dysfunction elsewhere. Also, it can be nerves or your viscera that can cause problems. And if we are honest, there is also the slight possibility that pysch stuff comes into it...but i don't think so in your case.

A grade I spondy at L3/4 is not a reason to operate. Also, it is not so common that high up...why is it there? Was there trauma? The reason for operation should have been clearly explained to you and would have included things like the disc was pinching the nerves etc and causing your leg pain so we are going to operate to remove the bone so there is room for the nerve etc etc etc.

As for K Bo, she is like the aerobics instructors of pelvic floors - a good strong workout which is great! But it sounds like you need need something more specific for your back.

"Unstable" or "instability" refers to the fact that you don't have the bone (lamina) there anymore so your back is not "stable" like it was before the operation. The lamina is extremely important in spinal stability. At L3/4, it was fractured anyway.

It doesn't sound like you were fused so i hope we can find a solution for you.

What you need is a straight-talking therapist who can let you know what is going on. Don't be timid - prepare ALL your questions NOW. Let the therapist/doctor/specialist know you have a list of questions you want answered then don't leave until you get your answers (and not fobbed off!).

Good luck. Let us know how you have gone.

BTW, don't need to find a physio who does pilates. Just find one who understands how to rehab backs as their speciality...

[alophysio]

Thanks for the "tamars" answer. We call it an "activator" in the land of Oz...is it the same thing?

I have actually had a play of one on myself - i can see some benefits for some patient populations.

My "chiro" patients either love it or hate it. Quite funny really! They either speak highly of it or lament the day their chiro went ot the activator!