low back pain 5 months after hemilaminotomy L3/L4 and L5/S1

I've been having low back pain for several months following hemilaminotomy on L3/L4 and L5/S1. I had gone to the ER for pain at that time and was admitted and had emergency surgery the next day.

It's been over 5 months and my pain prevents me from doing anything, including sitting and sleeping. Current prelim MRI report shows:

-partial lumberization of S1 vertebral body.
-status post right hemilaminotomies from L3 to S1. There is scarring in the soft tissues posterior to these levels.
-straightening of the normal lumbar lordosis.
-T2/STIR signal in L3 and L4 vertebral bodies are consistent with degenerative changes.
-multilevel disc dessication greatest at L3-4 to L5-S1.
-L3-4 demonstrates disc bulge with prominent right foraminal component and facet arthrosis. Small enhancing scar in right aspect of the canal. No significant spinal stenosis. Moderate right neuroforaminal narrowing.
-L4-5 demonstrates minimal disc bulge without significant spinal canal stenosis. Mild/moderate right neuroforaminal narrowing.
-L5-S1 demonstrates minimal disc bulge without significant spinal canal stenosis. Mild/moderate bilateral neuroforaminal narrowing.

I am concerned about these recent results so soon after my surgery. I have not fully recovered from previous nerve issues and now I have new pain and possibly new nerve issues. I have tingling on the bottoms of both feet, and constant muscle twitches from my back to my calves. These twitches are in my inner and outer thigh. I have butt and hip pain and my back feels tight all the time. I have some pain down the back of my thigh and on the front of my lower leg like the shin area.

I also have neck pain but I am waiting to see surgeon to get that checked. I am sure I have something going on there too because I gave neck, shoulder and shoulder blade pain along with numbness and weakness in my arms and hands.

Is my MRI stating I will need another surgery?

Dear MT,
Have you ever heard of the expression "once bitten twice shy"?

I won't pretend that the report is good; it's not, particularly the right foraminal component at L3-4. That's what causing the shin area pain. You have multiple level issues and hence the pain and twitches, known as fasciculations from multiple levels.

You are suffering from what the literature describes as failed back surgery, and there simply is no easy solution. I won't pretend that chiropractic has a miraculous solution; it doesn't.

If I was you I'd stay away from more surgery, and in your neck too. You don't want to have the possibility of failed neck surgery on top of all this.

Take three months off; do gentle back exercises every hour, lie down a lot, getting up every hour to walk about and sit very little. Find a local swimming pool where you can lie on your back and kick up and down the pool for half an hour every day.

Go for short walks every hour, perhaps as little as five minutes initially, just to the toilet and back and around the house. Don't bend at all. Try very hard not to cough or sneeze. If you're a smoker, quit entirely.

Start on a daily soup of bouillon made from chicken bones; look to antiinflammatory foods like olive oil and jalapenos, and omega-3 rich foods like fatty fish and freshly ground flaxseed. Become a health nut of note.

Go for a twice weekly massage from an experienced masseur, but lie on your side.

Perhaps see an experienced chiropractor, if you can find someone who will take on your case. It won't be easy.

The alternatives are too ghastly to contemplate. Another surgery, followed by another, and to your neck.

Partial lumbarisations and sacralisations are difficult for chiropractors too. Very careful examination to assess where the problem is will be required.

Use alternating ice and heat on your back a couple times a day.

Personally, I would love a challenge of a back like yours, so you might start looking for a chiropractor who will spend the time to carefully examine and treat a patient like you.

Be careful; no silly buggers.

I wish I could be more helpful. Exercise, ice, common sense and much less sitting and no bending is the rule.

Let me know how you get on.

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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