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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