[Vicki40]

#9126

Hi Everyone,
Will try make this as brief as possible. I was 18 when my lumbar pain began, severe disc bulges at L5/S1 and L4/L5. I ended up having surgery a few years later, due to the chronic unbearable pain.
In the early 1990’s I had a double spinal anterior/posterior fusion L5-S1 and L4-L5. 2 yrs later had L4-L3 fused. Then my pelvic joint was out and was told I needed to have the sacro-iliac joint fused on the left side. I have always had left sided severe leg numbness and weakness which has gotten worse over the years.
I will say each surgery was successful on paper and for short periods as it only lasted 6months to a year max before it flared again in the next level of spine. Then the Dr’s realised I had DDD and degeneration of the spine.
In 2001 I had a spinal stimulator implanted which was the best thing I ever did, was off all pain meds. Unfortunately in 2002 I was in a car accident, sitting at red light and a car rear-ended us. I had severe whiplash, so now have neck problems as well, but it made a mess of the spinal stimulator. They could not get it working again and because of the damage could not replace it.

Hence here I am 11yrs on, and I’m having severe thoracic problems around the T11-T12 level. I don’t know how to deal with it, It seems if I compensate for my lumbar pain I stir my thoracic pain up.
I’m not looking at having any surgery unless it was critical or its definitely going to help. I was wondering how others have worked around it and what have they done that helps them to cope on a day to day basis.
I don’t know how to proceed and am struggling on a daily basis. I have severe left leg weakness and numbness, also have left foot drop, last few months the right leg has developed weakness as well. Now have chronic lumbar and thoracic pain and neck pain. I’m getting a lot more migraines and can feel my neck and top of spine is out, there is swelling in the neck and top of spine at the present moment, mainly when it flares up.

I have had chronic pain for over 15 years but have managed it the best I can, I have my good and bad days but knew what I could and couldn’t do. I’m normally very positive and just battle on. I’ve tried everything over the years, hydrotherapy, physio, cortisone injections, prolotherapy, etc.
Since the thoracic pain has flared I’m not coping, its not settling down. I’m struggling to stand after ½ hour and walk long distances, I’m more house bound as I struggle to drive now.
It’s really affecting my life. The last six months to a year have been absolute hell and don’t know how much longer I can keep going if it doesn’t improve a little. It seems to be slowly getting worse and no Drs I’ve been to have been any real help, they just don’t seem to know what I should do, besides rest when it flares. I’m only 41 and want a little more out of life then hanging around the house and lying in bed.
Please if you have any ideas or advice I’d really appreciate it.

Thank you for reading Vicki

[Donald Corenman, MD, DC]

#9130

You unfortunately have a genetic predisposition to degenerative disc disease. I will assume that the fusion of L4-S1 was successful (a solid fusion) and you had some relief from that surgery. It worries me that you had breakdown of your disc at L3-4 only two years later. DId you restrict certain activities before that breakdown or did you go back to your normal life activities without restrictions?

I assume that the L3-4 surgery was successful (solid fusion) and that after that fusion you were instructed how to reduce activities (impact and loading) to reduce the chance of L2-3 breaking down.

Having the sacroiliac joint next fused really worries me as you are falling into the “fusion domino syndrome” where the next joint in the chain breaks down and you have another surgery. You finally understood that this process of fusion has to stop as it is really like dominos falling. This is when I assume you had the spinal cord stimulator implanted, a good choice in my opinion.

I do not understand why the stimulator cannot be replaced. This is performed commonly and if the leads are displaced, these can be corrected.

You have severe left leg pain and weakness. Why? Did you have this pain prior to one of your surgeries (due to nerve compression) and needed surgery to correct this compression or did this pain and weakness occur after a surgery? Did you have a workup to determine the cause of this leg pain?

Did you have a workup to determine why you have thoracolumbar pain (MRI, CT scan, etc..)?

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[Vicki40]

#9134

Hi Dr Corenman, thank you for responding.
Both fusions were successful and I did everything as instructed by Orthopaedic and physio’s during recovery. For some reason it just went to next level.
I was only early 20’s and wish I never had all the surgeries but unfortunately can’t go back and redo it. I was dealing with the then and there stage.

The spinal stimulator was removed by the Pain Dr who put it in, he said there was no way it could be re-done due to the damage and scar tissue in that area. The surgery initially was to fix it or replace it.

I have always had left sided weakness and numbness since before my first fusion. It has gotten progressively worse, which they say was due to nerve compression and why I had the fusions. The foot drop has been there for about 10yrs and I have an orthotic brace for foot drop.

Re: thoracic pain, I have had Xray and Bone scan. My GP – General Practitioner can only order those tests. He sent me to a Neurologist to find out what’s going on with Thoracic. So far they have been very unhelpful and haven’t even looked into tests, such as MRI, etc Even though Neurologist wrote to GP and said there was definite left sided weakness, marked definite increase in foot drop.

I’m not looking for more surgery, but need to know what I need to do to stop this progressing. As it does seem to be getting worse and I’m at a loss of what to do and where to go next.

Just a general note – after my first spinal fusion, when the pain started in L3/L4 my Orthopaedic surgeon, did all the tests, discogram etc. He sent me to the pain clinic hoping they could do the stimulator or something then, they refused as I was a good candidate for another fusion in their books. So was passed between pain clinic and Orthopaedic for a year.
Because I was so young, nobody knew what to do with me, and unfortunately I seem to be back to that place again. Nobody knows what to do with me.

[Donald Corenman, MD, DC]

#9135

A spinal cord stimulator can always be revised. Some pain doctors are not surgeons and therefore are not skilled at certain revisions.

The chronic pain and the weakness sounds to be from chronic radiculopathy. See the website for an explanation of this disorder. The treatment can consist of medications and a spinal cord stimulator.

The thoracic pain origin should be diagnosed by a spine surgeon as neurologists are not skilled at discovering the cause of this pain.

The note to your GP from the neurologist will most likely consist of the cause of leg pain being chronic radiculopathy. See above.

Popping and clicking in your back could be from a pseudoarthrosis. I might suspect the SI fusion but there are three other levels that could contribute. A CT scan might be helpful if there is suspicion of lack of fusion on the X-ray.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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