RS1234ParticipantJanuary 11, 2018 at 6:07 amPost count: 2
I had an L5-S1 ALIF procedure back in August 2017. A Zimmer trebacular metal implant was used. The surgery was done in response to degenerative disc disease / disc herniation, which was causing sciatic pain on the left side and impeding my movement (getting up from chairs / any jolting or jarring activities).
I am a 45 year old male, and am of normal weight and am otherwise healthy, I do not smoke. An MRI scan prior to the surgery showed my other discs looked healthy.
My recovery from the operation has been slower than I had expected, early on I had lots of strange sciatic discomforts / pains from walking (left side), but the physiotherapist seemed to think this was normal and that I was doing well. My general practitioner prescribed me Amitriptyline, and I am still taking 20mg daily. I have been fairly diligent with my physiotherapy exercises, stretching / strengthening for thirty minutes, six days out of seven, I walk 3-5 miles daily and I weight train at the gym twice a week.
For the last two weeks or so, my pain seems to be getting worse, particularly in the morning, and some of the pain feels quite similar to how I felt pre-op; sudden pinching type feelings at the site of the operation brought on by certain bending / twisting movements.
Prior to the operation, my surgeon told me that If I start getting pain that is like my old pain, it may be necessary to do another procedure (I don’t know the proper name, but I would paraphrase it as ‘posterior bracing’).
I saw my surgeon at three months post op, and he seemed happy with my progress and effectively discharged me. Because of where I live (UK), it is not easy for me to get a further consultation with him, hence asking for advice here.
I would be massively grateful for any comments about whether what I describe sounds normal, or whether I should try to get back to see my surgeon. I am somewhat hesitant about seeing him again, because I fear further (possibly unnecessary) surgery.
Thank you so much in advance.
R.Dr. CorenmanModeratorJanuary 11, 2018 at 11:04 amPost count: 5919
You had an anterior fusion at L5-S1 for degenerative disc disease and a disc herniation. An anterior approach for a disc herniation is unusual as the surgeon does not open the canal (which is in the back of the spine) and has poor access to decompress the root from the front.
However, you sound to have improved somewhat so I will assume that the surgery was somewhat effective. Return of similar pain at about the 3-6 month post operative time period can mean a pseudoarthrosis (failure of fusion). The simplest next step is a new set of X-rays with flexion and extension views. These should note fusion status. If these x-rays don’t immediately identify the problem (or even if they do note a pseudoarthrosis), you would then need a new MRI. That is unless the device used in the front of the spine has too much metal which would throw off imaging at that level. In that case, a CT myelogram would be indicated.
Dr. CorenmanPLEASE 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.If this forum has helped you, please let Dr. Corenman know!RS1234ParticipantJanuary 12, 2018 at 2:25 amPost count: 2
Dear Dr. Corenman,
Thank you so much for taking the time to respond to me, I am very grateful for your input. I will speak to my GP and report back here with any significant updates in case it is of use to other forum users.
R.Dr. CorenmanModeratorJanuary 14, 2018 at 12:06 pmPost count: 5919
Dr. CorenmanPLEASE 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.If this forum has helped you, please let Dr. Corenman know!
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