Chronic pain Support - Lumbar laminectomy

Author

Lumbar laminectomy - Advice Please

staraider

2004-08-21, 7:40 pm

Please provide advice on your experience here.

I am told, after 2 opinions, I need the Lumbar laminectomy for L5,S1.
Complicated by 20+ years of degenerative disc (arthritis), herniated disc,
and grade 1 Spondylolisthesis. I think I basically wore myself out with all
the work/projects renovating the house/yard etc...... Building rock retainer
walls just finished me this time.

a) Has anyone tried the new Dyneses spinal system for the
Spondylolisthesis?
b) Is there any need of concern about the open space left behind from the
laminectomy? Is the exposed spinal nerve subject to injury?

I have been very limited and very uncomfortable for 6 months now.
The 2 months PT gave no results, nor the first extremely painful epidural
shot (never went back for the subsequent shots) My Healthcare doesn't really
care that these are painful and won't approve the fluoroscopy method (hurrah
for HMO's [United Health Care really doesn't care] , try finding a spine
specialist in the plan.....they are clueless) .....but the shot didn't help
anyway.

I tolerate lots of pain, but not sure what threshold of taking the next step
is.

Have to be open here...to see who else is experiencing these symptoms as
well.......
Precursor for a year now.... some bladder control issues (doesn't quite turn
off when done [I'm not lazy] ) and I actually can feel pain and shifting
(crunching sound) during a bowel movement...I prefer not to hold my gas now
when I don't have to.....Lots of gas passed as it relieves the pressure and
pain.(Wife is thrilled with this part)

Leg is very numb all the time, not quite tingling, feels weak but is not,
like a dead log when walking for distances, and has delayed pain if
banged.....
I have the constant ache, and pain across the lower back and can feel that
pesky pain from the herniation. Sitting is worst, can't sleep well, standing
is best...but I'm not a horse and can't stand all day.

Can't do anything to aggravate me....extremely frustrating because I like
working in the yard, on the car, and the house......Sex of course is great
and I'm not to constrained (in the heat of the movement) ...but I am layed
up for 2-3 days after....
I have to dose up on the Ultraset for any of these flare-ups....but am
really trying not to take anything unless it gets bad.

Yes, I'm trying to be a bit humorous in my comments here....but I'm really
frustrated and need your experience and guidance.....

txks
Tom

tsberry@yahoo.com

2005-09-23, 7:01 pm

I've had spondylolisthesis for about 13 years now. I understand chronic
pain, believe me. From what you've posted I would recommend :

1. Change your pain management doctor. Those epidural shots are NOT supposed
to hurt.It may take up to three to get results.
2. Consider the TENS unit from Rehabilicare. Check out their web site at:
http://www.compextechnologies.com/a...cts.html#promax
3. Go to a physical therapist (DON'T try this one on your own).
4. Be careful what over the counter medications you're using. As for
prescription medication, one of the most effective are muscle relaxers.
(Valium, is probably the most effective, but is a habit forming narcotic.)
5. If you can't sleep (due to pain) while trying the above, and you don't
want surgery, look at the Medtronics web site.
6. If you decide to go through the surgery, check to make sure you
a: Understand exactly what the procedure is, and it's aftereffects. IE:
Fusion may stabilize the spine, but puts NEW stress where it wasn't before.
b. The latest surgeries should be minimally invasive (even fusions).
c. Look up your doctor on the internet. Nowadays, if he's been sued you can
check it out on the web.
7. Back braces may or may not work depending on your particular problem. If
you do get one, get it prescribed by a doctor.

TSB

OldGoat

2005-09-23, 7:01 pm

Dear Doc,
I'm really in to you, and you seem to very much know your stuff. I'm not
sure how this post showed up here from the middle of the story, but try and
keep in mind that most folks here are patients, scared as hell patients,
many of whom have total faith in what their docs tell them and when it comes
to drugs, most MD's lay down such a line of crap on these poor confused
people in pain, that even if the MD doesn't lay some bullshit line on them
to avoid Rxing narcotics for pain, usually blaming the DEA for what is just
a lack of testicles, patients have actually come in in dire fear of taking
a drug like OxyContin. "Will just one really make me an addict?" "this stuff
is like Heroin, right, is it ok to take it?' My mother in law said I was a
junkie, being on methadone. Even through it works well on my pain, I don't
want to be a junkie, can I just stop taking it?"
We're terrified, confused, hurting, lost and mislead by the medical
community at times, always by the media and their hunger for sensationalism,
truth be damned. That's really why I'd love to see you here frequently, do
what you want with your "handle". Even if you are just another voice asking
why the media is calling NSAIDS painkillers and declaring them so safe when
they kill tens of thousands or why neurontin is a "painkiller" Rxed in
thousands of milligrams a day, and in excess well beyond what would be used
in an epileptic, trading pain for psychosis. Not even, since I'm sure even
in lucid moments, the pain is still there.
But we are all at the mercy of what our physician says and unless one of us
knows different through their own experiences, places like this are the only
resource we've got, and there sure aren't enough of them. And I'm pretty
sure even with your "handle", people here know we're about information
support, advice, but none of it takes the place of real medical exams and
consultations, but we'd sure like to try to draw a line in the sand, between
"your doc sounds like bullshit, go get a second opinion" and what "could be
medically feasible, but you still need to see your doc, and a second opinion
still couldn't hurt."
I'm telling you you'd fit in well and see some amazing things and hear
amazing stories. People tell me I should write a book about this stuff.
Maybe once I get some talk-to-type software trained, I'll think about it.
There's some childish and irritating "clan wars" in here now and again too.
I won't tell you its all dead serious on topic. Sometimes its funny,
sometimes infuriating, even occasionally dull. But there's good people here,
some in big trouble, some looking at it. But the common thing is pain, what
do I do, where do I go, and where do I go next?
Something tells me you'd be very valuable here and do a lot of good and even
make a few friends. Whatever you decide, it's been good "meeting" you and
hope to see you around.

Best Wishes--og

"DoctorShame" <catscratchfiber@earthlink.net> wrote in message
news:1127034565.875441.75380@z14g2000cwz.googlegroups.com...
>I don't know who you are giving advice to but, I'm pretty sure you
> don't know much about the drug discussed here.
>
> 1)"Valium, is probably the most effective, but is a habit forming
> narcotic"
>
> ******** Wrong, while habit forming all right, valium is not classified
> as a narcotic. We know that it's called a muscle relaxant, anti-
> anxiety agent or an anti-convulsant.
> Narcotics are from the greek narcos which indicates sleep
> induction. BTW, you will never see the word narcotic in a medical
> textbook, because by definition it implies an "illegal" substance. You
> will find the term used in the newspapers and in legal papers.
>
> 2) Why would you refer anyone to the hardware website of the world's
> leading back pain supplier? Back surgery is to be avoided at all costs.
> Once you have anything done from a "lamy to a fusion to a salvage
> procedure to a pain pump and eventually a spinal cord stimulator; the
> companies right there with all the noxious hardware you don't need. On
> average once you have had that first surgery they are counting on you
> having 4.7 more back surgeries. Now you know why!
>
> 3) Neurosurgeons are operating on X-rays, not on people with pain. If I
> took the first 100 people that walk into a store and gave each an MRI,
> forty would have a film which showed that these people needed surgery
> right away according to the standards of the "back pain industry"
> today. Do those forty out of 100 people really need immediate surgery?
> Absolutely not, only one person out of that 40 even has complaints of
> "back pain"
> Once operated on, back surgeons continue to operate on
> "abnormal X-rays" til you are either totally disabled, out of money and
> totally disabled or out of money, totally disabled and in need of a
> psychiatrist. Of course the psychiatrist won't see you now, because you
> lost your insurance when you lost your job for being "sick" all the
> time with "back pain" that you never had to begin with.
>
> 4) If you really have an injury or condition that's in need of surgery,
> lose weight first, then and only then carefully consider the least
> invasive micro-discectomy procedure for less total scaring. Don't even
> think about the much more invasive back screws or fusion or anything
> else from the world's biggest "back pain supplier". Remember, less is
> more and "First, do no harm"
>
> 5) I'll post on the economics of the "back pain industry" later. It'll
> make you want to seek the advice of a gastroenterologist,sic
>

DoctorShame

2005-09-23, 7:01 pm

Can I pat you on the head?

DoctorShame

2005-09-23, 7:01 pm

Here's the definative answer. Read the conclusions, they are not
pretty.

Spine. 1996 Mar 1;21(5):626-33. Related Articles, Links
Click here to read
The failed back surgery syndrome: reasons, intraoperative findings,
and long-term results: a report of 182 operative treatments.

Fritsch EW, Heisel J, Rupp S.

Orthopaedic university Hospital, Homburg/Saar, Germany.

STUDY DESIGN: A retrospective study was performed of 182 revisions
on failed back surgery syndrome from the years 1965 to 1990. OBJECTIVE:
To analyze the reasons for failure of primary discectomy, the outcome
of the revisions, and factors that influenced those outcomes. SUMMARY
OF BACKGROUND DATA: The reported reintervention rates after lumbar
discectomy range from 5% to 33% depending on the type of surgical
procedure. The authors' former investigations reported a revision rate
of 10.8% in evaluating 1500 lumbar discectomies. METHODS: Because the
documentation was standardized, detailed data of all patients were
available. To gain further information concerning the long-term results
a questionnaire was used. Computer processing and statistical tests
were performed. RESULTS: One hundred eighty-two revisions were
performed on 136 patients. Forty-four patients (34%) were revised
multiple times. Generally, recurrent or uninfluenced sciatic pain and
neurologic deficiency or lumbar instability led to reintervention.
Recurrent lumbar disc herniation mainly was found at the first
reintervention. In multiple revision patients the rate of epidural
fibrosis and instability increased to greater than 60%. In 80% of the
patients the results were satisfactory in short-term evaluation,
decreasing to 22% in long-term follow up (2-27 years). CONCLUSIONS:
Laminectomy performed in primary surgery could be detected as the only
factor leading to a higher rate of revisions. A trend toward poor
results after recurrent disc surgery seems to be fateful because of the
development of epidural fibrosis and instability. In severe discotomy
syndrome, a spinal fusion seems to be more successful than multiple
fibrinolyses.

PMID: 8852320 [PubMed - indexed for MEDLINE]

k wallace

2005-09-23, 7:01 pm

<snip>
>
> 2) Why would you refer anyone to the hardware website of the world's
> leading back pain supplier? Back surgery is to be avoided at all costs.
> Once you have anything done from a "lamy to a fusion to a salvage
> procedure to a pain pump and eventually a spinal cord stimulator; the
> companies right there with all the noxious hardware you don't need. On
> average once you have had that first surgery they are counting on you
> having 4.7 more back surgeries. Now you know why!
>
></snip>

Usually I post as the partner of a chronic pain/wound sufferer. But this
(spondylolosthesis) is something I had personal experience with.
To make a long story short:
I was a gymnast as a teenager. I had an accident when I was about 17
that seemed to hurt and damage me way more than it should have. X-rays
were taken, doctors were consulted, and the above diagnosis was agreed
upon. My spinal cord was in danger of being compressed; they decided
upon surgery. My parents agreed to it (as a minor, I didn't have much
choice, or education, about it).
I have several- 4, I think? lumbar vertabrae fused together. I have a
6-inch scar on my low back, I was in a body cast for 3 months,
wheelchair, etc. until I was healed. I took prescription opiates for a
long time- way longer than I needed them, and that became a serious
problem in itself (not that it becomes so for everyone, but it did for me).

I have NO residual pain. I can do yoga, sit in lotus position, do a
backbend, still turn a cartwheel. I have maintained muscular strength
and flexibility for my whole life(I'm 35). I work out regularly, run, do
aerobics when I can find the time- high-impact doesn't bother me at all.

The only back related problems/pain i've ever had was dull aches and
stress during each of my 3 pregnancies, and absolutely awful pain in my
low back during actual childbirth(but I'm sure that's common to women
who haven't had back surgery, as well).

Yeah, my stress tends to settle in my low back, but a hot massage shower
usually takes care of it.

Surgery is not all bad. It can have wonderful results. I could have
ended up paralyzed- even I could see that from the x-rays as a teenager.

one person's experience with orthopedic surgery, anyway.

regards,
karinne

tsberry@yahoo.com

2005-09-23, 7:29 pm

OldGoat

2005-09-23, 7:29 pm

DoctorShame

2005-09-23, 7:29 pm

Can I pat you on the head?

DoctorShame

2005-09-23, 7:29 pm

k wallace

2005-09-23, 7:29 pm