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Thread: T12 l1 laminectomy fusion issues

  1. #1
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    T12 l1 laminectomy fusion issues

    Hi dr wise

    Im new to your forums. I recently had spinal surgery in late June of this year for what was told to me an emergency situation. Both my legs became weak and my groin was hurting. An mri was done which showed a disc bulge compressing my spinal cord at t12 and l1. The doctor stated this was conus compression. I also had moderate to severe stenosis at l2 l3. This concerned my doctor as well because I was being compressed in two places. The doctor recommended surgery. I had a posterior t12 l1 laminectomy with interbody fusion and instrumentation. I also had an l2 l3 left side hemi laminectomy. The doctor indicated he came in from an angle to insert the cage and did not have to retract or touch the spinal cord. I had no back pain or lower leg or foot pain prior to surgery. The only thing I had prior to surgery was left outer thigh pain which I had for awhile and it was intermittent but getting worse. I also started to get fasiculations in both my calves in the weeks leading up to surgery. The leg weakness came on very suddenly and I did not wish to wait it out so I agreed for the surgery.

    After er the surgery. I awoke with a burning left foot which was on my soles. The doctor said this was normal and was not concerned as the nerves need time to settle and heal. After discharge I still had the burning throbbing pain in my left foot. The nerve pain went down over time in my left foot but I have the nerve burning pain in both feet now as well as the calves. The left outer thigh pain is still there and my genital area feels slight sensations. I was never incontinent nor do I have issues with bowel or bladder other than now it takes a little longer to start to urinate which may be due to the opiates I take for pain. The nerve pain developed on the right foot and calf and the left calf about 5 weeks after surgery. I have had two post op Mris done and one cat scan. One of the Mris was done with contrast. My doctor who is an orthopedic surgeon said he sees nothing wrong and that I have been decompressed. The disc bulge was never removed nor were the osteophytes that were behind t12 and l1. The doctor said it didn't matter because the laminectomy opened up space for my cord. So I have this neuropathic pain in both feet and calves at 8 weeks post op. My doctor says it needs more time to heal. I'm concerned that he may have damaged something during surgery or there is still compression. I'm planning to see a neurosurgeon in Miami at the university of Miami center tomorrow. I am scheduled for a ct myelogram too. I'm a healthy 48 year old male non smoker

    I am very concerned and cannot get good information on what's going with me. Can you provide any insights or suggestions on what I should do or what may be going with me. I can walk fine but tire from the pain. I can provide more info. I would appreciate any guidance at this point.

    Thanks
    jerry

  2. #2
    If your spinal cord was compressed, the surgery decompressing it prevent further damage from occuring. what were your symptoms prior to the emergency surgery? did you have pain? or loss of function?

    You may have regained function but the remaining neuropathic pain may be with you. It may dissipate some. Nerves that are bruised can regain their function. Nerves damages may not.

    Think of it like an electrical cord that got damaged on a lamp. The lamp may work but the wires may still be frayed.

    Get a provider to get you on medications besides opiates to manage your nerve pain. Gabapentin is a first line neuropathic medication, and certain antidepressants are excellent to help the neuropathic pain. Opiates are helpful but after your have gotten baseline meds on board.

    pbr

  3. #3
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    Hello pbr

    i had no pain but only sudden leg weakness. I had a disc bulging into t12 l1. I'm taking lyrica and klonipan 0.5 mg. I feel there is dome reduction in nerve pain since the day after surgery. But I did not have this nerve pain prior to surgery. I came out of surgery with a burning left foot. It still burns 10 weeks later but not as bad. I'm not sure how well the meds work but I take them. I'm hoping the nerves and or cord will continue to recover as nerve pain is no fun


    thanks jerry

  4. #4
    Unfortunately nerve pain never completely dissipates it is managed.
    the medications help because if you stopped them then you would really notice.
    Try an antidepressant that is used for nerve pain
    it also may be helpful to see a pain team that has a pain pharmacist, psychologist, anesthesiologist, nurse and physician to get a big picture evaluation of your symptoms and medical history

    pbr

  5. #5
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    Hello
    i am seeing a pain management specialist, neurologist, neurosurgeon and a new orthopedic surgeon. So far the orthopedic surgeon has recommended a transforaminal epidural with solu medrol at the levels of the spine I had decompression. This doctor has seen my post surgical Mris and has commented on the high level of inflammation that is present. Therefore he feels the shots would help speed my recovery along. My pain mgmt doctor agrees with the shots. I had an emg ncs and the results were good although I have the nerve pain in my foot, lower legs and groin area. The neurologist feels my spine surgeon my have bumped my cord at t12-l1. Of course the surgical report says the cord was not touched at all and the fusion cage went in without having to move the cord. It was an oblique posterior approach. The neuro and ortho docs think I should improve in time. My surgery was 6 29 15. I hope they are right. Any insights ? I am taking a lot of meds including lyrica and Percocet.

  6. #6
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    Hi
    I am taking lyrica 75 mg three times a day. However I get pain in my feet, ankles and calves and it varies from day to day. The opiates help but not as much as I built up a tolerance. My pain is from burning to achey to cold at times. It's been 10 weeks since the surgery. Not sure if the surgeon dinged my cord. He said he didn't touch it. I awoke from surgery with my left foot sole burning in pain. The pain is less but still there. I was told in time it will heal. Other doctor suggested esi due to inflammation he saw on post op Mris. I had none of this pain pre surgery. I have a pain mgmt doctor who wants me to try 25 mcg fentanyl instead of percocets. What can I expect ? How much time?

  7. #7
    It does take a while for the nerves to heal. # months after surgery with Doctor's ok they will usually let you take Naproxen 500 mg po twice a day-with food- this is a NSAID and helps with the nerve irritation. When I had my "simple" laminectomy my surgeon told me to take twice a day until a year was up then about reducing it. If that doesn't help then ESO but I would try NSAID first if you haven't already.
    CWO

  8. #8
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    Hello
    I'm concerned based on my own research on line that the surgical approach and technique my surgeon used was not optimal for my case. I have a calcified disc at t12 l1 which was pushing toward my spinal cord. My surgeon used a posterior approach to perform a laminectomy at t12 l1 with interbody fusion and hardware. The calcified disc was not removed. I have read that this approach can lead to neurological issues. What can you share about this? I don't know what I can do now about it. I believe this may be why I'm having all these nerve issues. Also I awoke from surgery with a burning pain in left foot. It was very bad. I still have the pain 3 months later but not as intense. I also have other nerve pain in both feet and calves. My surgeons report indicated he did not touch the spinal cord or have to retract it to get in the cage. I don't know if that is possible ? Any insights would be helpful. Thanks. Jerry

  9. #9
    There is significant risk for causing neurologic damage with surgery for spinal stenosis or disc surgery. This is one reason that surgery should be considered a very last resort; which I am sure was explained to you prior to having surgery. In addition, the purpose of surgery is to prevent further neurologic deterioration, and there is no guarantee that it will remedy pain. Chronic long term pain after spinal surgery is often called "failed back syndrome" and is a major cause of long term chronic pain in the USA.

    (KLD)

  10. #10
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    Unfortunately my doctor did not explain in detail any of those risks. Not much I can do about it now. Is there an effective procedure for dealing with epidural fibrosis or scar tissue? And are there doctors practicing them? I would really like to know to see if anything can help me. The burning pain is incredibly hard to deal with. Would a scs help ?

    thanks
    jerry

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