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I'm facing more surgery; Advice please anyone?
Topic Started: 11 May 2010, 02:59 PM (2,287 Views)
Lynda
Advanced Member
[ *  *  *  *  * ]
Oh Mrs R,

Sorry you're in this situation; sometimes going with your gut feeling is the best option especially as you are not happy about proceeding with the further surgery right now. I fully understand why you are hesitant to agree to the further surgery not knowing if it would indeed help.

You have nothing to loose by seeking other opinions and just because you don't have the procedure done now does not mean you cannot have it in the future if necessary.

Do you see a pain management consultant? It could be a different combination of medication could control the pain and get you through this? The diclofenac does not seem to be too effective from what you have said. Have you tried the usual heat/ice/tens/massage and other alternative therapies? I found acupuncture some help in the early post-op months for residual leg pain following my lumbar TDR's.

In a way, it is reassuring that both surgeons have recommended similar procedures. I sought several opinions regarding my cervical spine and got a variety of options which just added to my dilemma. I researched as much as I could and eventually went with the option I felt most comfortable with.

I hope the trip to Cheshire and back hasn't increased your pain and that you are able to find a way forward soon.

Two hours walking a day is very impressive and quite an achievement so keep hopeful that the pains you have will resolve one way or another. Have you tried doing shorter walks more frequently, rather than the three walks taking two hours? You may find doing so lessens the flare-up of pain.

Very best wishes

Lynda

xx
May 2008 onwards - Lumbar facet injections - First post-op ones four years post surgery, have lost count of the number I've had since then but they do help. Pre-op they didn't make much difference- Mr Shackleford, Warrington
Feb 2008 - Cervical TDR, (Activ C's) C5/6 & C6/7- Mr Shackleford, Warrington
May 2006 - Craniotomy and resection frontal lobe brain tumour - The Walton Centre for Neurology and Neurosurgery
Feb 2004 - Lumbar TDR, (ProDisc's) L4/5 & L5/S1 - Mr Shackleford, Warrington
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Alastair
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Alastair
[ *  *  *  *  * ]
Hi Mrs R,
I agree with Lynda, and see if that helps, having been an athlete previously this obviously is a big "setback" and you've got to take a step back and review your situation.

As Lynda says you can have the surgery any time at all, if you can just cope with your lifestyle and keep going. Have you tried pain management?
Best,
Alastair :D
Founder of this board 24th February 2007
Slow and Steady Wins This Race
Over 23 Years experience and research into spine surgery and over 2500 surgeries discussed and recorded

ADR L5/S1 Surgery with Dr Zeegers 26th July 2002 in Munich
8 facet joint ablations 28 – 8 – 12 with Dr Baranidharan and Jake Timothy in Leeds Diagnosed Forestiers disease
Your Best Asset Is Your Health
I live in West Yorkshire aged 81 now

Knowledge is power
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Mrs R
Full Member
[ *  *  * ]
Hi all, thanks for your replies.

The problem with leaving the surgery for as long as I can stand is that nerve damage could become permanent, there is no way of knowing.

Thanks for all the suggestions re TENS, acu, heat, pain consultant etc. Sadly I have tried them all. Believe me I have tried everything. I could probably write a book about pain managment. I barely ever take my TENS machine off.

I have made an appt to see Mr John Sutcliffe who is a neurosurgeon. We'll see what he thinks, might have a different persepctive than an orthopaedic surgeon. I do realise I am clutching at straws.
2004-05 After 12 yrs of serious competitive sport, degeneration and tears L5/S1 and L4/5. 6 wks off work and went back p/t only. Told too young for surgery at 31 and that it probably won't help
2005-09 Dorsal root ganglion/steroid injections, amitriptyline, physio, osteopath, pilates and swimming 4 times per wk, back to working f/t
2009 Pain worse, saw Mr Lam at Guys. MRI: further degeneration in both discs and tear in L4/5. Discogram May 2009
14 Jan 2010 ADR L4/5, fusion L5/S1 by Mr Lam
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Lynda
Advanced Member
[ *  *  *  *  * ]
Hi Mrs R,

I'm sorry you're in this predicament, I wouldn't say you are clutching at straws, you have a problem and are simply seeking advice from the experts in spinal surgery, the leaders in their field, in an effort to resolve the issue in the best possible way. Gathering information will help you make your decision although it must be so very difficult when the experts don't know what is generating your pain or whether further surgery will improve your situation or not..... it shows just how complex spines are.

Very best wishes

Lynda
May 2008 onwards - Lumbar facet injections - First post-op ones four years post surgery, have lost count of the number I've had since then but they do help. Pre-op they didn't make much difference- Mr Shackleford, Warrington
Feb 2008 - Cervical TDR, (Activ C's) C5/6 & C6/7- Mr Shackleford, Warrington
May 2006 - Craniotomy and resection frontal lobe brain tumour - The Walton Centre for Neurology and Neurosurgery
Feb 2004 - Lumbar TDR, (ProDisc's) L4/5 & L5/S1 - Mr Shackleford, Warrington
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Gilly
Advanced Member
[ *  *  *  *  * ]
Hi Mrs R. Sorry that you didn't feel any better having seen Mr Shackleford but as has been said at least they were in agreement with your possible treatment. I think you are right to see someone else and as you say more imput the better. Mr Sutcliffe will be able to advice as to how much is nerve pain and how much they may be affected if you do go ahead. I do so feel for you - you should have been recovering well by now but have faith with your walks that you are doing something positive.
All the very best to you
Love Gilly xx
1990 MRI - disc protrusions levels 4/5 - fusion offered but
declined due to poor prognosis.
2007 MRI - disc protrusions Level 4/5 level5/S1
2010 2 level lumbar ADR Mr Ian Shackleford Warrington General

2010 MRI - disc protrusions at levels C4/5 C5/6
2011 27 June 2 level Cervical ADR Mr S at Spire (on NHS)
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Mrs R
Full Member
[ *  *  * ]
Thank you Lynda and Gilly. The pain has actually got worse this week, has spread to the front of my thighs as well. Have not been able to fall asleep before 2 am the past 2 nights, and then only with the aid of dihydracodeine. I did 4 hours in the office today as part of a phased return, I am exhausted. I just can't get my head around the situation, as you say Gilly I am walking so well, my back seems strong and stable, so what is causing this awful pain?

My private pain management consultant has refused to treat me anymore, he says this is because he does not agree with Mr Lam only trying epidural injections on me nly once and thinks they should be tried again. I was totally nonplussed and quite upset by this. The injections did not work so I don't think there's any point trying them again. I think it is an excuse bcause I'm a complicated case, he wants to get rid of me. Very upsetting though. At least he did not charge me for that final consultation.

He also suggested I should see the private pain consultant at London Bridge Hospital because he can do treatments like pulse radiofrequency there. So I am considering this. The pain consultant's name is Dr Adnan Al Kaisy. Has anyone ever consulted Dr Al Kaisy, or experienced pulse radiofrequency?
2004-05 After 12 yrs of serious competitive sport, degeneration and tears L5/S1 and L4/5. 6 wks off work and went back p/t only. Told too young for surgery at 31 and that it probably won't help
2005-09 Dorsal root ganglion/steroid injections, amitriptyline, physio, osteopath, pilates and swimming 4 times per wk, back to working f/t
2009 Pain worse, saw Mr Lam at Guys. MRI: further degeneration in both discs and tear in L4/5. Discogram May 2009
14 Jan 2010 ADR L4/5, fusion L5/S1 by Mr Lam
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Gilly
Advanced Member
[ *  *  *  *  * ]
Hi Mrs R, sorry I don't know anything about the radiofrequency treatment but think you are right to stand your ground with the pain specialist - as you say he probably doesn't know what to do for you next which is his problem ;) . Hope the pain gets easier soon.
Love Gilly xx
1990 MRI - disc protrusions levels 4/5 - fusion offered but
declined due to poor prognosis.
2007 MRI - disc protrusions Level 4/5 level5/S1
2010 2 level lumbar ADR Mr Ian Shackleford Warrington General

2010 MRI - disc protrusions at levels C4/5 C5/6
2011 27 June 2 level Cervical ADR Mr S at Spire (on NHS)
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ajj1001
Advanced Member
[ *  *  *  *  * ]
Not heard of the pain consultant, do you know what specialism he is from? Does he practice in the NHS as well?

The only info I have on the pulse radiofrequency is an article I saw a while back, I'll keep my eyes open for any more info. Hope you get some answers soon.

Percutaneous pulsed radiofrequency applied to the L-2 dorsal root ganglion for treatment of chronic low-back pain: 3-year experience

Journal of Neurosurgery: Spine, Feb 2010, Vol. 12, No. 2, Pages 190-196

Percutaneous pulsed radiofrequency applied to the L-2 dorsal root ganglion for treatment of chronic low-back pain: 3-year experience

Hsi-Kai Tsou, M.D.1,2,3,4, Shao-Ching Chao, M.D.1, Chao-Jan Wang, M.D.5, Hsien-Te Chen, M.D.6, Chiung-Chyi Shen, M.D.1, Hsu-Tung Lee, M.D.1, and Yuang-Seng Tsuei, M.D.1. 1Department of Neurosurgery, Taichung Veterans General Hospital; 2Division of Neurosurgery, Shun-Tain Hospital; 3Department of Materials Science and Engineering, Feng Chia University, Taichung; 4Center for General Education, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County; 5Division of Neurosurgery, Wei Gong Memorial Hospital, Miaoli County; and 6Department of Orthopaedic Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China. ©1944-2010 by the American Association of Neurosurgeons

Object
The authors assessed the effectiveness of percutaneous pulsed radiofrequency treatment for providing pain relief in patients with chronic low-back pain with or without lower-limb pain.

Methods
Data were obtained in 127 patients who had chronic low-back pain with or without lower-limb pain due to a herniated intervertebral disc or previous failed back surgery and who underwent pulsed radiofrequency treatment. Their conditions were proven by clinical features, physical examination, and imaging studies. Low-back pain was treated with pulsed radiofrequency applied to the L-2 dorsal root ganglion (DRG) and lower-limb pain was treated with pulsed radiofrequency applied to the L3–S1 DRG. Patients underwent uni- or bilateral treatment depending on whether their low-back pain was unilateral or bilateral. A visual analog scale was used to assess pain. The patients were followed up for 3 years postoperatively.

Results
In patients without lower-limb pain (Group A), 27 (55.10%) of 49 patients had initial improvement ≥ 50% at 3-month follow-up. At 1-year follow-up, 20 (44.44%) of 45 patients in Group A had pain relief ≥ 50%. An analysis of patients with pain relief ≥ 50% for at least 1 month showed that the greatest effect was at 3 months after treatment. In patients with low-back pain and lower-limb pain (Group B), 37 (47.44%) of 78 patients had initial improvement ≥ 50% at 3-month follow-up. At 1-year follow-up, 34 (45.95%) of 74 patients had pain relief effect ≥ 50%. An analysis of patients in Group B with pain relief ≥ 50% for at least 1 month showed that the greatest effect was at 1 month after treatment.

Conclusions
The results of this prospective analysis showed that treatment with pulsed radiofrequency applied at the L-2 DRG is safe and effective for treating for chronic low-back pain. Satisfactory pain relief was obtained in the majority of patients in Group A with the effect persisting for at least 3 months. The results indicate that pulsed radiofrequency provided intermediate-term relief of low-back pain. Further studies with long-term follow-up are necessary.
Std Meds Gabapentin, MR Tramadol, Paracetemol, Laxatives
2011 Sept PLIF L4 - S1
2010 May Discogram L2/L3 & L3/L4 both looking ok.
2009 May PLG Fusion L5/S1 Charite in situ
April Dismissed
2008 Caudal Epidural failed to work
2007 Deterioration L5/S1 Facet arthritis, Loss of disc height.
2004 Returned to Work
2002 Aug - physio
March 2 level ADR Charite L4/5, L5/S1
2000 Broadbased disc prolapses L4/5, L5/S1
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Lynda
Advanced Member
[ *  *  *  *  * ]
Mrs R,

I have heard of people having a set of three injections in close succession before and having significant pain relief as a result, which goes along with your pain doctors' views.

However, I have also read that if there is no response to facet injections then the ablation is less likeley to be effective. Have you had facet injections into the joint or not? I can't quite remember, they would perhaps confirm or rule out the facets as the pain generators. (Finding the source of the pain can be trial and error.)

I have been offered radiofrequency ablation for my lumbar spine and have researched the topic. I understand that although it can be effective there are cases where, when the nerve grows back, it is finer and more sensitive and so the pain is worse, which is why I declined the offer.....for now at least, I may change my mind in the future. That said, there are several members here who have had relief after radiofrequency ablation.

There is some information on the pain clinic wesite here.

The following is taken from their website too:

Radiofrequency techniques (RF)
◦Application of a high frequency electrical signal to a nerve causes it to heat up.
◦Classical RF lesioning involves the nerve being "cooked" at 80 deg C for 60 - 90 seconds, causing nerve coagulation and disruption (rhizotomy) with permanent interruption of pain signal conduction.
◦A newer technique called pulsed radiofrequency (PRF) gently warms the nerve to 42 deg C for 10 -15 minutes. This technique does not seem to cause nerve destruction, but still achieves neuromodulation of the pain.


I think that sometimes, as nerves recover from being compressed and/or stretched, the pain can feel worse before it feels better and I hope that this is what you are experiencing. I hope you turn a corner very soon and begin to feel some relief. It must be so very difficult returning to work with continued/worsened pain and I am sure your journey up country and back will have taken it out of you too. Can you not stay off a little longer? It took me eight months before I returned to work. Have you looked at a dermatome chart to see if your pain correlates with a particular nerve? Do stretches help or make things worse? Hang in there and keep looking for answers Mrs R, I wish I had something more to help you and I am saddened to read you continue to have this awful pain.

I would go and see Dr Adnan Al Kaisy to see if he can help and Mr Sutcliffe too, what have you got to loose other than the financial cost of the consultations? Hopefully when you have seen them all you will be able to see a way forward or make a decison regarding the further surgery that has been offered.

Wishing you peace and some sleep at night as well as relief from that nasty pain.

Cyber hugs

Lynda
May 2008 onwards - Lumbar facet injections - First post-op ones four years post surgery, have lost count of the number I've had since then but they do help. Pre-op they didn't make much difference- Mr Shackleford, Warrington
Feb 2008 - Cervical TDR, (Activ C's) C5/6 & C6/7- Mr Shackleford, Warrington
May 2006 - Craniotomy and resection frontal lobe brain tumour - The Walton Centre for Neurology and Neurosurgery
Feb 2004 - Lumbar TDR, (ProDisc's) L4/5 & L5/S1 - Mr Shackleford, Warrington
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Mrs R
Full Member
[ *  *  * ]
Thanks for the info. Bit worried to hear the pain can come back worse. But anyway things have changed a bit with me in that my worst pain is now in the front of my thighs so don't think that is from the L5/S1 nerve root like the rest of the pain. The thigh pain is appalling, it is a burning pain and I cannot even bear my clothes to touch my skin. I had to get the Dr out last night and got some oxynorm which eased it enough for me to sleep, but only after being sick from taking that on top of the codeine and paracetamol I'd taken earlier and which did not touch the pain. My stomach did not like all the drugs, although gp said this was a safe combination otherwise.. Have not got out of bed today as too scared of setting the pain off again, it was unbearable.

I have no idea what is going on with me, a starting to wonder if I could be allergic to the BMP in my fusion or something like that. Still can't get a date out of Guys for seeing Mr Lam again so made an appointment privately at LBH, but he is not there until 28 June so going at 9am that day.

My appointment with Mr Sutcliffe is on Wednesday this week. I hope he has some idea what's wrong with me as I am truly frightened now.
2004-05 After 12 yrs of serious competitive sport, degeneration and tears L5/S1 and L4/5. 6 wks off work and went back p/t only. Told too young for surgery at 31 and that it probably won't help
2005-09 Dorsal root ganglion/steroid injections, amitriptyline, physio, osteopath, pilates and swimming 4 times per wk, back to working f/t
2009 Pain worse, saw Mr Lam at Guys. MRI: further degeneration in both discs and tear in L4/5. Discogram May 2009
14 Jan 2010 ADR L4/5, fusion L5/S1 by Mr Lam
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Alastair
Member Avatar
Alastair
[ *  *  *  *  * ]
Hi Mrs R,
I hope that your meetings with the various surgeons go well, Mr Sutcliffe is one of our stars, and seems to do the impossible now and again.

I know Mr Lam is extremely busy at this time, and he's attending conferences all over the world in addition to his commitments to his patients.
ATB
Alastair :D
Founder of this board 24th February 2007
Slow and Steady Wins This Race
Over 23 Years experience and research into spine surgery and over 2500 surgeries discussed and recorded

ADR L5/S1 Surgery with Dr Zeegers 26th July 2002 in Munich
8 facet joint ablations 28 – 8 – 12 with Dr Baranidharan and Jake Timothy in Leeds Diagnosed Forestiers disease
Your Best Asset Is Your Health
I live in West Yorkshire aged 81 now

Knowledge is power
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lovecatz
Advanced Member
[ *  *  *  *  * ]
Facet nerve ablation with RF is one of the many 'conservative' treatments that I tried prior to seeking a 2nd opinion with Mr Lam. It didn't have any effect at all. I had it done at 3 levels and I can only liken it to being prodded with a cattle prod. At the end of it I cried with relief that it was all over and I have a high pain threshold. Firstly you are sedated and then woken up when the rods are insitu. They then turn it on and you have to tell them if it is the right nerve,(which is painful enough) if not they can damage nerves that will lead to you not being able to walk very well until they regenerate. Then they blast the nerve and it is soooo painful. It's far from pleasant with undeterminable results. As has been said the nerves do regenerate and the pain can be worse than before.

Karen x
DDD S1/L5 L5/L4 L4/L3
Lower Back Pain Since 2003
Fusion L4/S1 & ADR (Pro Disc L) L3/4 07/01/09 Mr Lam
Posterior Fusion with instrumentation 14/01/09
Neck pain diagnosed with bulging C5/C6 Jan 2010
Cervical ADR booked for 11/08/10
Further neck/back pain Nov 2011
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ajj1001
Advanced Member
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Mrs R,Jun 14 2010
04:41 PM
My appointment with Mr Sutcliffe is on Wednesday this week. I hope he has some idea what's wrong with me as I am truly frightened now.

If you get worse before then call your GP or emergency out of hours service for attention. Hope that things settle down.
Std Meds Gabapentin, MR Tramadol, Paracetemol, Laxatives
2011 Sept PLIF L4 - S1
2010 May Discogram L2/L3 & L3/L4 both looking ok.
2009 May PLG Fusion L5/S1 Charite in situ
April Dismissed
2008 Caudal Epidural failed to work
2007 Deterioration L5/S1 Facet arthritis, Loss of disc height.
2004 Returned to Work
2002 Aug - physio
March 2 level ADR Charite L4/5, L5/S1
2000 Broadbased disc prolapses L4/5, L5/S1
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dalhousie
Advanced Member
[ *  *  *  *  * ]
I hope Mr Sutcliffe can give you more concrete answers tomorrow. I don't know how you're managing to work as well as cope with your spine situation. Keep on keeping on.

Wishing you well.

xx

2005 Anterior fusion L1/2 with BMP & floating rib removed.
2009 ADR (activ L) L4/5.
2010 Chronic pain from Facet Joints T10-L2 with lots of muscle pain
2013 Attended Walton PM Programme: not much help.
2014 Chronic Pain - Facet Joints L4-S1
2017 Nevro SCS for thoraco-lumbar & lower lumbar facet joint pain
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Mrs R
Full Member
[ *  *  * ]
I saw Mr Sutcliffe today. I found him to be a very confidence-inspiring person. I told him all about my terrible new thigh pain and the possible further surgery for the L5 nerve root pain, which do not seem to be the same problem. He has kept hold of my scans to go through them with his radiologist colleague and will let me know what the next step should be, possibly another scan because of the new pain, maybe diagnostic injections. He has a couple of theories which are that the L4/3 disc is involved or a small fracture above the ADR, but they are just theories at this stage. Otherwise he agrees with everyone else that the ADR and the previous surgery looks good, but I am relieved someone is going to take a fresh look at the situation as it is developing.

By coincidence today a copy of Mr Shackleford's letter about my consultation with him arrived as well. It is very detailed and thorough. I am so confused.....waiting to see what Mr Sutcliffe thinks before I try and make any plan.
2004-05 After 12 yrs of serious competitive sport, degeneration and tears L5/S1 and L4/5. 6 wks off work and went back p/t only. Told too young for surgery at 31 and that it probably won't help
2005-09 Dorsal root ganglion/steroid injections, amitriptyline, physio, osteopath, pilates and swimming 4 times per wk, back to working f/t
2009 Pain worse, saw Mr Lam at Guys. MRI: further degeneration in both discs and tear in L4/5. Discogram May 2009
14 Jan 2010 ADR L4/5, fusion L5/S1 by Mr Lam
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