Chronic Back Pain After Multiple Surgeries: Seeking Answers and Relief

Persistent lower back pain and discomfort?

Doctor: Hello! I am a 22-year-old girl experiencing weakness.
Since undergoing surgery for a herniated disc on April 1st of this year, I feel like my life has turned black and white.
Why is that? After the surgery on April 1st, I have been experiencing significant pain at the surgical site.
Upon my family's recommendation, I consulted a physician at a medical center.
Initially, the doctor suspected discitis, indicating inflammation at the surgical site, and noted elevated white blood cell counts.
He recommended hospitalization for intravenous antibiotic treatment, which began on May 17th.
The week prior, I felt much better at the surgical site and thought I could go home, but to my surprise, a week later, the pain gradually returned.
After two weeks, the pain intensified, and I needed pain injections every 1-2 days.
Strangely, after receiving the pain injections, I would feel sleepy and sleep for 3-4 hours, only to wake up feeling extremely fatigued.
The doctor noticed no significant improvement in my condition and arranged for an MRI.
The results showed a clear and significant protrusion of the disc, leading the doctor to recommend another surgery.
I underwent the second surgery on May 30th.
After this surgery, my right leg was very numb and weak, making it impossible for me to walk independently; I had to rely on a crutch.
The doctor briefly explained the surgical outcome, stating that the surrounding nerves were compressed and swollen like a thumb.
He cleaned around the nerves, assuring me that the numbness in my right leg would gradually improve.

The doctor's conclusions were as follows:
Diagnosis: DISPLACEMENT OF INTERVERTEBRAL DISC, SITE UNSPECIFIED, WITHOUT MYELOPATHY.

Diagnosis details: A case of right L4-5 herniated intervertebral disc status post two surgeries (first at a local hospital).
Second surgery included L4-5 discectomy and foraminotomy two weeks ago; now experiencing pain again with aggravation likely due to immediate post-operative adhesion of the nerve root.

Diagnosis conclusions:
1.
DISPLACEMENT OF INTERVERTEBRAL DISC, SITE UNSPECIFIED, WITHOUT MYELOPATHY.

2.
LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY.

3.
FASCIITIS, UNSPECIFIED.

These are the conclusions made by the attending physician.
After several follow-up visits, my condition has shown little progress, and I am still in pain, which makes me feel very sad.
Why am I suffering from this at such a young age? In July, I underwent a neuroablation procedure, and again in September, but there has been no significant improvement.
Recently, I have been experiencing numbness and pain below my right knee, with occasional sharp pains that are quite bothersome.
Additionally, I have a problem when I have a bowel movement; my right leg experiences significant pain, especially when straining, sometimes to the point of tears.
Is there nerve compression involved? This never happened before; it started after the second surgery.
I have also recently developed pain in the left side of my lower back (the surgical scar is a straight line, and the pain is to the left of that line).
Is it possible that the issue has shifted to the left side? Occasionally, my left leg feels numb.
An orthopedic surgeon suggested another surgery, stating that operating from the back is no longer an option and that it should be approached from the front, specifically the left side of my lower back, which would be more complex.
Is this true? Why approach from the left side? If I undergo another surgery, will it alleviate my suffering? Doctor, please provide me with treatment options or advice! I am begging you to help me! The surgical difficulty is very high.

Xinyu, 0~9 year old female. Ask Date: 2002/09/22

Dr. Ding Xianwei reply Neurosurgery

Hello, Xin Yu! Based on what you have described, it appears that much of your information is incomplete, making it difficult to determine your specific condition.
However, generally speaking, the course of illness you described could be indicative of failed back surgery syndrome, which has many potential causes.
From your description, it may be related to nerve inflammation, but the true cause requires a detailed medical history and additional imaging studies for clarification.
As for whether surgery is necessary, that cannot be determined at this point.
Therefore, I recommend consulting with several other physicians to gain a better understanding of your treatment options.
Wishing you and your family peace and happiness.
Sincerely, Dr.
Ding Hsien-Wei, Neurosurgery, Taoyuan Hospital, Department of Health, Executive Yuan.

Reply Date: 2002/09/22

More Info

Chronic back pain following multiple surgeries, especially at a young age, can be incredibly distressing and frustrating. Your experience reflects a complex interplay of physical and emotional challenges that often accompany such conditions. Let's break down your situation and explore potential avenues for relief and understanding.

First, it's important to acknowledge that after undergoing surgery for a herniated disc, it's not uncommon to experience ongoing pain, numbness, or weakness in the affected areas. The fact that you have undergone two surgeries and are still experiencing significant discomfort suggests that there may be several factors at play. These could include post-operative complications such as scar tissue formation (adhesions), nerve root irritation, or even the possibility of adjacent segment disease, where the stress on nearby discs increases due to the altered mechanics of the spine.

Your description of pain radiating down your right leg, along with numbness and weakness, indicates that the nerve root may still be affected. This could be due to inflammation or compression from surrounding tissues. The fact that you also experience pain during bowel movements could suggest increased pressure on the lumbar spine or pelvic floor, which might be exacerbating your symptoms. It's crucial to communicate these specific symptoms to your healthcare provider, as they can provide insights into the underlying causes.

Regarding the suggestion of another surgery, it's essential to weigh the potential benefits against the risks. Surgical interventions can sometimes lead to further complications, especially if there is already significant scar tissue from previous surgeries. The recommendation to approach from the front (anterior approach) rather than the back (posterior approach) may be due to the surgeon's assessment of your anatomy and the specific issues they believe need addressing. However, this decision should be made collaboratively with a trusted orthopedic or neurosurgeon who can explain the rationale behind their recommendation and what they hope to achieve with the surgery.

In terms of conservative management, there are several strategies you might consider:
1. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can tailor exercises to strengthen the core and back muscles, improve flexibility, and promote better posture, which may alleviate some of the pressure on your spine.

2. Pain Management: Discuss with your doctor about pain management options. This could include medications, nerve blocks, or alternative therapies such as acupuncture, which some patients find helpful for chronic pain.

3. Mind-Body Techniques: Chronic pain can take a toll on mental health. Techniques such as mindfulness, meditation, or cognitive-behavioral therapy (CBT) can help manage the emotional aspects of chronic pain and improve your overall well-being.

4. Lifestyle Modifications: Maintaining a healthy weight, engaging in low-impact exercises like swimming or walking, and ensuring good ergonomics at work and home can contribute to better spinal health.

5. Regular Follow-ups: Keep an open line of communication with your healthcare team. Regular follow-ups can help monitor your condition and adjust treatment plans as necessary.

It's understandable to feel overwhelmed and discouraged, especially when recovery seems slow or stagnant. Remember that healing is often a gradual process, and it's essential to be patient with yourself. Surround yourself with supportive friends and family, and don't hesitate to seek out mental health support if you're feeling particularly low.

In conclusion, while the path to recovery may be challenging, there are multiple avenues to explore for pain relief and improved function. Collaborate closely with your healthcare providers, advocate for your needs, and consider a holistic approach that addresses both physical and emotional aspects of your health.

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