Hello! - Advice needed 2+ years post L5-S1 ADR
 

Hello All,

First, I'd like to say thank you to all the people whose postings I read (usually late into the night) before I decided to have my ADR surgery in October of 2014. This forum is an incredible resource and all your stories gave me the confidence to move forward.

Long story, short - I had a discectomy in 2007/2008 at L5-S1 after a major herniation. I struggled mightily for the next 6 or 7 years with all the usual suspects, e.g. nerve pain in legs and buttocks, facet pain, general diseased disc pain, muscle spasm etc.

I decided to take the plunge and have a ProDisc inserted at the same level at TBI by one of the top dogs. My surgeon was/is great and the actual recovery was not very difficult (compared to the daily pain of the previous 7 years). By the two month mark I was at least 70-80% better and continued to improve.

I operated more or less without pain (including no pain when sitting, which had always been the hardest part) for the next year or so. The dark cloud had been lifted and it was a wonderful time getting back to life without thinking about my pain on a minute to minute basis.

Roughly 8 - 10 months ago I was sitting at my desk and had a significant flash of pain like a lighting bolt and my back spasmed shortly thereafter. I followed up with my surgeon and he did several x-rays. He said it was very difficult to tell but the disc may have moved a small amount, maybe 1 to 2 millimeters at most and that it shouldn't cause any problems. I recovered more or less but as time went on I started have pain when sitting. It started oddly enough as a pressure like pain in my tailbone. After sitting I could reach around and touch my tailbone and it would be extremely sensitive. After awhile I noticed that the pain was also encroaching on my left butt cheek. This pain felt more like nerve pain in that is was a change in sensation and a burning on the inside of the one cheek only. So I made a follow up with my surgeon and described my symptoms. He took some more x-rays and concluded it was coccyx pain and not related to possible shift in my ADR. He referred me to a pain management Dr.

At this point I can't really sit at all without one of the coccyx pillows with the cut-out. I seem to be getting worse and it is taking a toll on me. Also, the funny part is I don't really have any back pain at all. The terrible facet and ddd pain are mostly gone. But as soon as I put a load on my spine (i.e. sitting) the pain becomes intense in my butt and tailbone area.

I trust my surgeon and don't think he would just "punt" the issue but at the same time I would like to know if the device has migrated or subsided and is causing this pain. Also, I didn't have a great bone density report pre-op. It does seem odd that even if the implant had shifted a little, it would manifest itself as tailbone pain (bypassing the sacrum). The possible referred pain in my butt I could understand, but my surgeon said that there was plenty of room for the nerve roots on both sides on the ADR (per the x-ray).

Does anyone have any thoughts on what do, similar pain post op or advice to give. Thank you so much!

Also, if I posted this in the wrong place, please let me know. I've never posted on a forum site before, only lurked.
Chris

a CT scan will give you a much better picture compared to the xray about what might be happening around that disc. It does seem unlikely that it subsided after two years. You bone density must not have been so low, or TBI would not have implanted the devices. But if the cause for your low bone density was not discovered and/or treated, perhaps there might be a hairline fracture on the S joints that were not apparent on the x ray? have you had a recent bone density test?

Hi Philly Joe - Thanks for the reply! On the 1st visit my surgeon did mention getting a CT in the future if I didn't improve but he did not mention it on my recent visit. Maybe I should request one.

I think I really was borderline. On my pre-op check in papers the morning of the surgery it stated I was going to have a fusion with instrumentation done in the alternative (this was a surprise to me). The surgeon said he would have to make the decision once I was on the table and surgery had begun.

I did ask about things I could do to improve bone density. It seems there aren't a lot of treatments for an otherwise healthy 36 year old. And no, I haven't had a bone density test since right before surgery.

Thanks again.

Sorry about the latest news. Did you actually read the radiologist's report on your imaging? Perhaps there is a spur that slowly developed and is impinging on a nerve?

Also, what's very helpful to know is that a radiologist will usually note changes from previous studies. And you can request a re-read as well as a comparison.

Let us know the exact language of the latest radiology report...

Also see this dermatome chart:

http://tlccrx.com/resources/printable-dermatome-chart/

Do you know what could have caused this sudden appearance of, presumably coccyx related, pain? Did something happen during the day or the day before? A dislocation of coccyx could be possible, but it sounds strange, since the keels of the prodisc should keep it in place? I hope you can find the cause of this pain.

Hi Harrison - thanks for the reply and also all you do for this site. There wasn't any report that I'm aware of. The x-rays are done "in-house" by the surgeon. I have x-rays from one-year post op (felt great) then one year later (on set of pain) and one month ago (feeling worse).

When you state impinging on a nerve- do you mean at the L5-S1 area? As Philly Joe stated, I should probably try to get a CT scan for a better diagnostic of that area.

Looking at the handy dermatome chart you provided - the pain is definitely in the S2 and S3 area. After I have been sitting for a little while, I can press in that area up against the bone (sitting bones for lack of a better term ) and it will light up. I'm starting to think this is a different issue than the pain on and around my coccyx.

Can the L5-S1 nerve roots refer pain to this area?

Hi Blizzaga - Great questions! I can't remember any significant traumatic event other than a very bump boat ride. No major falls or anything like that. The pain management Dr and I looked at the x-rays. He did think that my tailbone was oddly shaped, almost a 90 degree turn in about halfway down, but he didn't think it looked any different from the x-rays one year ago when I felt fine.

He is planning on giving me a numbing shot directly at the angle of my tailbone where it turns inward. If that helps, he wants to freeze the nerve in the area.

I agree, I do think it would be odd that the prodisc could cause actual coccyx pain. If the disc had subsided, wouldn't there be pain in the bottom vertebrae or the sacrum? Seems odd that the pain would skip all of that bone and manifest in the coccyx.

Great to hear from you. Thanks again for the insight.

Chris, I would go after the XRays aggressively and get the radiologist report. Maybe request a re-read too.

The dermatomes are pretty accurate. However, everyone's anatomy can be a little different; as is evident by your tailbone. As well, my brother has SIX lumbar vertebrae!

CT scans are very helpful, but I don't like how much radiation you get. See how far you can get with XRay imaging first...

Not to scare you, but theres always the possibility that you have a disc bulge or herniation at another level.

I'm sorry to hear that you're struggling with such intense pain. Sitting is such a big part of daily life....

Have you looked into the referral patterns of piriformis muscle dysfunction?