Back Injuries and Surgeries

I know this is a bit long, but please read this first paragraph as this isn't for me, but to help a friend. I'm hoping to get info from anyone who has had or is looking at back surgery, and more specifically disc trimming, bone spur removal, and fusions. There is a TLDR at the bottom.

My friend has serious back injuries that the VA neglected to treat for years (read as over a decade) so he is now paying the price. Without sharing too much of his business, he is a Veteran and was injured in a Humvee explosion that left him an inch shorter than when he entered the service. That's the tip of the iceberg, but gives you an idea of the kind of trauma his spine has endured.

Currently he has multiple herniated discs (13 I think) and has just muscled through the pain for years. Toughest S.O.B. I've met to date. The pain had been spiking worse than normal for over a month and he was trying to get some kind of consult/treatment, but the VA told him "your lucky you have the appointment in 6 weeks." Typical and sad.

Well, it finally culminated in him having severe pain through his right shoulder and arm and that spread to his right leg over a few hours while he was working. Long story short he has a neurologist friend who he talked to and she coached him on what to say when went back to the ER, and he finally got imaging done.

That led to his first surgery was a few days ago for his neck and I believe they trimmed a disc or two to alleviate the pain. He's experiencing numbness and weakness in his arm now and is worried about what this is going to cost him because of the VA's negligence. Not looking to bash the VA, but it is what it is.


TLDR: If you have any experience with treatments mentioned in the first paragraph, can you share your experiences and advice to help put my friend's mind at ease? He could use good info to keep from slipping into a funk. Any info on recovery timelines and or time for issues and symptoms to improve would be appreciated.

 

@Patch999 IIRC you had some back surgeries done. Can you shed any light to give my buddy some hope?

 

I blew out L5/S1 at 29. The pain was 12/10 constantly. I had six ESI shots which did absolutely nothing than finally a microdisectomy. The pain shoots down your leg and feels like somebody is twisting a knife stabbed into your leg non stop. I couldn’t walk, sit or work. That time period sucked. 10 years later and it’s still holding. I walked out of surgery and was back to somewhat normal in a few weeks. It takes awhile for everything to heal.

 

Sorry bud wasn't me. My bones creak a lot but no surgeries yet.

 

Hmmm. I guess my memory is off. I can't keep names straight to save my life!

 

Mother in law just got out of her second back surgery last week. She’s now slowly moving about on her own and finally has been able to feel in her right leg more than ever. She’s been getting sporadic pain shooting but it’s the nerves refiring. Doctor said it’s going to be slow progress but progress nonetheless and to stick with the pt etc

 

Maybe one of the other Texan ToyoMafia members


So I've never had a disc trimmed, but I've had fusions and a lot of other shit done. My only recommendation is to communicate back to the surgeon/doctor that did his procedure. Keep them informed and have it documented that he called and is having (insert current issues) and ask for advice.

It took a long time for me to heal and this was done when I was 17 and healing at a faster rate then I am now. They cut and reattached a lot of nerves and other things, I definitely have some odd sensations and loss of feeling in some areas but in general I'm worlds better. A few days after my surgery as I was becoming more conscious and aware, I knew I was in pain but it was different pain. The "new" pain faded and went away as I healed. I'm not saying he should suck it up and wait, but it is not an easy process and he should communicate what he is feeling back to the surgeon/doctor.

I also found out about 1.5 years ago that I have arthritis, bulging discs, and multiple bone spurs in my neck along with some narrowing. Bunch of imaging and being sent from one doc to another, they got me doing PT and put me on muscle relaxers (ironically the first time I'd ever taken them) and I was amazed at how quickly I saw improvements.

Its a battle and back issues are one that really stay with you and you have to monitor and stay on it. I wish him the best of luck and hope things start going his way.

 

My mom got her neck fused about 7 years ago..she was complaining about numbness in her arms and fingers and slowly losing her mind, memory and began to hallucinate... I have my own back issues where it feels like I'll lose my legs eventually..

I don't think surgery is the answer, but my brush with the VA is hit and miss... I keep a private doctor and upload records to them they pawn me out for care and then abruptly discontinue it... which is why I see both...

 

Good Gravy @RobertD ...

Subbing for info. I don't have much to add to the conversation that is useful. I only have second-hand (or is it third-hand..?) experience with the VA and can see from the outside how difficult it can be to get treatment. I know some good folks that work with the VA and they try their hardest to push agains the machine and help people.

I have a child-hood friend in a similar situation to you, @GODZILLA , but he has become a hermit and won't really engage with anybody. I lost contact with him after high school as we went separate ways and he became a grunt, then went Airborne. I ran in to his folks a few years back and heard a very similar story. Tried getting back in touch with him, but continued avoidance.

I'm sure I'll be paying for some back-related things down the road, but NOTHING like your buddy or mine. Ouch.

 

Good info and advice. Trying to get him to communicate that there is pain and problems is a challenge. It's just not how he's wired. He doesn't like to be a burden or appear weak (with good reason that I won't get into here), but he's growing on that front. He finally got his disability rating reevaluated and upped after he was convinced to not hold back on what hurt and was going on. I'm hoping his surgeon and docs are decent and will work with him. He's the ideal patient. He follows instructions to a T and has great discipline, but he's damn terrible about telling them when something is wrong until it's been wrong for a long time or gotten much worse. Hoping he breaks that habit.

 

Omg sounds like me
I'm great once I go to the doc and they tell me what to do. But I'm stubborn about going. I had massive headaches (daily) that were close to migraine level (once or twice a week). We are not going to say how long it took for me to go to a doctor... who instantly had me referred to a neurologist, who got me doing PT, and about a month th later I was seeing massive improvements.

Its also hard when you are in constant pain, it sadly just becomes normal so you forget that you need to communicate about it.

I really wish him luck and hope he does communicate and that helps them correctly address what is going on.

 

A little more info from him. Copied with his permission.

"my back is jacked up from my neck to my tailbone loaded with bone spurs and arthritis. When the doc looked at the MRI, he figured it would be a 2" cut and a single disk to trim.

Unfortunately once he got inside me the cut had to extend to 7" and the disks had hardened to the point of being inoperable. He has said the feeling may or may not return to my arm and the pain will persist because I have wedging of several thoracic vertebrate that will need fixed.

Unfortunately I have to wait to see a different specialist to do this."

 

Oof....

Well, sounds like they know where some of the pain is coming from. He should still communicate with them so it can be documented.

Sadly, sounds like he will need more surgery to get relief. Hopefully they can get him in to that specialist pretty soon, to at least get evaluated and then have surgery scheduled

 

Even if he goes to the Doc, he sometimes will not convey it. For example, in the hospital for for this he told the nurse his pain was at an 8. The nurse asked him some questions and observed, then told him that was complete nonsense. Said "You're at a 10" because he was involuntarily writhing, sweating, and getting tunnel vision. If he's not dead he doesn't think it's worse than an 8.

 

Yeah, after the surgery he was told he was looking at 3-5 more surgeries and potentially fusion of multiple points. I'm hoping they'll lean into the PT more and that it can work, because he's super active and I don't want him to lose so much of the stuff he loves. He'll be okay and he'll adjust, but I worry it'll put him in a depression spiral. I'm trying to keep him positive and hopeful because I know how much that helps recovery and healing too. The human body is a weird thing.

 

Sorry to hear of your buddy’s troubles. I have had three lumbar surgeries ultimately resulting in fusion of l4-s1 at a very young age. My father just had two laminectomies done last week at age 81….injave worked in sports medicine for 28 years and see / rehab a lot of these types of injuries, albeit not as extensive as your friend. I will offer the best advice that I can.

1. This will not be a quick process and is not something he wants to rush to get done. Do the research to find out who on his area does these types of surgeries regularly. It sounds like, from what you describe, is he is heading for a fusion at multiple levels. He wants an orthopedic spine surgeon and not a neurosurgeon. In this case, it is likely not going to be as “easy” as a decompression of the nerve. Find an orthopedic spine surgeon and ask them for references of former patients…..then call them and see how they did post operatively.

2. has he tried alternative means of treatment? I know you say he has been dealing with these injuries for quite some time, but has he tried steroid injections? They can be focal to the areas of pain, have few adverse effects and can be very effective in treating the inflammation and other factors that cause pain. Not saying it’s the end all be all but it can buy him some time, especially while he is waiting on these appointments. The VA may be slow to deliver on these types of appointments too.
3. The surgeries can often cause issues not seen before - sounds like that is what your friend is experiencing with the arm and neck pain. Once you decompress the nerve it opens another can of worms. Your body tends to adapt to injury in a way that is pretty fascinating - it can compensate, shut off, self splint, etc. What happens when you decompress the nerve is that it immediately tries to “wake up”. Nerves take an inordinate amount of time to heal and depending on the amount of damage may never fully recover…..during the healing process he will feel things that he hasn’t felt in a long time. Numbness, tingling, shooting pain, etc.

I tend to recommend that patients keep a detailed and descriptive log of activities that they do, the work they perform and what happens directly before and after the back felt really good or felt bad. This gives a ton of information to the doctor….they’ll be able to connect the dots. Is it spasm? Instability? Rotational or axial that exacerbates pain? Etc. Many times people who go to the doctor with back pain, image and find out the extent of injury. The doctors treat the image and not the symptoms if that makes sense…..what they should be doing is treating the acute symptoms and addressing the individualized (or multiple) injuries. Many people are likely walking around with herniated discs that won’t even need surgery or extensive treatment. Others may have what doctors call a “minor herniation’ that wreaks havoc on daily living activities because it has caused an instability that has a cascade effect of symptoms.

Has he tried formal, focused and prolonged physical therapy? A good therapist can work wonders! It is highly likely with his level of injury that they won’t be able to address everything in PT, but even if they can knock a couple thins off the list and give some relieve it is worth it.

I guess this is all to say that patience is key here - he shouldn’t rush into surgery with the first person he sees. Often people are in so much pain and discomfort that they just want relief and go with the first person who says they can fix them. I get it - I have been there. If you can tell me what area of the country he is in, I have a pretty extensive contact list to draw from to see who in his area is good. I know you said he is a veteran but is there opportunity for him to go outside the system?

I wish him the best and please thank him for his service. Not many realize the impact that even minor back pain has on peoples daily living activities and how it can alter the psyche. Depression and other feelings often accompany prolonged pain cycles and I would encourage addressing that aspect too. Happy to chat off line if you’re interested.

 

His neurosurgeon friend explained stuff to him, but she was not involved in treatment. I'm not sure who the doc that did the surgery is.

The VA has long waits for anything. That far off appointment would be the first time he would be able to pursue anything, steroid or consult for surgery, etc. He had to hound them to get him an appointment at all and he was trying for nearly 6 weeks before they would schedule anything. Steroids might work/help, but seeing a doc for anything at all is the same long process.

He had the arm/neck pain and numbness before the surgery. That was what prompted his ER visit.

He has a strong preference for PT over surgery. After this surgery he was told he has to heal for 6 weeks before he can do any PT.

Wyoming is where he's at. Specialist he is being referred to is Dr. Turner.

 

From your first post @GODZILLA i think his numbness and weakness is likely a result of post surgical inflammation/swelling as the site heals vs negligence or poor technique.
See if he qualifies through the VA for an at home traction device or at least appointments at physical therapy 2-3x where this is implemented. I had some neck injuries/ issues while in the army and experienced numbness in my business hand (but no weakness thankfully) and it was scarring swelling around some cervical vertebrae that was pinching / restricting the initial part of my brachial plexus resulting in the fingertip/hand numbing. Obviously not as severe as your friend as the traction therapy all but cured me.

Without climbing on too much of a soapbox have him do everything he can to stay away from opioids for pain management. They are short term (post surgical) pain relief only. Regardless of the stigma surrounding cannabis it’s a much more effective pain management solution.
Good luck, and hopefully he gets the care he needs and has more than earned.

 

Weakness and numbness was prior to surgery. It has just persisted after. He is terrified of pain pills. He avoids weed because it makes him useless and he's a come down dick, apparently.

 

In Denver at the Sweedish Hospital is a Dr. Wade Smith. He is one of the best tramatic orthopedic surgeons we have in this country.

They guy has a whole team of his own from plastics to pt to infection. From a friend who was out of luck and going to lose a leg from a crash at work and leg is saved and the guy can do everything but run fast.

He would be a good person to contact and would most likely have someone he has trained or worked with that would be a good candidate for such a injury.

He works with a lot of fighter pilots that have ejected and needed breaks fixed due to the shear force of impacts.

 

I am not a physician and have never had any sort of back surgery (nor would I), but when considering back surgery here is what you need to keep in mind... I realize your friend has already had surgery, but here is my take...

The spinal column is a bunch of bones (vertebrae) and soft discs stacked up with a foramen where the spinal cord and nerves run through, EVERY vertebrae and disc relies on the one below it and above it for stability and movement, the spinal cord and nerves also rely on the foramen staying open so that compression of nerves doesn't happen. When you take movement away (spinal fusion) or that soft disc (any disc removal) away you may be solving the pain for a short term, but guess what happens when the vertebrae above and below the area that has been worked on start having to absorb the extra strain. VERY FEW folks who have had back surgeries report long term relief, some even report that it becomes worse, then they have another surgery to relieve that pain, and another and another... You get the picture.

There are some emergency situations, like you acutely injured and break a vertebra or in a case of Cauda Equine where nerve decompression becomes an emergency because of complete loss of function, I am not referring to this type of scenario. I would have your friend speak to patients who have had back surgeries prior to going through that, if that is the treatment he wants to proceed with. I recently read an article where at an orthopedic conference full of spinal surgeons they had them take a survey and asked how many of them would allow spinal surgery on themselves, and only 1 said yes.

I want to reiterate I AM NOT A DOCTOR or provider in any capacity, so I am not at all saying surgery is not right for your friend if they recommend it again, he needs to make a decision based on his physician's (when he finally gets to actually see one) and his discussion and the physician's assessment of his particular situation and injuries, but I am saying proceed with caution when it comes to back surgery! As a nurse I have seen people completely or partially paralyzed after back surgery has gone wrong, the spinal cord is a very sensitive organ! If your friend's physician thinks it is appropriate I would consider some aggressive physical therapy first and some treatment at a pain clinic!

Thank you to your friend for his service and sacrifice for our country! I hope he finds some relief soon, back pain sucks!! (Sorry I realized after I typed all of this that your friend already had surgery, I guess I will leave it since maybe it could help someone else decide not to have surgery).

I hope Permafrost is right and that it is just the initial swelling and inflammation, perhaps a steroid would help.

-T

 

I have just one disc off, and when it is bad it is indeed like a knife in the leg. Or whichever nerve gets pinched. Spending 2 months basically handicapped, laying on hardwood floor and not risking to get up for peeing for hours, because pain will be, yes, 12/10. Luckily, I've had only two such bad times in past decade. The rest of life I still feel something is wrong, like my legs always feel a bit numb, but at least no knives. When constant pain drops to under 3/10 I'm so grateful for just normal life without intolerable suffer.

My advise to those without herniated disc yet: don't lift unreasonably heavy stuff. Yes, you can lift it easily, but your spine will draw another mark in its pocket book and you'll pay later. If not spine that would be a joint. I also avoid sitting. My work setup is a standing desk w/o chair. Seems to help.

 

@GODZILLA, I also was in a humvee rollover back in 2006 during my first tour.

long story short, it’s taken me 10plus years and multiple appeals to get my VA disability where it needed to be and they finally granted my surgeries because of my “age” was lower then the approval rate.

I go in for my first disc shaving in September. Like you buddy, I’ve already lost feeling in my legs with the possibility of losing the use of my legs in the future due to the damage because the VA didn’t want to approve my surgeries.

I have a bunch of questions. If you’d like man, reach out and I’ll give you my number and maybe connect me with your buddy to discuss the VA nonsense.

prayers to him and his family.

It’s not fun but they do say you have a 33% chance of it getting better, 33% chance it does nothing and a 33% chance it gets worse.

 

If the local VA can't see him in a specific time frame, he should be eligible for care in the community. I live far enough away that I can get private care on the VA's dime as well as the time before an appointment.

The VA can be hit or miss, really depends on the area. I would encourage your friend to avail himself of the patient advocate at his local VA, or Community Care advocate.

I am only about 60 miles from the Portland VAMC, and always get my care referred to the community because of the distance involved, and that my wife doesn't do Portland traffic/freeway traffic. I have to allocate at least 2 hours each direction to account for traffic issues if I have to go to the VAMC for anything, which results in my taking nearly an entire day off from work.

I really like my primary care doc and some of the specialty folks I have seen for PT, Rehab Medicine/Prosthetics-Orthotics/Audiology and Sleep Medicine. I wouldn't let any of the resident doctors there operate on me though.

 

True to an extent, only if the providers are an approved provider within the Tricare system. I’ve tried to go to a top facility but got denied because it wasn’t in their approved system.

Like you said, varies on location. Gaining a patient Advocate could help. I don’t really trust the healthcare system but needing something to help me be more proactive and happier with my family. Still being considered “young” in age but can’t do nearly half the stuff individuals twice my age is hard.

 

I worked in a Pain Clinic for 6 years running the C arm, it was a military training hospital (not VA). I am not a provider but I talked with them every day for 6 years. I will let you know what their recommend paths are. ( These providers were active military so no matter what they did they got paid the same, so there was no upsell. I haven't worked there in years so its from memory. no opioids avoid them at ALL costs.

1. Tell him get a tens unit. we gave them to all of our patients and it's covered by VA. (you can get them on Amazon for 100-200 if you don't want to wait. It provides electrical stimulation across the nerves to confuse the nerve signal to reduce pain. Its just sticky electrode pads placed around the painful area.
2. you can get a cheap neck decompression device on amazon. (the one that was used on me to decompress me was amazing at phys therapy and one of my favorite things, the cheap one was just ok but it helped)
3. acupuncture, yes the military now practices voodoo, most people swear by it.
4. exercise and yoga. exercise may be counterintuitive but it is one of the best things he can do.
now more invasive, these are walk in walk out procedures.
5. Epidural steroid injections. they inject steroids into the area and it helps with healing. lasts 6-12 months.
6. RFA: radio frequency ablation: they stick long needles into you back and "burn" the nerves that are causing problems. lasts around 9 months or so.
7. tunneling (I forget what the procedure was) basically they core out any narrowing that is pinching nerves.
More invasive
8. implanting a tens unit. same as tens above but the stimulation part is placed in the spine.
9. fusion, laminectomy, etc ( we didn't really do any of these as it was more ortho/neuro. 2 of the docs had invasive spinal procedures and both of them said they would not do it again. As stated above it shifted the pain/issue somewhere else.


As Shawn said above. Make them treat the patient not the x-ray. I have seen some fucked up backs and it wasn't the fucked up area that was causing the problems.

 

All good points.....but from experience, stay away from #6 at all costs. Unless it is the last bullet in the chamber. I have seen some very bad results from a chronic pain perspective following these RFA procedures I have seen some permanent and irreversible pain cycles created following this procedure. It has its place to be sure, but I would steer clear of that option unless literally every other option is exhausted

 

Wow, never heard of that. We did about 10 a day 4 days a week and I never heard of anything bad, we had a few that didn't work but never any problems. We even did cooled and never had any issues. What happened?

 

The issue with these procedures is it is viewed as a "quick fix" for pain relief. As you know, the RFA essentially deadens the nerve so that sensory pain is diminished. It is supposed to last for three to twelve months in most cases.....and then the nerve starts to regenerate. The things that I have seen with these is that the RFA procedure was performed, and it is a painful procedure......the patients got little to no relief and then the nerve pain associated with it during the healing or regenerative phases was debilitating. I just saw way too many of these patients coming back with little to no relief and most times worsened symptoms to know that I never want anyone I know to deal with that.....

I suppose I shouldn't have said permanent and irreversible. However, in the cases that I have seen (which are in the dozens), the patients do have consistent pain associated following the procedure. Only less than a handful got any relief. You've admittedly seen WAY more than I have and mine is just anecdotal but impactful in the population that I served.