L5-S1 Lumbar Laminectomy Surgery Recovery

April 21st, 2013, I felt a pop and started to experience great pain.  An hour later I was in the emergency room.  I don’t remember much, but that is when I learned I did indeed have lumbar disc issues.

May 1st, 2013 I had lumbar laminectomy surgery to repair a herniated disc at my L5-S1.  Every case is different and I will chronicle my journey and my laminectomy surgery recovery here.

I will continue to add to this as I move through the recovery process.

Update – My L4-L5 finally failed, I’ve documented my L4-L5 surgery as well.

Time Log for my Laminectomy Surgery Recovery

• May 1st Day of Surgery – An early and hard day, but I don’t remember much.
• First Few Days (Day 2 and Day 3) – A lot happens in a short time; improvement, pain and adjustments.
• Week 1 – Coming out of the pains from the surgery and slow progress.
• Week 2 – Ups and downs and a generally good visit with Dr. Bawa.
• Week 3 – I can feel and see good progress.
• Week 4 – Feeling much better. Long road, but solid progress. I have almost no pain now and there is marked improvement with the numbness.
• Week 5 – The plateau week; nothing much noticeable, but into a regular routine of walking and being bored
• Week 6 – Dr. Bawa cleared me to start full physical therapy.
• Week 8 – Pool therapy has been great, and I’m feeling better.
• Began riding my real bike – first sitting and now some rides
• Week 11 – More normal, but still a long way to go to full strength
• Week 12 – Calf muscles are coming along finally
• 3 Month follow up visit – Dr. Bawa confirmed that I am surgically healed.  I’m no more likely to re-hurt myself now than if I hadn’t had the laminectomy.  This was true from about 6 weeks post-op.  The challenge is rebuilding my core and back muscles to maintain myself for the future.  Another thing I’m working on is my bad posture; I think that was one of many causes, so I’m working hard on learning to walk properly still.
• August 11th – I did my first calf raise with right leg.  Hard, but a major accomplishment for me.
• September 1st – I think this marks 4 months.  Life is pretty back to normal.  I still have strength to regain, but I’m riding (426 km so far since re-starting), fishing (Even offshore), swimming, playing is surf a bit with the kids and enjoying life.  I still have mental challenges/fears and I get uncomfortable when I sit too long, but I’m very happy with where I am now.  There is still numbness, but I think I have use of all, or most, of the muscles again.
• November 5th – I had my 6th month follow-up visit today.  Anti-climatic.  The way it should be.  I’m mostly back to a normal everyday life.  I do more core exercises and walk plenty, but people don’t notice there is anything wrong with me and I’m doing most things in life that I used to do.  I’m weaker (and older) and there is still numbness, but I’ve gotten better and adapted.  Better enough that I’m doing more life things than updating my recovery.
• March 1st – I’ve crossed the 10 month marker.  4 months since my last entry.  Why?  Things are going well.  Am I 100%? No.  I am recovering well.  I am generally pretty normal. 3 steps forward and one step back is the norm.  I am trying to get strength back and fix a lot of old posture and form problems, so that is adding to my recovery.
• At about the 11 Month mark, I did the Medi Fondo (54 miles) of the Campagnolog Gran Fondo in very good time
• 18 Months – Things are much better, but I’m not perfect.  Numbness in foot and some of lower leg is still there, not all of the muscles are 100% and I get some pain.  I can tell that I am still improving even though I’m very close to normal again.  Most friends have forgotten about it; I think that is a good thing.
• May 1st, 2015 – 2 Years – Life is pretty normal and my back doesn’t limit me much.  I do get some pain and I am still working on the therapy with my muscle imbalances.  That said, even 2 years older I’m riding my bike as well as before the surgery or better.  There are things I avoid (lifting heavy objects), but for the most part I am living a normal life.

All blog Posts on Laminectomy Surgery Recovery

My detailed recovery blog can be found here.

Contents

• Recovery Phases
• Background and Why
• Diagnosis
• Laminectomy Surgery
• Laminectomy Surgery Recovery

Recovery Phases

I’m adding this section at my 4 months post-op time frame.  In hind sight, I think recovery is the hardest and most critical part.  I’ll add to it more as I gain the wisdom thru experience.  This is for my condition, others may be different.

• Immediate relief (day of surgery) – The general anesthesia blocks the pain of the incision and you realize your leg/back pain is much better.
• Initial wound healing – Your back muscles were cut and stretched for the procedure.  This is what all of the pain is from and is the main healing part for 6-8 weeks.  It is also what may have you doing very little aside from walking.
• Depression – This set in pretty quickly during my down period, maybe week 2.  This is the hardest part.  It lasted well into the physical recovery phase.  I tried to set walking goals, but walking was still all I could do.  I asked, will it ever get better?  Is it worth it?
• Disc is healed – around 4-6 weeks the disc itself is healed.  The healing process means a lot of muscle atrophy, scar tissue and tightness.
• Rebuilding phase – Rebuild strength, get muscle control back and learn how to reuse the muscles.
  • Re-learning how to do things like walk, pick things up, stand properly… this may induce using muscles that were lost.
  • Mental adjustment – starting to do new things is mentally hard. For me the fear of re-injury was huge. What can I do? Will it hurt? Did it hurt? Did I hurt myself?
  • Gain muscle – gaining control of some muscles causes soreness and tightness there.  Need to stretch and train the new muscles.  Some muscles are “new” from starting to re-use them and some are new because the nerves are healing and re-connecting.  Really, the muscles were there, but not connected and atrophied.
  • Condition the muscles – I’ve got them, get some endurance.
  • Gain confidence in using them.
• Metal assessment of progress – There was progress over time.  Maybe slow, but it was there.
• Repeat the rebuilding phase – I feel like I’ve repeated the rebuild part many, many times.  Sometimes it is with simple things, other times is is hard with the full mechanics of how to walk (still working on that).  Maybe I start something new in therapy, or just get better use of a muscle.  Everything is linked so the process of rebuilding is cyclical.

Background and Why

I wrote a longer blog post on the what and why, but it is good to restate some of it here.

There is no smoking gun that I can point to.  I don’t know how I got to the point that my disc herniated the way it did.  In the past, I’ve been banged up a bit.  If you look at my recovery from microfracture surgery, you will see that I’ve had a few bumps.

I think a combination of things led to my disc problems and need for surgery.  I think that I likely had degeneration of my disc for a while.  After the disc herniated, I ended up in the ER where a CT scan showed degenerative disc disease.  My lower back discs have been wearing down more than they should have.  That is something that happens over time, particularly to those of us who sit for long periods at a time.

Possible Contributing factors

• Sitting at my desk for long hours every day – apparently this is common among males who sit 6+ hours at a time in the 35-40 age bracket.
• Significant decrease in walking after my dog passed away (November 2012)
• Significant muscle imbalance.  This might be a factor of my rehab from the microfracture surgery on my right knee. My physical therapist noticed that I am out of alignment in the months leading up to the herniation.
• Lack of core strength.  I bicycle a lot and have a strong back.  That enabled me to cheat through all of my core exercises without knowing it.  More poor form like the muscle imbalance.

I likely won’t ever know what caused it.  There is a lot of research out there on recovering from disc problems which should help me in preventing more problems in the future.

Weeks Prior to the Herniation

In the two months or so before the disc herniated, I was having a lot of “odd” problems.  They started with swelling in my left knee.  That seemed to map back to very tight let hip flexors, a tight left abdomen and a tight lower tight back.  Stretching the hip out helped my knee a lot.  As my knee improved, other symptoms surfaced.

My physical therapist saw that my walk was very asymmetrical. My pelvis was rotated slightly and my right shoulder diped a lot.  This bend, or twist to the right put excess strain on the right side of my back.  Is it a coincidence that the herniation was on the right side?

I was in physical therapy for about a month when my physical therapist identified my symptoms as similar to disc problems.  We fixed a lot of other problems with the PT, but she was on to something.  Unfortunately I fully ruptured it days later and ended up in the ER.

Diagnosis

Sunday April 21st started as a lazy Sunday morning.  I woke up, checked in for my flight the next morning, took a nice warm shower and did my physical therapy exercises.  The day before I actually rode my beach cruiser around; my first time on a bike in a while.  I sought out physical therapy since my pain had me off my bike.  So I was pretty happy thinking I might start riding again soon.  Not back in action, but I could sense the path.

Then as I bent over to get something off the floor there was a pop.  And pain.  I directly laid down hoping the pain would go away.  I was stuck in pain for about 30 minutes not moving.

When I tried to get up, the pain kicked up a lot.  My memory of the day fades at this point.  It wasn’t long before I was in shock and headed to the ER in an ambulance.

In the hospital, I got some much needed pain killers.  They also gave me a CT scan.  The scan showed degenerative disc disease, stenosis and two herniations.  The L5-S1 herniation was 9mm and the L4-L5 was 5mm.

The MRI and visit to Dr. Bawa

A few days later an MRI confirmed the herniations.  The L5-S1 was 10mm and the L4-L5 was 4mm.  The problem was that the L5-S1 was pushing on the nerve very hard.

In my office visit, Dr. Bawa did some tests on my legs.  Pain was obvious.  He also discovered weak muscles. He game me a good description of what was going on along with two realistic options sine the steroid pack wasn’t helping.  I could get an epidural or surgery.  He explained that discs will heal them selves over time, but this was more than just a disc as the nerve was also impinged.  We needed to get the pressure off the nerve.  Epidurals are heavy doses of anti-inflammatory steroids administered in the surgery center.  Surgery is, well, surgery.

His concern for me was that I failed the muscle tests.  I had lost use and control of multiple muscle groups in my right leg.  Emergency back surgery is done when you lose control of you bowels or bladder.  I didn’t have that, but Dr. Bawa explained that I was at risk of permanent nerve damage.  The steroid pack (anti-inflammatory) I was on had no effect, so the expectations for an epidural were low.  The longer the nerve is impinged, the greater the risk of permanent damage.

Pain and numbness were not reasons to have the surgery.  The muscle control loss is a reason.

Laminectomy Surgery

At this point, I still could not walk or even sit up.  I really could only lie on my stomach.  Based on the risk for permanent nerve damage and the fact that I was not able to live my life at all, we elected to go with the surgery.  This would be a lumbar laminectom discectomy surgery.

I didn’t know what that was, but Dr. Bawa described it as a way to relieve pressure on the nerve and get the herniated disc material off the nerve.  The procedure (he never said surgery) typically takes about an hour and most people are up walking the same day.

Risks

There is an old saying that minor surgery is that which is performed on someone else.  Dr. Bawa listed the normal risks; infection, bleeding, a leak in the spinal fluid and re-injuring during recovery while the disc is still weak.

I asked what happens if the nerve gets cut thinking I could be left completely paralyzed.  The L5-S1 is below the spinal chord, so that is actually not a risk.  It was described to me by multiple doctors that you can damage the nerve there a lot and I would end up the same as when I went in (but likely with less pain).

Based on my condition, the risk of permanent damage and the relatively minor risks; we decided to go ahead with the “procedure”.  Procedure sounds much nicer than surgery.

The Surgery

Very early on May 1st we arrived at the Surgery Center.  My wife was an angel through all of this.  She got me where I needed to be on time and with minimal pain.  She got my prescriptions, made the house comfortable and put up with me.  The latter being the hardest probably.

I’ll leave most details out here for simple reason. I went in scared and was quickly asleep. I don’t remember much.

When I woke up, they had me walk right to the bathroom. I could walk. Wow.

The actual “procedure” tool slightly longer than expected as the disc was a little worse than expected, but it is better to take you time and do it right.

Laminectomy Surgery Recovery

For me, the upside was an immediate relief in the sciatic pain and I got some use of my leg back within hours of the surgery.

Reality is that recovering from laminectomy surgery is not a fast process.

The Hard Part of Surgery Recovery

Pain comes in as a second place for the hard part of the surgery recovery.  First is mental.  When things go well, you mentally feel great, but you may still only be at a fraction of your former abilities.  On bad days, you are very far behind.  There have been many days where I felt like I was fighting a losing battle, and wondered why I should continue.  I have no answers about that.  The whole process takes time and it is hard.

Pain

Before the surgery, I was having significant pain throughout my right leg.  It was like there was a fire in the middle of my leg down through my thigh and into my calf.  After the herniation, I was in the most pain of my life (far more than when I had blood clots from my last knee surgery).

Initially after the surgery, I had a lot of pain in the area of the procedure.  No longer did my leg have pain, but mu lower back hurt.  It hurt bad.  It seemed that most every movement amplified this pain.

“Stay ahead of the pain,” is what I was told.  That means take the pain meds on time.  I tried to be tough.  That was a bad idea.  There is a lot to not like about pain meds, but even less to like about the pain.

So yes, there is pain in the recovery; particularly in the first 10 days.

By the third week, most of my pain was gone.

By the fifth or sixth week, I was looking at dis-comfort that is likely from the muscle imbalance.  Not full pain, but not comfortable either.

Numbness

With the pain gone, I had a new sensation.  Or maybe I can better describe it as a lack of sensation.  Much of my right leg was numb.  My butt, outer thigh, calf, heel and little toes had very little sensation.

The numbness had a few obvious bits of improvement.  That said, numbness is one of the slowest things to recover.  The estimate is 1mm per day measured from my L5-S1 to my foot.  I’ll call that six months.

3 Month Update – I still have a lot of numbness, but it is far enough down that sitting isn’t as bad.  I feel like I have a constant sock crease in my shoe; even when I am barefoot.  That is a sign things are coming back.

Sleeping

You heal when you sleep, but that doesn’t make it an easy task.  No matter what position you are in, your spine will be effected.  Some positions feel better than others.  The challenge for me is that I don’t sleep in the same position all night, and initially just getting into bed was hard.

Lets start with getting in and out of bed.  It literally took 30 minutes of false starts, pain and frustration.  A little flex of my back or core and it hurt.  To get out I would bend my knees at a 90-degree angle with my thighs also at 90-degrees to my torso.  Then I would roll to my side and use my arms to push myself into a sitting position.  For me, my right leg/side was the problem spot, so rolling left was much more comfortable.  It did get easier with time.

Initially, every time I rolled over I woke up.  In pain.  That usually meant I had to go through the above process again.  Many nights I would stand up and wait for the pain medication to kick back in so I could get back into bed.  Again, it gets better with time, but I woke up a lot.  I’ve had fewer good nights of sleep than bad ones, but the ratio is tilting back to my favor.

As I progressed through the trauma of the actual surgery, sleep got much better.

Progress

I have not been able to measure progress day by day.  Instead I notice improvements when I compare back a few days or a week.  The nerve was damaged pretty good and nerves repair slowly over time.

For me, the first major milestone after walking out of the surgery center was the incision healing.  It takes time for the wound to heal and muscles to recover.

Then I noticed some muscle improvement.

Then sensation started to come back with continued muscle strength.  This give me hope for my recovery.

After being surgically cleared, I started the rebuilding process of supporting muscles; this is where my life began to return to normal.  Again, this isn’t a quick process.

Rehabilitation has been a combination of loosening up of muscles and rebuilding strength.  They both go together.  Strength in the most impacted muscles has been the hardest; they don’t want to even begin flexing.  Once I can get them to flex, then I start to rebuild them.