Why does distratcion pain start weeks later?

[Michelle]

I'm hoping maybe PainDoc can help answer this for me. I've heard people mention getting distraction pain post ADR placement by a couple of weeks. If the nerves are irritated by the increase in the disc height, why doesn't it start immediately after surgery? Also, will it help me that I've had 2 laminectomies at the same level as my ADR-as I understand it, they widen out the passage for the nerve through the bone? Thanks for giving your time to us spineys!!!!

[mmglobal]

Michelle,

Distraction pain is a patient's term to describe what I call 'surgery-induced leg pain'. Some surgeons have adopted the same term, others call it 'stretch neuropraxia', to describe symptoms caused by distracting the disc space, stretching the nerves, remobilizing the segment, or even the assault on the nerves during the decompression where they may be removing tissues that have adhered to the nerves.

Onset of these symptoms at several weeks post-op can mean many different things. If you have a serious change in your situation, you should certainly tell your doctor. Depending on what's going on, he may want to do some xrays just to insure that everything has stayed where it's supposed to be.

Are these completely new symptoms or is this pain pattern familiar?

It's possible that new symptoms could be associated with a new problem. It could be associated with the same level or even a different level.

It could also be that you are ramping up your activity level and have reached a place where you are generating an inflammatory response that is causing more nerve root irritation. Remember that it's possible that the operated level is now more mobile than it used to be, but at low post-op activity levels, you never get to the place that is still sore. With higher activity as you get further away from the surgery, you can find out how much is too much.

The bottom line is that every situation is different. There are so many things that can cause these symptoms. Some are completely benign and some are not. Make sure that your doctor is aware. If you are doing something that hurts... especially so close to your surgery.... let pain be your guide... don't aggravate the situation. No-pain-no-gain therapy may have a place in rehab for some people at some point, but not in the weeks following spine surgery for most of us.

Good luck, please keep us posted.

Mark

[Michelle]

This leg pain is in the same pattern as it used to be, only on the left instead of the right leg. It came on quite severe in my left leg only a few hours after I'd been significantly more active than before. (I wouldn't have thought that 5 hours out of bed was that much 3 weeks after surgery but I guess it was too much). I laid down feeling fine, then the pain started a few hours later, and I hurt most of the night. It went mostly away by the next a.m., and is back to the minor bilateral leg pain I've had since surgery. The inflammatory response makes sense, though why wouldn't it have been bilateral? Is it also true that the less the disc had to be distracted from where it was, the less leg pain that is typically experienced? I don't know yet how much of my disc height was restored. I'm not really worried because it does follow the same pattern as my previous leg pain, and had abated drastically, just curious. Thanks for your insight!

[mmglobal]

Michelle,

Did you let your doc know about your symptoms. He may consider that changing legs are new symptoms. Even though the pattern is similar to your familiar pain in your other leg, that may still be cause to take a look. I agree that there is no reason to be worried, but you should still take the onset of new symptoms seriously... tell your doc and let him decide.

Are you scheduled for control / follow-up xrays? 6 wks? 3 months?

As far as whether or not the pain that appears is bilateral, it will simply depend on where the inflammation may be, why, etc. The tolerances are quite thin... for many of us, it doesn't take much to flare up symptoms.

Remember... I'm not a doc, so my opinion is of little value... check with your doc.

Mark

PS... many times during my recovery, I became frightened about symptoms and found myself Monday 8am waiting for the doc's office to open, saying, "fit me in today... I want xrays." In all cases there was nothing to worry about. That happend as far out as 2 years. I always looked back a couple of days later and laughed at myself for panicing, but I'll do the same thing again if I experience the onset of symptoms that seem to be from my ADR levels and I can't explain them.