What level of treatment could be next for me ?


Q: Im on WC from the fire department who hurt his back. MRI revealed l4-l5, l-5-s-1 disc herniated at s-1. Neurosurgeon performed laminectomy, discectomy , which stopped pain in right leg. Therapy started and made it 2 weeks to pain. Therapist sent me back to doctor who said it was just muscular, and sent me to pain management doctor. Took 3 weeks to get approved by workers comp, in between that time i was scared that this doctor was just going to put me on pills, so i had xray on my own, that i walked in with to pain management doctor, which he was happy bc i told him i didnt want pain medicine, just to look at this xray, for which he took to my neurosurgeon and they decided that it wasnt muscular, my joints are messed up, and after diagnostic testing, they performed a nerve ablation, for which 3 weeks later my back hurts worse than it did before, not the sunburn feeling of nerves not dead yet. Before he did the ablation, he did state that my "horse could be to far out the gate", for which i dont know what that means. I have my appointment next week to see whats next. I cant bend backwards, or rotate with out major pain. What step would you guess to be next. I wish the doctors would just be more upfront with me. Thanks for your help. Cory

Symptoms:  LBP chronic. Surgery. Nerve ablation

A:   Hello,
Thanks for contacting askthedoctor.com for an opinion.
At your age group , if you have already undergone a laminectomy and discectomy for disc prolapse at lumbosacral vertebral level , then ideally you should have waited for some more time with your primary treating physician who operated you as it takes about 6-8 weeks to be able to resume normal functions and for the pain in hip , back , leg and feet to go away. A schedule of physiotherapy exercises are advised along with, for 4-6 weeks after 2 weeks of operation along with pain killers.
You have reported to pain management center for pain relief within a month expecting speedy recovery and early relief, and they reported problems with joints which is unlikely as your joints at this age are perfectly fine and even before your prolapse, so the procedure of nerve ablation was an over do in this case and can be attributed to your anxiety and result orientedness . Now this procedure has its own side effects like, there may be sudden shooting pain in lower limbs sometimes, with numbness setting in often,. The pain lower back is again here to stay for 2-3 weeks and can be controlled with opioid analgesics like inj.tramadol and then again you have to be shifted to physiotherapy exercise schedule to attain maximum range of movements at the level of hip joint and lumbosacral region.
i hope i have answered your query in detail,
wishing you good health,

Comments / Follow Ups

Patient: My question of what level of treatment should be next wasnt answered
Patient: First of all, it was 6 weeks in between back surgery and the start of physical therapy, then i started to hurt by week 2 of therapy. Thats when i was sent back to the doctor, who decided to send me to pain management doctor, thinking its just muscular. Evidently xray shows that they believe i have trouble with my joints, and decided to perform the nerve ablation. I believe also that the nerve ablation was unnecessary. With the histort of my family with horrible backs, these doctors actually treat them also, is what they said is just genetics. I just wanted to really know is possibly a fusion of this area all that i have left as an option to stabilize these joints.
Doctor: Hello,
Vertebral fusion can always be performed for you if the other modalities are ineffective and the decision if for your physician to take,

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