Back Surgery and Pregnancy

[loopie]

Hi all

I know there are other women who have had back surgeries and I wanted to get some feedback

me- lots of PT, pain suppression, and a few surgeries - finally ending up Nov 2006 - fusion with instrumentation (donor bone, rods, screws) of L4-L5-S1
back pain had improved- movement fairly limited - but agonizing nerve damage to both hips- doc says it was a result of the surgery.
I have been pretty good, and have only taken mild pain meds a couple of times since january - all in all- been feeling healthy -
lately, I have begun to have increasing pain in my back and hips - this is not really the big deal- I was sort of expecting it- and amazing that it's not happened sooner or been worse- i just try to take breaks often - I mean, I think I was under the impression that I'd be on bedrest for more than 1/2 the pregnancy, so I am extremely grateful!!!-though we'll see what is in store for a vaginal vs c section....

I am actually very curious- I have been reading Mayo clinic guide to pregnancy, and I see that as we get into the latter months, our backs are supposed to curve to accommodate increasing bellies, and to keep balanced - umm, so how is it that i'm not falling over, and is it the pressure of my back trying to arch that is increasing the pain?
am i in for it as my bump grows?

any of you been in a similar situation?


thanks!

loopie

[rali]

Hi Loopie, I just came across your message, and wanted to reply and see how you were feeling. I had a laminectomy in 2001, and had my 2nd surgery (through my stomach) in 2006 which included titanium cages and several screws with injection for bone growth/fusion. (L3,4,5). I too thought that I would have extreme pain throughout the pregnancy, but I did not. I am now 38.5 weeks and my back is curving inward, just like everyone else. I thought it would not bend, or I would be in more pain, but there is no pain. My back has adjusted to the weight gain, and so far so good. I do feel that I cannot arc it like I used to though. I met with an anesthesiologist about epidurals & pain meds for labor, and he asked me to round out my back so he could examine me, but I felt like I couldn't get it rounded. He even commented on it. Unfortunately I cannot get an epidural because of my lami...it caused too much scar tissue in my epidural sac. I am allowed to get a spinal block though, as well as IV narcotics if need be. Just something else to think about if you haven't met with an anesthesiologist yet. Some just won't touch you regardless. I am a little nervous about not being able to get the epidural, but I won't be the first, nor the last. Good luck, and PM me if you want to talk more.

Rali

[loopie]

Rali-
thanks for the response -best of luck with delivery- you are super close!!!

I am hoping to have as natural/medication free a birth as possible, but in the event that things get too much for me - yes- I, too am now concerned with what pain relief I may want vs what may be possible.

It seems they do epidural/ spinal at the L4-L5 region, so with scar tissue( 2 surgeries through the back), titanium, and a lack of movement- it seems unlikely an anesthesiologist could do anything. Did you supply previous x-rays or MRIs? or was this purely upon inspection/ consultation that they made this diagnosis?

I will be eager to hear how things go for you -wishing you wonderful, peaceful birthing karma

BUMPIN' 08!

loopie

[rali]

Hi Loopie, yes I did bring in my readouts for a cat scan that I had after surgery. The anesthesiologist requested MRI's, but I asked my neurosurgeon why CAT's and not MRI's and he said that the CAT's showed bone growth better, so we never went with MRI. I had plenty of paperwork for him to read through, but he still couldn't tell from what I had if my epidural sac was full of scar tissue or open. So I asked my neurosurgeon and he said that in his opinion, knowing my history, he believed that I was full of scar tissue b/c the incisions were exactly at the L4 L5 region. He said it was up to me to take a chance to see if it would work, but he said I might have to go through the procedure and then nothing. I felt after talking to him that I would rather have an established plan, than to go in just betting on this to work.
I would meet with your anesthesiologist if I were you and bring whatever paperwork you have. You can even get a transcript of the actual surgery from the hospital. The Dr told me that a spinal block goes directly into the spinal fluid (the area you want to AVOID hitting with an epidural) with a very thin needle and can provide pain relief only for 1 1/2 to 2 hrs. He suggested I wait as long as possible since it doesn't last as long. I asked him what is the difference between the Spinal and the Epidural, and he said the epidural only enters the epidural sac (where all scar tissue is...blocking anesthesia from getting where it needs to go) and they use a catheter which is much thicker than the spinal needle. If the catheter were to enter the spinal area, that's when you run a risk of a leak or a monster headache that can last for days. The risk is still there with the spinal block, but he stated it is much lower. Talk to your back Dr as well to see if he knows of any former patients who went through the same thing. Let me know how you make out with the Drs and I will keep you posted on my delivery. Only 5 days left!

[loopie]

rali- hope you are doing great and baby comes on time for you

many good wishes for a safe and painfree delivery!

BUMPIN' 08!!!!


loopie

[loopie]

Just wanted to update- I met with the Obstetric Anesthesiologists, we discussed my situation, and it seems like if i decide i want medication, or if it becomes necessary for csect, they will be able to give me an epidural. It will be higher than where they usually put the catheter, so more numbness is likely farther up.
Some issues are that due to scar tissue, it is possible that the meds will not travel through the canal, and I may not have uniform pain relief or numbing, or it may not work at all. In such a case, they would remove the catheter and try another spot- if nothing works, and we go into needing csect, they would have to do general anesthesia- a bit more risky for baby, but would do as fast as possible. Meds should not affect breast milk.
I will also be putting my xrays in my birth bag and will take them to the hospital when baby's ready to be here.

RALI- I hope everything went great and can't wait to hear your good news!

cheers

loopie