Hip Pain After Spinal Fusion: What Causes It?

Experiencing hip pain after spinal fusion surgery is relatively common. But finding relief means identifying the root cause.

Spinal fusion is a surgical procedure that fuses (attaches) two or more vertebrae together. It’s usually done to reduce pain and improve the stability of the spine.

While it can be a helpful procedure for many, it can sometimes lead to new issues such as hip or pelvic pain. This is often due to the relationship between the spine and hip, which can be compromised postsurgery.

If you’ve had spinal fusion and experienced hip pain, you may be wondering whether there is a connection between the two.

This article explains the relationship between the spine and hip, the causes of hip pain after spinal fusion, and your treatment options.

From your head to your toes, your bones and muscles are connected to help you move around.

In particular, your upper body is connected to your lower body by way of the pelvis and spine. These two are connected through the sacroiliac (SI) joint, which connects each side of the sacrum (the bottom of your spine) to the inner surface of the ilium (the butterfly-shaped hip bone).

Your pelvis also connects to your femur (thigh bone) at the acetabulum, a hip socket that holds your femur bone in place.

Because your pelvis and spine play a major role in movement and are closely connected, issues in one area can affect the other.

After spinal fusion surgery, you’ll need time to recover, which likely means you’re going to be less active. To protect yourself while you heal, your muscles may tighten and function differently than usual.

For example, your hip flexors may tighten, which can put additional stress on your hips, causing greater pain.

Because the spine — particularly the lumbar spine — and hips are closely connected, decreased mobility of the lumbar spine may create greater reliance and stress on the pelvis and hips to maintain posture and support movement.

In fact, spinal fusion is known to cause changes in posture and gait (walking and balance) and may require the hips and pelvis to overcompensate, leading to pain or discomfort. Also, there may be greater stress on the sacroiliac joint, resulting in greater pain.

There are many potential causes of hip pain after spinal fusion. The main causes include:

• greater load onto the SI joint after spinal fusion
• misdiagnosis of back issues instead of hip issues
• bone graft harvesting in the iliac joint (which is next to the SI joint)
• concurrent spine and hip issues (known as hip-spine syndrome)

Also, muscle weakness may occur postsurgery, which is why physical therapy is often recommended.

Hip pain — in particular, SI joint pain — after spinal fusion surgery is relatively common, affecting an estimated 32–42% of patients.

However, this statistic also includes patients who may have had preexisting SI pain before surgery. One study found that new SI pain after lumbar spinal fusion occurred in about 12. 6% of patients.

Due to the multifactorial nature of hip pain after spinal fusion, you’ll need to work closely with your healthcare professional to get a proper assessment, especially if the pain does not decrease or actually worsens after recovery from surgery.

Likely, your healthcare professional will first recommend conservative treatments such as nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen), wearing a pelvic belt to decrease movement of the hips, and physical therapy.

During physical therapy, your therapist may implement strategies that help improve the stabilization of your pelvis, restore posture and balance, correct any walking and balance abnormalities, and strengthen your surrounding musculature.

In some cases, steroid injections or surgery may be needed if conservative treatments do not work.

How long does hip pain after spinal fusion last?

Depending on the cause, your hip pain can be temporary as you recover from surgery or last much longer and may require treatment.

Is hip pain after spinal fusion typical?

Hip pain after spinal fusion is relatively standard. Studies suggest that stress to the sacroiliac joint is one of the main causes of hip pain postsurgery, affecting nearly 32-42% of patients.

What are signs of a failed spinal fusion?

Known as failed back surgery syndrome, signs and symptoms of a failed spinal fusion include new or worsened pain, burning, tingling, or weakness in the lower extremities, reduced mobility, headaches or neck pain, or a return of previous symptoms.

The hips and spine are closely connected, meaning if one is injured or has decreased mobility, the other may have to overcompensate.

Before deciding to undergo spinal fusion surgery, be sure you and your surgeon have a clear understanding regarding any other co-existing hip and pelvis problems in order to optimize your post-surgical outcome.

After spinal fusion surgery, it’s common for the hips to have to “pick up the slack” from the spine and may cause pain or discomfort.

To help relieve this pain, your healthcare professional may recommend first-line treatments such as pain medication or physical therapy to restore strength, posture, and stabilize the hips. In some cases, additional surgery may be required.

If you suspect that your hip pain is due to your spinal fusion, speak with your healthcare professional to find the best course of treatment for you.

Experiencing Groin Pain After Surgery?

If you are having groin pain 6 months after a surgery—hernia repair, vasectomy, C-section—we may have the answer for you. We know the intense symptoms are affecting your life—patients tell us exactly how they feel, and it isn’t pleasant. There is no reason, though, for you to still be suffering. As you will see, you can actually do something about this other than take an endless supply of pain pills (if they even work at all)!

Dr. Eric H. Williams has been able to help numerous patients find relief from severe pain after hernia surgery, and it’s certainly possible he will be able to help you as well. If this is something you are experiencing, come see Dr. Williams for a consultation at his Baltimore, MD office.

Groin Pain Following Hernia Surgery (and Other Procedures) 

You might not be aware of this, but depending on what medical literature you read, there are reports that hernia repair surgeries have a 3% – 30% chance of chronic (over 6 months), disabling pain. There have been changes in the ways the surgical community performs these repairs, but one thing remains the same – no matter how the hernia is repaired, there are always going to be some patients who will suffer disabling pain after this surgery.

The various reasons for this disabling pain include the fact a nerve could occasionally be trapped by a suture that is placed around or through the nerve accidentally. More commonly, the nerves in the groin (the ilioinguinal, iliohypogastric, and genitofemoral nerves) may become entrapped in the mesh material commonly used now to repair the hernia and strengthen the abdominal wall.   

When this mesh heals in place, it creates tissue inflammation and scar tissue that can draw a nerve up into the mesh, thereby pulling on it and causing pain. The mesh does a great job creating strength to the abdominal wall, but it sometimes can cause a problem as well. We have generally traded off trying to lower the rate of hernia recurrence by using the mesh for making little headway in improving chronic post-herniorrhaphy pain. 

Please understand this is not a statement to encourage patients to avoid getting their hernia repaired. This should be a decision weighed carefully between surgeon and patient, and most patients end up very happy and with less pain after surgery. Our attempt here is to make you aware that if you do have severe pain 6 months after hernia repair – you are NOT alone and there is hope to eliminate your pain.

If you are reading this page, and you’ve already had your hernia surgery, there’s a good chance that you are having difficulty with sitting, turning, and sexual intimacy. It could be painful to wear belts or underwear with elastic banding. Simply touching your skin, even lightly, hurts. Perhaps you are in such pain it feels as though you have an “elephant standing on [your] testicle,” “a blowtorch on [your] scrotum,” or “barbed wire around [your] lower abdomen” (a few colorful, direct quotes from patients).

When you exhibit agonizing symptoms like those, life is not fun. It can affect your work, personal, and love life in profoundly negative ways. As we said, though, there is hope for you. One of the most successful procedures Dr. Williams performs is used for resolving intense groin pain after hernia repair.

In addition to hernia repair, the same symptoms can occur after a vasectomy, tummy tuck, or a Cesarean section (C-section). The root cause in all of these cases could be a nerve damaged during your procedure. If this is the case, contact our office to request a consultation with Dr. Williams, and he will evaluate your condition by reviewing your appropriate records and medical history, performing a physical exam, and likely recommending a nerve block. If your situation is appropriate, and if the nerve block works temporarily, there is an excellent chance that Dr. Williams will be able to dramatically improve your pain and symptoms.

It is important to note that in all of these instances, there was a surgical procedure before the severe pain had started. If you have no idea why your groin hurts, or you have genital pain, you should start by consulting with your primary care physician, a urologist, or OB/GYN.

Treating Your Post-Hernia Repair Surgery Pain

There are many instances where your best bet for optimal pain relief is through a coordinated effort of doctors and medical personnel. A prime example of this can be seen when we discuss the measures needed to help you find relief from the pain you’ve been experiencing since your hernia repair, vasectomy, tummy tuck, or C-section.

If it’s been less than 6 months after the procedure, you should start with discussing this with your previous surgeon, and starting with conservative treatment options like physical therapy, steroid treatment, and medical pain management professionals. You may be able to find the relief you need in these avenues. Once it’s been longer than 6 months, you may be a candidate for surgery and should give our office a call for an appropriate work up.

In the event Dr. Williams and you both agree surgery is a reasonable course of treatment for you, you can expect an outpatient procedure that takes about one to two hours for each side. We will use general anesthesia or deep sedation. In most cases, Dr. Williams is able to reuse the original incision in the groin, although it may need to be extended in some circumstances. Then the appropriate nerves are removed—usually including a combination of the ilioinguinal, iliohypogastric, and genitofemoral nerves—in order to turn off the pain. 

It is important to know that the groin and affected areas will be numb permanently after surgery. A patient has to be willing to trade terrible pain for appropriate numbness. This numbness will shrink with time. Frequently, the patient does not have as much numbness as they would expect. This can be attributed to the fact that the nerves that provide sensation are already injured – hence the reason why the patient has pain in the first place. With that being said – the patient must have the mindset that they would prefer “blissful numbness” to “terrible pain.” Incidentally, the nerve blocks performed in the clinic prior to surgery can help the patient and doctor determine the area that can be expected to be numb after surgery. 

A common concern for patients is how all of this will affect sexual arousal sensations. We are happy to let you know there is no need for concern. The penis and clitoris get their sensations from a completely different nerve that will not be affected by the procedure. Further, since Dr. Williams will be taking away the intense pain you’ve been experiencing, physical intimacy will be even better than it has been.

After a typical operation, you will be allowed to go home. You will want to use an ice pack on the incision for several days, but you should be able to walk and sit as you normally would. You should be able to slowly increase your activities after a few days. Typically, the operation is easier to recover from than the original hernia repair. Most patients notice a difference in their pain levels very quickly. For other patients, it may take more time as the angry nerves settle down. 

Of course, there are risks associated with any surgery, including bleeding, infection, a build-up of fluid (seroma), and anesthesia concerns. Complications more applicable to surgeries for groin pain include:

• Unpredictability in the healing process, including scar formation
• Need for a second procedure to remove certain nerves (if not removed during first surgery)
• Unfortunately, there are always a few patients who do not see the relief we had both hoped for, but we try our best to determine this before surgery by determining the response with the nerve blocks. If the nerve blocks don’t work, the surgery typically will not be helpful and we do not recommend it.

Get the Help You Need Now!

Now that you understand why you’re experiencing intense pain after hernia surgery and what you can do about it, it’s time to take action! Become one of the many patients who have found the relief they were seeking here at our Baltimore, MD office. Call us today at (410) 337-5400.

Pain in the groin and lower back – is a disc herniation to blame?

Contents:

1. 1. Causes of pain in the groin
2. 2. Dysfunctions of the hip joints
3. 3. Dysfunctions of the iliosacral joint
4. 4. Inguinal hernia 900 06
5. 5. Complex of exercise therapy for the prevention of inguinal hernia

Among the complaints Our patients often experience such an unpleasant symptom as pain in the groin. These pains are usually accompanied by discomfort in the lower back, where MRI reveals many hernias or protrusions. However, groin pain is so annoying that it drowns out lumbar symptoms and causes many people to go under the knife of a neurosurgeon to have a herniated disc removed. And here comes the moment of truth: the pain in the groin after the operation does not go away, and the limitations associated with the surgical intervention are added to it. This happens because pain in the groin is very rarely due to an intervertebral hernia, and almost always due to changes in other organs. Let’s see why this happens.

Among lumbar hernias, the vast majority are (localized) between the 3rd, 4th and 5th lumbar vertebrae, as well as between the fifth lumbar and the sacrum. The nerves that are pinched by such hernias go to the legs, so the pain radiates to the thigh, knee, calves, and so on. In order for the pain to radiate to the groin, the hernia must be at a higher level – between the 12th thoracic and the first lumbar vertebrae. And fortunately, at such a high level, herniated discs are very, very rare, much less common than pain in the groin and lower back. At the same time, certain manifestations of osteochondrosis of the lower lumbar vertebrae occur in almost every patient.

Causes of groin pain

Why does groin pain really occur? As our observations show, more than 90% of pain in the groin in men and women is due to three reasons:

• dysfunction of the hip joints;
• dysfunctions of the iliosacral articulation and
• banal inguinal hernias.

The rest of the pathology accounts for no more than 10% of cases when a patient comes to our center with pain in the groin. Let’s take a closer look at these three reasons.

Hip dysfunctions

The hip joint connects the bones of the pelvis (acetabulum) and the femur of the leg. Thanks to him, we can walk freely. Dysfunctions of the hip joints are, as a rule, inflammatory changes and coxarthrosis of varying severity. Coxarthrosis can be associated with malnutrition of the cartilage of the femoral head as a result of an injury, or due to a sedentary lifestyle and certain conditions. Diagnosis of coxarthrosis is based on an X-ray of the hip joints, but an experienced osteopath can determine it with the help of special tests.

In the late stages of coxarthrosis, a person is practically unable to walk, or is very lame and needs a hip replacement. The early stages of this disease proceed unnoticed, are characterized by mild pain in the pelvic region and can be given to the groin. It is good if the patient gets to the osteopath at this stage, without waiting for the consequences.

Iliosacral joint dysfunctions

The sacroiliac joints connect the spine and pelvic bones. Their dysfunctions are also widespread and highly variable in symptoms, among which groin pain is not uncommon. SIJ dysfunctions are usually the result of trauma. Diagnosis of pronounced forms is possible on x-rays, mild disorders can only be detected by osteopathic techniques. Sometimes a person can forget the moment when he received an injury that led to SIJ dysfunction. Fortunately, the treatment of this pathology is successfully carried out by osteopathic techniques. In some cases, one or two sessions are enough with the setting of the sacrum by the method of trust in the normal position.

Inguinal hernia

Inguinal hernia is the most common and obvious cause of groin pain. But, unfortunately, in the pursuit of intervertebral hernias, both the doctor and the patients often lose sight of what is at a distance of one consultation of the surgeon. Let’s say a person is tormented by pain in the groin and pulls the lower back a little. He takes a targeted MRI scan of the lower lumbar region, which reveals one or more hernias. All existing symptoms are immediately attributed to disc herniation, and the patient is no longer examined. Thus, another existing disease is missed, despite the fact that it was so easy to identify it – to send the patient to the surgeon. Treatment of inguinal hernia is only surgical.

Apparently, not everything is so obvious and simple in the diagnosis of such a common symptom as pain in the groin and lower back. If this problem worries you, we advise you not to dwell on the search for intervertebral hernias and osteochondrosis, but to undergo a thorough examination by several specialists so as not to expose yourself to unjustified risks from taking unnecessary medications and complex neurosurgical operations.

Exercise therapy complex for the prevention of inguinal hernia

Rather than treat an already existing disease, it is better to prevent it at an early stage. Fortunately, unlike dysfunctional disorders of the lower back and hip joints, which must first be diagnosed, an inguinal hernia is quite definite and amenable to preventive treatment.

A simple set of exercises to help strengthen muscles and maintain muscle tone. They are recommended for people leading a sedentary lifestyle with minimal stress, suffering from obesity; those who are worried that they may develop a hernia. You should not do a workout if a hernia already exists and goes away with complications, the state of health is unsatisfactory (pain, temperature, inflammatory processes), there is a history of severe cardiovascular diseases and other severe “chronicles”. We recommend that you first consult with your doctor or osteopath – he will explain how to start a set of exercises correctly, how hard you can load yourself, which loads are best avoided.

And remember: if you feel any discomfort during the exercise, stop it immediately. No need to do anything through pain and inconvenience.

All exercises are aimed at strengthening the muscular belt, because weak muscles are one of the main causes of inguinal hernia.

Exercise 1. Sandbag. Position – lying on your back, stretching your legs. A bag of sand, cereals, sugar or any other load weighing 1-2 kilograms is placed on the stomach. On the inhale, you need to tighten the abdominal muscles, on the exhale – relax.

Exercise 2. Position – on the stomach, with emphasis on the elbows and toes. While inhaling, you need to raise the pelvis, hold it in an elevated position for 10 seconds, and slowly lower it while exhaling.

Exercise 3. Position – lying on your back stretched out, arms along the body, straight legs slightly raised above the floor. The essence of the exercise is to alternately crossing the legs, in a movement that imitates “scissors”.

Exercise 4. Position — lying on the floor, with a ball between the feet. You need to lift the ball and hold it on weight for 10 seconds, then gently lower it.

Exercise 5. Position – sitting on a chair facing the back. It is necessary to slowly lean to the left, stretching and strengthening the lateral muscles, freeze in this position for 10 seconds, then slowly lean to the right.

Exercise 6. Position – sitting, legs extended. On the exhale, you need to bend over, reaching out to your socks with outstretched arms, straighten up on inhalation. Repeat 2-4 times.

Exercise is suitable for those who are preparing for surgery, but be sure to talk to your doctor about the advisability of physical education beforehand. If you do not have a hernia, but you lead a sedentary, inactive lifestyle, exercises can be done without fear and concern. And if you feel good, you can do physiotherapy exercises to strengthen the muscles of the lower back and abdominal muscles:

*This material is for guidance only. Before use, consult your doctor.

Apparently, not everything is so obvious and simple in the diagnosis of such a common symptom as pain in the groin and lower back. If this problem worries you, we advise you not to dwell on the search for intervertebral hernias and osteochondrosis, but to undergo a thorough examination by several specialists so as not to expose yourself to unjustified risks from taking unnecessary medications and complex neurosurgical operations. Also, lead a healthy lifestyle and exercise regularly.

Author of the article:

Malashenkova Nadezhda Vladimirovna

Doctor of osteopathy. Teacher of the Russian Higher School of Osteopathic Medicine. Therapist.

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Rehabilitation after surgery to remove a herniated disc. Rehabilitation treatment – ​​Department of Vertebrology NCC No. 2 (CCH RAS)

An intervertebral hernia can occur in the thoracic, cervical and lumbar regions. Localization is determined by the presence of a load on a certain area and its mobility. The operation is a radical method of treatment, but the restoration of health does not stop there. This is followed by the stage of rehabilitation, which is decisive in the treatment of spinal hernia. This period can take a month or a year, depending on the type of operation performed, the characteristics of the body and the patient’s compliance with all doctor’s prescriptions.

Foundation for postoperative rehabilitation

Proper recovery consists of several important points:

• Comprehensive supervision of specialized specialists – a surgeon, neurologist, rehabilitation specialist and others, if necessary.
• A well-designed recovery action plan that takes into account all the characteristics of the patient.
• Use of relapse prevention measures, lifestyle modification and elimination of precipitating factors.

The patient feels relief after the removal of the hernia, there is no more pain and you can gradually return to normal life. However, if the recommendations are not fully implemented, the situation may return and worsen. Recovery can be effective only with the proper organization of the recovery period and full compliance with the instructions.

The rehabilitation center of the clinic deals with the issues of recovery of patients after surgery to remove the intervertebral hernia.

Duration of postoperative rehabilitation after removal of a herniated disc

The term is determined by several important factors:

• The type of transaction performed. For example, after a discectomy, the system will recover for at least six months.
• If the intervention was minimally invasive, the recovery time is greatly reduced and can be less than a month. The risk of complications with this approach is also minimal.
• The patient’s age, weight and general health are also determining factors for recovery time.
• Also an important role is played by the age of the hernia, the time during which it appeared and the difficulties encountered in its treatment.

Rehabilitologists have at their disposal a number of techniques that allow patients to recover as quickly and without risks as possible.

Adaptation period after surgery

After the patient is discharged home, his adaptation begins. At home, a number of rules must be observed in order for the process to go faster. The patient needs:

• Wear a corset that fixes the spine in the correct position and protects against injury.
• Avoid prolonged standing or sitting.
• Avoid sudden movements, strong turns, tilts, lifting heavy objects.
• Transport in the first months after surgery is not recommended. If necessary, the patient should take a reclining position.
• Four weeks after discharge, physical therapy exercises can be started.
• Any exercise or load must be agreed with the doctor.

Active rehabilitation can begin in 2-4 months.

LFK

Since the patient is not allowed to play sports, a course of physiotherapy exercises is prescribed. Exercises will help keep the tissues in good shape, return the spine to normal functions. All exercises are performed in a sparing mode, mainly in the supine position.

Massage

A massage course is one of the most important elements of rehabilitation and can only be carried out by a specialist. The effect is mild, aimed at ensuring blood flow, warming up tissues and accelerating the body’s own recovery processes. The application of efforts and manual therapy techniques are strictly contraindicated.

Physiotherapy

Procedures can be started at any time after surgery. In the arsenal – laser exposure, ultrasound, magnetic field, iontophoresis. All manipulations are aimed at removing muscle tone, eliminating swelling and pain, ensuring active microcirculation in the tissues.

Dieting

Nutrition plays an important role in the recovery of the spine. Food should be well-chosen for better assimilation of all useful elements.