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Old 05-12-2009, 06:24 AM   #1
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Questions to ask Dr. regarding fusion

To give a little background, I had L4/L5 laminectomy/discectomy surgery last August followed by another surgery two weeks later to clean out a massive hematoma/infection caused by the first surgery. My severe sciatica never went away (I can't sit at all!) and my surgeon said he couldn't explain my symptoms.

I have been to lots of various doctors for 2nd & 3rd opinions & such, and have been told everything under the sun was causing my problems, and had several doctors tell me that they were absolutely certain my spine was not the problem.

A PM doctor recently found my problem with an upright MRI and discogram, and it turns out my L4/L5 disc is completely shot and dye leaked out the side and back of the disc in the discogram and recreated my back and sciatic pain. The PM doctor said while he isn't the surgeon, he strongly suspects I will need at least a one-level fusion (my L3/L4 disc is also bulging but not causing pain at this point).

So I see the surgeon later this week and I'm seeing a different surgeon than my first surgery. I am really not that familiar with fusions and since there is a strong likelihood I will need one, I would like some advice on what questions I should ask this surgeon. I'm in a terrible mindset since I want to get fixed so badly right now after being in pain for such a long time and getting such a runaround that I would be likely to go along with whatever this doctor recommends. I know this is wrong and I should really question him and understand the procedure recommended and why. I have looked through some of the previous posts and it looks like a 360 fusion is the preferred method. What do you all think I should ask about or know about?

 
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Old 05-12-2009, 07:30 AM   #2
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Re: Questions to ask Dr. regarding fusion

Hi Brenda,
I'm sorry it's gotten to this point for you. It's so frustrating when reputable doctors have conflicting opinions. We have to remember that they aren't God; there's a limit to what they can do. They can only draw their best conclusion based on their education, and sometimes that just isn't enough. You've done well to persist in getting multiple opinions! I hope the appt with the surgeon is satisfying to you, that you feel comfortable with him and in making your decision about this surgery.

Here are some of the questions I had for my doctor before my fusion surgery:

Will the graft be my own bone, donor bone (cadaver?), or synthetic?

Will I be able to go upstairs once I get home? How long do I have to stay up there?

How long should I plan to abstain from sex?

Will I have a brace? How does the brace get fitted after surgery? Will I wear it 24/7? Sleep in it, shower in it, etc.?

Will I have a walker or other special equipment at home?

Do I use an enema prior to surgery?

Is there a weight limit guideline for lifting after surgery?

What is the hardware made of? Will I set off metal detectors? How often do these screws/rods break or come loose?

How common is it for the fusion not to happen?

Is there anything I can take (vitamin, etc.) that will help me to have a strong fusion? Are there things I shouldn’t take (caffeine, ibuprofen, etc.). Is it okay to take my vitamins, Fosamax, and calcium up to the day of surgery? What about percocet?

If I’m heading into menopause, is it necessary to take hormones in order to build bone?

Will I have staples, regular stitches, or dissolving stitches?

Will my insurance pay for the bone growth stimulator?

Can I use a vibrating massager on my neck?

Is it possible to get a temporary handicapped parking permit?

Is it okay to use a heating pad after surgery for leg cramps?

What should I expect my limitations to be and for how long? How long sitting in a time span, how long to be up and around, how long until can sit for any length of time.



I had a 360 fusion. It's a harder surgery to recovery from, since you have two incisions and they've moved things around in both the front and back, but it has a higher success rate. Which method they opt on for you depends on your specific circumstances.

Let us know how your appt goes. And hang in there, sweetie! You've been through a lot. Let's keep up hopes that relief is coming soon!

Blessings,
Emily

 
Old 05-12-2009, 06:34 PM   #3
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Re: Questions to ask Dr. regarding fusion

Hi Brenda, First off I will tell you that a fusion should be the last resort. I got a couple opinions before I had my second fusion, the first one was out of my hands as I was younger and it was for scoliosis that was getting pretty bad. Just look at all your options first since fusion is permanent and the wear and tear on the upper and lower portions of your spine take a toll and may require further surgery/fusions in the future. I am sure your Dr has told you that ...or I would hope so.
Now the good side is that a succesful fusion surgery relieves alot of the pain associated with DDD, ruptured disks ...ect.
As far as preparing for surgery, there isint much. You just show up and check in.
After surgery a bowel movement may be an issue, depends on how long you are under anesthesia, the longer your under usually the longer to get the digestive system to work like normally ..... But it will return too normal. Pian meds after surgery also effect your bowel movement since they can cause constipation.
You should get any o/t assistance devices you need before you return home.....a occupational therapist will decide what you need. And a visiting nurse may be assigned to you for a couple weeks at home.
My surgery was pretty extensive, old hardware removal and extended fusion so I do not think you will have so many difficulties, just laying out the facts for a worst case scenario. Your Dr will have you sign a release for surgery , he/she will explian any and all potential risks associated with the surgery. Its protocal just in case.
Best Wishes

 
Old 05-15-2009, 08:09 AM   #4
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Re: Questions to ask Dr. regarding fusion

Emily and Hooksinkers,

Thank you so much for your replies and advice. It definitely helped me when I saw my surgeon yesterday.

My surgeon said that I need a one-level fusion at L4/L5. He said the discogram shows a huge tear on the side of the disc that can only be fixed with a fusion. Thank God for the discogram - I know there are others on this board that are having discograms done right now also, and I can just say they are worth every bit of pain you have to endure! Also, the pain you have with a discogram is short-lived so it's very tolerable.

My surgeon was running way behind and was very short on time, so I didn't get all of my questions answered, but they gave me a 3-ring binder which answered a lot of my questions, and I plan to write down my remaining questions and contact my surgeon's nurse in the next few days to get those answers. Also, I really felt comfortable with this surgeon - he is very personable and someone I can trust.

I'm just so excited that after such a long journey I finally have a chance for some resolution in sight! I don't expect to ever be back to 100%, but I want to be functional and productive again. I just hope I don't end up the same or worse off after surgery - been there, done that already. My heartfelt sympathies are with all of you who have had multiple surgeries that have not given you resolution or made you worse off.

 
Old 05-15-2009, 08:27 PM   #5
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Re: Questions to ask Dr. regarding fusion

`Brenda > I wish you the best of luck with your surgery , Emily gave you some great advise.. I had a diskogram done on 5/14 , and it hurt BUT we got some good info from the test.. I am trying to figure out the info the best that i can , got the ct.scan report and still waiting for the diskogram report.. Going to see my doctor next friday , and we will speak about further treatment..

I all ready had 2 back surgeries and really do not want to go threw it all again.. Had a 2 level fusion l4.5 l5.s1 two tears ago.. I see that your having your l4'5 fused , GOOD LUCK you will do fine..

DEv

Last edited by deviphish; 05-15-2009 at 08:28 PM.

 
Old 05-16-2009, 02:54 PM   #6
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Re: Questions to ask Dr. regarding fusion

Hi Brenda, I am so glad you started this thread. I had a dicso on Wednesday and am meeting with my second opinion surgeon on Monday (the first said I needed a two level fusion due to my DDD). I have a list of questions, but it is no where near as comprehensive as the questions put forth in this thread, so thank you!

Emily, Thank you for taking the time to write down all of those questions to ask. I hadn't thought of so many of those!!

Hooknsinkers, Thank you for pointing out that fusion should be the last option. It's the debate that my husband and I are having regarding my situation. I am 31 and have had back pain since 16. It's been the past year or so where it has become unbearable and I am not able to live any sort of normal life. He has a medical background and keeps telling me that I should wait as long as I can since a double fusion can eventually cause problems with the other discs (especially if getting the double fusion at 31) and this can become the first of many surgeries. We really want to start a family, but there is NO WAY I could put the stress of pregnancy on my back in this state. It's such a tough decision, but at the end of the day I just want to be out of pain.

Brenda, I hope everything goes well for you and you get some relief from your pain.

Tara

 
Old 05-16-2009, 03:49 PM   #7
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Re: Questions to ask Dr. regarding fusion

Tara,

Thank you for the well wishes, and I in return hope the best for your situation. Did your discogram show that both disc levels were shot? Which levels are giving you problems?

Getting a fusion is a really tough decision to make, and I agree that it should be put off if at all possible. However, I also think there comes a time where having a fusion offers more potential benefit than risk. That time has definitely come for me as I have been unable to work and completely unable to sit at all for over a year now. Even if this fusion doesn't get me back to 100%, I at least should be more functional than I am now and be able to drive and go out to dinner with my family and do things that have been impossible for me for so long.

So I guess that's the way for you to decide - does having the fusion offer more potential benefit than risk to you at this point? Also, if you want to have children, I imagine you would need to wait at least a year or so after a fusion before you could even become pregnant, so waiting longer may mean having more potential pregnancy problems as you would have an advanced age in respect to the pregnancy.

I wish you all the best in making your decision! ((Hugs!))

 
Old 05-16-2009, 03:56 PM   #8
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Re: Questions to ask Dr. regarding fusion

Dev,

It really stinks to be facing yet another surgery after you've already endured back surgery, doesn't it? You're probably as sick of it as I am and ready for this phase of your life to be history.

As you still having sciatic pain or just back pain? If so, what disc level does it implicate?

Good luck with your doctor's appointment next Friday and we'll all be anxious to hear what the doctor has to say!

 
Old 05-17-2009, 12:13 PM   #9
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Re: Questions to ask Dr. regarding fusion

THANKS Brenda. I am having sciatic pain running down my right leg and into my foot and toes. Most of my pain is in my back , it's deff. coming from my l3-4 levels. My lower back hurts as well but the pain is unbearable in the mid line lumbar regions , it really hurts right above my scar from my previous surgery..

I'm a musician and I can't play my guitar for any longer than 15 - 20 minutes , before my back starts killing me ! I'm concerned because this is the same pain that i had before my last fusion surgery , and I'm a carpenter on top of that ! I can't get ahead , 2 steps forward and 1 step back - I'm going to write a song now about that `LOL`..

THANKS : B "
DEv

 
Old 05-18-2009, 11:43 AM   #10
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Re: Questions to ask Dr. regarding fusion

Billy, we have a house full of musicians here! Definitely write a song about this. And I want to see you on American Idol! (Um, let me know when, since I don't watch it!!!)

How did your discogram go? Are they saying more surgery?

Love ya,
Emily

 
Old 05-18-2009, 02:33 PM   #11
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Re: Questions to ask Dr. regarding fusion

THANKS EMILY , I do remember you saying that your son is a musician :think it was your son:.... I had the diskogram done last week and it was pianfull , but helpfull. I go to see my surgent on friday too see what the next step is..

They found at l3-4 , there is a small right posterior annular tear with an associated small right paracentral disc protrusion. It also says that fluid density is identified posterior to the spinal canal esp. at the l5 level.. that was the ct.scan report.

Thr diskogram says that l3-4 had degerative appearance with posterior leak of contrast.. My PM doctor who did the procedure , seemed like he saw something serious and wanted me to see my doctor asap..

What do you think after reading that report Emily ? I'm all nervous over here , and my back has been killing me..
THANKS
DEv

 
Old 05-18-2009, 03:13 PM   #12
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Re: Questions to ask Dr. regarding fusion

I'm not too good on this gobbledegook, as sometimes what the report is saying is that everything is normal. (Why can't they just say, "It's normal?") But I'm thinking it doesn't really sound good. The leakage of the contrast has to be a concern, at the very least. But you know, if this means more surgery, then that means there's hope for pain relief! I'm sure it's a tough pill to swallow, but you'll get through it if that's what your doctor suggests. I wish you could feel the big hug I wanna give you! I'm so sorry the last surgery didn't end your problems.

Keep us in the loop!
Emily

 
Old 05-18-2009, 03:52 PM   #13
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Re: Questions to ask Dr. regarding fusion

Thanks Emily . you are truly a sweet heart !!!! I can almost feel the hug that you're throwing at me & I like IT <> I agree , all these reports get a little confusing.. My PM doctor said that he saw a good amount of contrast leak out of the 13-4 disc after he did the diskogram , and that i need to consult my ortho doctor..

If it does come down to surgery so be it , I need to get out of this misery. My back has been killing me as of late , if surgery means pain relief than sign me up.. I no how hard the last surgery was on me , and what you have to goo threw -- so at least i will be ready.. I will keep you posted Emily and thank you so MUCH for always being there for me and every one else..

billy

 
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