After the advice of 7 doctors (I know, crazy) I have it narrowed down to a 2 level procedure. It will either be a 2 level fusion L4/5, L5/S1 or a fusion at L5/S1 and a TDR at L4/5.
So my question has anyone had a 2 level fusion at these levels, and did it change the way you moved, bent over or did normal every day activities?
It's looking like a 2 level TLIF.
I hope you get some feedback, as I am going to have a 2 level fusion too. L4-S1.
What are your symptoms, and biggest problems. Have you taken any more consevative approaches first. Like lumbar injections, manipulation,P/T, traction, etc. ?
I am curious from others as well. I had L5-S1 fused 7 months ago, and now need L4-L5 and possibly L3-L4. I see the surgeon on Dec 1st so will find out what is going to happen. He already told me though that he will not go through my abdomen (my first surgery was a 360, he went through my back and abdomen.) I am going to ask if I can have a disc replacement instead of a fusion because my first surgery was difficult to handle.
In 1993 I had an L4-S1 fusion with hardware. I was 26 at the time. It didn't really change my functioning too much and I didn't notice much change in range of motion. I bend forward but would never stretch to try to reach my toes from a standing position and wouldn't even consider yoga unless it was "back friendly". And I've been careful about lifting and bending from that point forward. Basically I just decided to be more ergonomic in what I did and if at any time I felt a twinge I'd adjust what I was doing.
I am facing more surgery but that's only because I have a very unique a history of lax ligaments and tendons. So now nearly 17 years later I have to extend the fusion to L3.
And, I should add. It did change my life for the BETTER. The pain I had was gone. That was the most important thing in choosing surgery for me.
Thank you SpineAZ that's what I was wondering about. To answer the other questions....I have been to 4 physical therapists, one that actually "let me go" and told me not to come back and finish my sessions as there was nothing she could do for me. I have been to 3 chiropractors, acupuncture, Sports spine specialist, that told me to get an injection, which I flat out refused because they just aren't healthy for you and I didn't want to cover up the pain, I wanted to solve the problem.
A friend that works in the disc replacement industry showed my MRI's to multiple surgeons that said pain pills and PT. I was up to 6 pain pills a day and hanging in there with one PT guy (that had stuck with me FOR FREE). Finally after trying every option I could think of I went back to a orthopedic surgeon to ask how I could change my PT to give myself more relief. He offered to do a discogram and it was at that point they saw how degenerated my 2 discs were. For me I had back pain only. No leg pain at all, no tingling, no numbness, nothing.
The guy told me TDR at L4/5 and fusion at the L5/S1. Well insurance doesn't pay for TDR, but I found a dr. that had found a way for insurance to pay for some of it. But it will still cost a pretty penny. And it's an anterior approach, which I am not to excited about. There is a TDR study going on right now if you have 1 bad level you can get a TDR for free if you qualify. I didn' t qualify but was told I would still be a good candidate. So I found a guy that lives in Las Vegas that would take me to Greece and perform the surgery there. The nice thing is it is a lateral approach, which I am interested in.
Anyways as things have some full circle after 6 months of searching I have almost settled on the 2 level TLIF. I just need to find a doctor in my area to do it. I have had the great opportunity to talk on the phone (because of my friend in the industry) to several surgeons. I am currently communicating through email with a great guy in Rhode Island right now. And if I didn't live in Oregon I would make my way to see this guy right away. He has answered many questions about why fusions are successful and how they can go wrong. he has really put me at ease.
So now I need to find a doctor whose specialty is mini TLIF. I know it's routine, but according to all these surgeons, they have some surgeries that they do more than others, and therefore they have ones that are super successful for them, or....their specialty.
All that to say, I have way to much information and making an educated decision has been tough. I just want to make sure I can go back to my lifestyle of playing sports for pure enjoyment, hiking and if the opportunity comes up again, like it did this fall, coach my kids' sports teams.
Megss you realize that the approach that they use to do a disc replacement is the same as a fusion. The only difference is what they put in. In the states they will only do anterior TDRs. But in Germany, Greece and Brazil you can get a lateral approach that is less invasive. But for the L4/5, according to my last doctor that I saw it's hard to do laterally to get the disc all the way back and in well, and not do nerve damage (temporary nerve damage) that's why many prefer to do that level anterior. Let me know what you find out, I am always interested in more opinions.
Have you ever heard of, or tried, Prolotherapy? I have a similar problem as you in that there is no leg pain. But I have a lot of instability due to retrolisthesis and other problems. I had also tried the injections and PT and the next step was surgery, which I really did not want to have. I know that some people have positive experiences but I think that generally many problems can, and do, still exist after surgery. Prolo has been a lifesaver for me.
Hi guys, I have chronic lower back pain that was in he start only localised and most of the doctors I saw told me that surgery was most successful when the legs where involved so I have been on pain killers etc for close to 8 years now.
In the last 6 to 12 months my problems got worse, I had terrible shooting pain up my spine and down my legs for the first time. After about 12 times of excruciating shooting pain I realised that My life as it was had to stop and I now am very limited in the activities I can do. Basically I am stuck at home most of the time and every time I do anything to physical I have terrible pain with now leg pain and shooting pain from above my waist through my bottom and into my thighs. With some numbness in my feet.
The surgeon I first saw made out that I should have gone back to him years ago but another 2 neurosurgeons refused to treat me (surgery that is). I have been diagnosed as having compressed nerves at L5-S1 but I think it is at the L4-L5 as well.
I have tried to get surgical help in the public system without any success so far but have now taken out private health insurance and will have to wait 12 months before they will treat a pre existing problem. It seems that I won't have any surgery in the public system for at least that long but I know I will be treated with much more respect.
I do hope to have a double disc replacement if that is possible and if I can get a surgeon to agree. I don't know what else would help me as I have problems with the facet joints as well as the nerve roots and a tare in one disc. With some herniation and degeneration with loss of disc hight in both discs.
I know just how you feel and hope that you can get the disc replacement rather than the fusion that will limit your movement and ability to bend. Good luck I hope you can find the right surgeon to help you.
Jen I had never heard of that, but went and read up on it. I have a general consensus from a lot of doctors that my pain is caused when the liquid comes out of my degenerated disc and hits nerves. So I don't know if that would be a solution for me. But I never rule out anything until I have thoroughly researched it. Still reading.
Allan...I am speechless. I am the worlds biggest complainer because I have been on pain pills for a year. I am glad you got a better insurance and I hope you find a good solution. Let you journey begin today, because it will take you 12 months to find a perfect solution. I have asked many doctors that exact question of I have back pain only will this surgery be successful, I have gotten a 100% saying yes.
Here are a few nuggets of info that seem to work in the states as far as insurance goes. Insurance here will pay for fusion but not TDR. the reason being...well according to my friend, it's just because they don't want to, no real reason. So some doctors here have found a loop hole and they are trying to use this loop hole on me. The L5/S1 really doesn't move that much at all even in a healthy spine, so fuse it, therefore your surgery now has a fusion in it, so insurance will pay hospital visit, doctors, x-rays, procedure costs, but they won't pay for the artificial disc that goes into L4/5. I will pay out of pocket for that. If I chose only a 2 level TDR the whole procedure would be my expense.
I had a two level 360 done at those levels and at a year post op now...it was a tough recovery and was well worth it...I have some disabilities from it...I can' reach my feet and have trouble putting shoes and socks on...getting dressed is a big changed from this as well...I do howerver have another injury that hasn't been addressed yet and may be keeping me somewhat restricted as well ...over all I would do it again in a heartbeat!...the biggest thing is walking as soon and as much as possible....it does take every bit of a year to get normal feeling...every week I get just a little better. I would be glad to answer any other questions you may have.
AmyBB. you can get a direct lateral interbody fusion in the states. I'm scheduled for january 2010. although not many surgeons trained to do it I'm wondering if anyone on this forum has had it done as I need feedback on how it went for them.
Are you getting the XLIF? I want that one, but they won't do it for me. If you go to nuvasive's website you can see the procedure (in animation). I wanted it because it seems to have great results. Since I have 2 levels they only want to do one approach and the L5 S1 can't be approached that way.
I hope yours goes well!!!
i have a 3 level fusion L3-S1. My surg was in April 06. the hell of a recovery that i had, definately outways the pain and discomfort i had prior to the surgery.
I was 30 when the dr said that i really need a 4 level fusion, but i was too young for that. So He did a 3 level. i discussed with Him about TDR vs fusion and both have the chance of causeing havoc on the above/below discs. Fusion has less of a chance per my dr in 06 ( not sure if things have changed). Prior to my surgery, i was in EXTREME pain... could not sit longer then 5 mins, stand for 10 mins, all i knew was my bed with MANY pillows.
now 3 yrs later.. i am working.. in a newer relationship with 2 kids and loving life.. Sure i have pain everyday.. and i know that my other discs are going to cause problems down the road. but for now.. i just want to enjoy the 2 yrs that my back has taken from me and not look to the future til it happens.
Remember 1 thing: Exercise, excercise, and excercise some more after the surgery. This will help in the long run. there are days that i cant cross my legs or put my socks on. that is because i did not excercise my muscles.
Amy...I'm getting a DLIF, which I think is similar to an XLIF, just different equipment. Can you have a DLIF AND a TDR? I'm confused. I see my surgeon on Monday so I'll ask them. During a DLIF they do put something in place of the disc then do a fusion. That may be a TDR?
I had never heard of a DLIF so I had to look it up and yes it is similar to the XLIF, which is the lateral approach. I have heard this is supposed to be an easy recovery, so I am excited for you.
You can choose a fusion, which is no movement or a Total Disc Replacement(TDR), which helps you maintain movement like a normal disc. Insurance won't pay for a TDR and I just got quoted $19839 for a new disc. That's quite a price tag. Insurance will pay for a fusion.
Thus the question this started with, can I live with a 2 level fusion because $19839 is a bit steep for me.
I hope your surgery goes well.
JAM317, thanks for your input, that was really helpful. It's nice to know there is still a normal life on the other side.