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Old 03-19-2010, 10:32 PM   #1
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To Fuse or Not to Fuse L4-LF

I am new at this and have researched all over the internet about Anterior Lumbar Fusion. I have seen 3 different doctors over the past 10 months regarding my lower back. I am 30 years old and have 2 kids, 3 and 11. I was in a car accident at 20 and started having back pains. After many rounds of steroids, cortizone injections, pain pills, muscle relaxers and physical therapy I was finally sent to a Pain Management doctor. He did what they called an epidural block in my spine. I woke up from surgery and did not hurt for 7 years. It all woke up again in May of 2009, after therapy and pain medications I went right back to the dr. I had seen before. He decided to do 3 series of nerve root block injections. $2200 later I was feeling much better, it is now 7 months later and it has woke up already. I saw my back dr. last Friday and he said ultimately I need a fusion but I am so young. I have degenerative disc disease, Spondylolisthesis, and bulging discs at L4/L5. I have stabbing pains in my thighs, pins and needles in my lower legs, my feet and lower legs go numb when I cross them, my lower back hurts constantly and recently it has moved a little further up my back. This is so frustrating. I am not sure what to do...I am seeing a spine specialist on Monday which is supposed to see about doing some more "diagnostic injections" to see if he can help. This is a different dr. than the one that gave me the last ones and the series of 3 were 8 different injections at one time. My new back dr. did not exactly agree with that either.

The decision I have to make is whether or not to just go ahead now with the surgery. It is inevitable that I need a fusion. I have had 3 doctors tell me this but not sure if I want to hold off. I hurt all the time and I have kids to tend to. Any suggestions out there?

 
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Old 03-19-2010, 10:38 PM   #2
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Re: To Fuse or Not to Fuse L4-LF

Surgery is a personal decision but I can tell you that I'm the kind of person who, if after all kinds of treatment I am in pain, I go for the surgical route if it has been recommended by a doctor (or doctors) that I like and that are well regarded. Back surgery is not easy, by any means, but I can tell you that 6 weeks out from a major revision my pain level is much better than it was pre-surgically. I'd do each of my surgeries again in a heartbeat as each resulted in me feeling much better after!
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Rt&Lt thumb arthroplasty 2012 ; RT TKR & Bilat CTS 2011
Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
Old 03-20-2010, 06:48 AM   #3
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Re: To Fuse or Not to Fuse L4-LF

Like spineaz said, this is a personal decision, but you asked for opinions, so we're happy to give them.

Surgery should ALWAYS be the last resort. It sounds to me that you're there. If a fusion is inevitable, why wait? Youth is on your side. The younger you are, the faster your recovery, in general. The biggest concern I have for you is that the longer you wait, the greater the chance of permanent nerve damage. Nerve irritation would be the reason for the numbness and stabbing pains in your legs and feet. That might be something to ask your doctor about. I haven't had that, as my back issues were different from most here, but I've read about it from a number of other posters.

If you do decide to go for the fusion, come back and talk to us. We have lots of suggestions that will make your recovery easier.

Blessings,
Emily

 
Old 03-20-2010, 01:07 PM   #4
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Re: To Fuse or Not to Fuse L4-LF

You might consider the following Alternative to fusion.
The Aspen Technique. Briefly it's designed for patients
with degenerative disc disease or spondylolisthesi in the
lumbar spine (low back). It is less invasive than a pedicle
screw fusion. Because of its design, it is safer than the
pedicle screw based systems which present risks of nerve
and blood vessel injury. The aspen system is easy to implant.
Again, I don't know if this is right for you. I did not have
the opportunity to try this, but if you do a google search,
you'll find the information on the first google page.

Personally I am 17 months forward with fusion on L5/S1 using
the pedicle screw based system. I'm still in pain with a impingement
on a nerve, need corrective surgery which I'm in no rush to do
right now. Do your due diligence and make sure you & your doctor/
surgeon are on the same page. Read the release/consent form
of exactly what is going to be done, just don't sign it blindly. You
also have to remember, things can change during surgery when the
surgeon opens you up for better or worse.

Whatever your final decision. I hope the best for you and a speedy
recovery.

 
Old 03-20-2010, 08:42 PM   #5
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Re: To Fuse or Not to Fuse L4-LF

Thanks so much for your reply. I am leaning more towards the surgery now b/c I want to live again.

 
Old 03-20-2010, 08:45 PM   #6
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Re: To Fuse or Not to Fuse L4-LF

I will look into that procedure on Google. I am open to suggestioins and will research anything. Thanks!

 
Old 03-21-2010, 08:08 PM   #7
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Re: To Fuse or Not to Fuse L4-LF

Hey there,
I'm 23 and had a spinal fusion last year and am doing fantastic. I have severe grade 3 spondylolisthesis and was fused from L4- S1 with 2 rods and 4 screws and am almost pain free (90%). Research your surgeon and make sure they deal with degenerative back problems. I also had pins and needles in my leg and numbness. Hope this helps! Good Luck!

 
Old 04-01-2010, 05:53 PM   #8
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Re: To Fuse or Not to Fuse L4-LF

Were you born with the spondylolisthesis? I have a severe spondylolisthesis myself, probably grade 4-5, I am 36 but have suffered low back pain since my 20s and have always had an exaggerated curve. I also had osteopenia and I am worried because I don't want to be worse off. Your story is encouraging.

 
Old 04-01-2010, 07:31 PM   #9
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Re: To Fuse or Not to Fuse L4-LF

Spondylolisthesis is very often congenital (meaning it was there from birth) it's just that most people don't know they have it until late teens or early 20's (or later) when symptoms occur.

Unlike other spine problems like herniated discs or back spasms, spondylolisthesis can only be fixed by surgery. I had my L4-S1 for spondylolisthesis in 1993 in my late 20's and just had L3 slip forward. BUT, I have a history of lax ligaments and tendons so all joints in my body, including the spine, move too much. So the fact I had to have it done for another level is rare. For most people it exists at L4-S1 (somewhere in that range of levels) and often once fixed is never much of a concern again.
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Rt&Lt thumb arthroplasty 2012 ; RT TKR & Bilat CTS 2011
Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
Old 04-02-2010, 11:37 AM   #10
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Re: To Fuse or Not to Fuse L4-LF

Just thought i'd throw my 2 cents in.....Iam 33 year old male who "had" been suffering from low back pain for over 15 years. I, like yourself exhausted all non-envasive procedures in order to deal with this pain.
On feb 12/10 I went in for my fusion(l5/s1 posterior with hardware).
I just passed the 7 week mark and I can honestly say that iam doing fantastic. I quit all pain meds 2 weeks post and i have been walking about a K and a half a day.
The pain that I had for around 15 years is gone altho i do have a little pain from the occasional nerve flare..

That being said, iam still very "young" in my recovery and I don't know what will happen once i return to work as my job is extremly physical by nature.
My surgeon adviced me that i will prob need another fusion down the road but we both agreed that a few years pain free is better than none.
Yup it is a personal descision that you have to make and all i can say is do your homework and prepare yourself bigtime if you do decide to get this done. You and I do have age on our sides and I also suggest even tho your in pain at the moment, you get yourself in the best shape you can prior to surgery.
Best of luck and many wishes

 
Old 04-07-2010, 08:22 PM   #11
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Re: To Fuse or Not to Fuse L4-LF

I was born with a Pars defect that allowed my spine to slip over the years. I have aways had some level of pain but it just eventually hit a wall and I couldn't do anything anymore. I could hardly sit and stand sometimes the pain was so bad. I had a spinal fusion 2/2009 with 4 screws and 2 rods S1- L4 and the minute I woke up I felt better. My back was really tight and stiff but I wasn't in the constant pain. I can do pretty much everything that I could before (range of motion changed some but nothing big) and the best part is NO PAIN. I'm 23 now and feel like I can finally live my life. I'm a surgical assistant so I knew exactly what they were going to do which made it more difficult to let go lol. But wouldn't take it back for anything it saved my life.

 
Old 04-07-2010, 08:59 PM   #12
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Re: To Fuse or Not to Fuse L4-LF

I hear good stories and bad. I'm glad this did wonders for you. I'm concerned because I have osteopenia with a BMD of -2.2 and I wonder if this would heal correctly. I've been telling myself I feel better to avoid surgery, but I know it's only a matter of time before the wrenching pain in my back and down the legs comes back. Such decisions!

 
Old 04-07-2010, 09:04 PM   #13
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Re: To Fuse or Not to Fuse L4-LF

This sounds really promising and I'm glad to hear you're doing so well. I think I'd feel better if the surgeon would fuse from L4 to S1, instead of just L5-S1. I have an appointment in two weeks to either confirm or decline the surgery, so I'm collecting all my questions for him.

 
Old 04-07-2010, 09:07 PM   #14
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Re: To Fuse or Not to Fuse L4-LF

See if he'll consider fusing higher if test results show it may be needed. The day of surgery I told my doctor to do whatever necessary, even if it meant fusing more levels.
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Rt&Lt thumb arthroplasty 2012 ; RT TKR & Bilat CTS 2011
Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
Old 04-07-2010, 09:43 PM   #15
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Post Re: To Fuse or Not to Fuse L4-LF

Hi Stephie,

It sounds like we're going through similar situations, except for a few areas. I just went to my neurosurgeon this afternoon and was told I needed fusion on my L 4/5 and maybe more.One of my problems is that I too have Osteopenia with about the same number as you. The other thing is that I fractured my T12 at work about 4 months ago, and had a procedure called Kyphoplasty where they inject the vertebra with cement like glue. Now this other surgeon told me that through a recent MRI that the T12 is compressed even more, so now I'm in a real pickle. (the neurologist I saw for the T12 fracture is through Work Comp, but he's a pretty good Dr.) The other Neuro. I saw in 2006 for the Lower back issue and I know him well because he operated on my daughter who lives with us who had back surgery in August and he also removed a tumor from her brain 10 years ago. In other words I trust him, and I know his work first hand.
Currently I can only be on my feet for 20 minutes at a time before the pain in the mid-back and lumbar stop me and I have to sit down. My current Neuro today said that the other Dr. must take care of the T12 because there needs to be strong vertebra for the screws and rods to be able to hold. Then I have to go to my other primary Dr. and get on something for the Osteopenia, which I have been on, but now they are going to do a once a year infusion for the Osteopenia. So, be sure you find out if your bones are able to handle a fusion. By the way, I am 59 years young, and I'm married with a daughter who lives with us, so be sure you have support before and after. Yes, I DO know about the Wrenching pain, and go through it every time I walk or lean. I've been out of work because of this for 4 months and need to go back to work because of the medical insurance for me and my disabled hubby, but if I cannot, I need to accept that as well. If you want to send me a private message, I'm also on Face Book too. Hope this helps a little, and sorry about the length. There's no quick way of describing what we are going through.

 
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