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Old 12-06-2010, 01:07 PM   #1
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lumbar fusion after discogram.. Help I have questions

Hello.. I was at the neurosurgeons office today and had a Sitdown MRI performed and met with him 1hr later.. He looked at my new MRI and said there was significate degeneration at l5-s1.. Said I would need a fusion and wanted to send me for a discogram next week to do 1 at l4-l5 and l5-s1.. I was curious as to why he would want a discogram done if hes gonna do a fusion anyway.. Could he be looking for pain in l4-l5 also even though they look ok on the MRI? When I have the fusion what should I expect after the surgery? How long will it be before normal activities can be resumed? Has anyone had a fusion here and had great results? Just looking for a little encouragement and answers to a few questions.. Thanks for any help

 
Old 12-06-2010, 02:38 PM   #2
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Re: lumbar fusion after discogram.. Help I have questions

You've asked several questions that many of us could answer with pages!

First, about the discectomy, sometimes a disc that does not look diseased on imaging will in fact be causing pain. The surgeon is being cautious in trying to determine exactly which disc or discs are causing your pain so that he doesn't operate on the wrong one, or operate on only one when you actually have pain coming from more than just the one that looks diseased.

I am not familiar with your "issues" so don't know if this is an ongoing condition or if the recommendation of fusion is a surprise to you. Regardless, it is a good idea to get more than one opinion when you are entering into such a big surgery. Fusion is of course appropriate for some situations, and remains the only procedure for a couple issues. That being said, there are new developments in technology that allow fusion to be used less often than in the past. It used to be the only option available for many people, but that isn't the case today.

Fusion is a big surgery. Recovery is usually a long, slow process. Of course it varies from person to person, whether the surgery is open or minimally invasive, whether they go in from the front, the back, or the side, etc. Then there are the differences caused by the person's age, health, level of activity, fitness, weight, etc. I think most people find that they do not return to work until six weeks at the earliest...and three to six months is not at all unusual.

At least from what I've read on the boards, from my Spiney friends and from my own experience with two fusions, I think sometime between two and three months is when people are able to start doing some things, and start to feel reasonably OK. By six months, people have regained their strength and most are back to work, etc...but it takes at least one year for the bone to become strong and well-formed. Signs of fusion will show much sooner than this, but in terms of the bone being fully grown and matured, it takes at least one year for most people.

The words "successful" and "great results" are words that have different meanings to different people. I believe you are asking whether anyone has had a fusion and is now pain-free -- would that be correct? Statistically, a doctor will consider a fusion "successful" when he accomplishes what he set out to do, and there is bone growth joining together what he intended. Pain relief does not really factor in, statistically. So it is possible to have a "successful" fusion that leaves the patient in as much pain as before the surgery. It doesn't happen often, but the surgeon cannot guarantee the patient the outcome of the surgery. He can give out statistics -- 90% of patients report feeling better after...but he cannot tell you how the surgery will turn out.

Many people on the board have had a fusion, so feel free to ask any questions. Someone is bound to have an answer for you!!

Good luck with your decision. Just select your spinal surgeon with as much care as you have ever given to a BIG decision....

 
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Old 12-06-2010, 08:35 PM   #3
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Re: lumbar fusion after discogram.. Help I have questions

I had a TLIF fusion 4 weeks ago at L5-S1. So far I am happy with the way my recovery is going. Since 2 weeks post op Ive been functioning very well...can do anything that doesn't involve bending, twisting or lifting. If it wasn't for my sensitivity to anesthesia and IV pain meds I would have had a good first week post op too. Pain-wise it hasn't been any worse than what I've felt before...I was surprised because I was expecting a lot more pain.

My surgeon has told me that I will be able to slowly resume my normal activities after two months. I am hoping by 4 months I should be getting back to normal.

Hope that helps

 
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Old 12-06-2010, 10:54 PM   #4
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Re: lumbar fusion after discogram.. Help I have questions

Teton you have expressed yourself very well. An excellent post.
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Old 12-07-2010, 05:19 AM   #5
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Re: lumbar fusion after discogram.. Help I have questions

Thanks for your reply.. The surgery will be posterior and said to be done because the pain is from the degeneration and also causing sciatica symptoms.. There is also a central disc protrusion and annular tear at the same level.. He sais hes gonna hope to do the PLIF through endoscope mininvasive but depends on the discogram results.. I will post when I find out.. JWW

 
Old 12-07-2010, 07:55 AM   #6
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Re: lumbar fusion after discogram.. Help I have questions

I've had that fusion done. My question to you is just HOW bad is your pain on the 1 to 10 scale? Is it tolerable? How bad is your degenerative disc disease is a question for your doctor. I also had the discogram. It will show your doctor exactly which nerves are being affected and causing your pain. You will be put in a semi-conscious (that "I'm awake but don't care state of mind"), needles will be placed in the nerves and electricity will be jolted in. Basically, they are looking for YOUR reaction to see if there's pain. (I THINK I'm right on this. It's MY understanding of it). I was told I wouldn't remember anything but remember VERY well trying to come OFF the table when he hit the nerve causing the most pain. I'm NOT trying to scare you...just let you know what to expect because NO ONE told me. MY back, at L5-S1 was in horrible condition. I had spondyolysisthysis (sp?) level 3...level 4 being the worse. Also, do your research on your neurosurgeon. I had to have mine redone because the 1st neurosurgeon didn't know what he was doing and I had NOT done my research. As for your question did it help...for me, definitely...because my back was in such bad shape. I do still have some pain in my hip, thigh, leg and lower back. BUT, it's not nearly as bad as it was AND there are other issues with back as well. I too have degenerative discs disease have just had to have a fusion in the cervical section, replacing 3 of the disc, and have 3 herniated disc in the mid section. You can expect the FULL recovery to take about 6 months. The first week, it will be hard to get out of bed. It gets a little easier each day. The best thing you can do is to WALK every day. I would walk down my driveway, starting the day I got home the hospital. I'd go a little further each day. Don't push too hard. Your body will let you know your limits. You also need your rest. I tend to push too hard, too soon. It's hard NOT to do things you know shouldn't when you start feeling so much better. That's when you have to really be careful. You'll still need to limit the amount you lift and be careful about bending. I hope I've answered your questions. I wish you the best and will have you in my prayers.
Evie

 
Old 12-07-2010, 08:04 AM   #7
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Re: lumbar fusion after discogram.. Help I have questions

Thank u for your response.. My pain level is a 6/10 daily and when Its gets at its worse its a 9.. The doc is great hes the neur for the local NFL team

 
Old 12-08-2010, 07:15 AM   #8
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Re: lumbar fusion after discogram.. Help I have questions

Sounds like you have a GREAT doctor! You will all kinds of stories, both pro and con. At the end of the day, you have to do what's best for YOU. You are the only one who knows YOUR pain level and how it affects YOUR daily life. Weigh the pros and cons and if you exhausted all other options (bedrest, physical therapy, medication, etc). I wish you the best of luck!

 
Old 12-08-2010, 07:34 AM   #9
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Re: lumbar fusion after discogram.. Help I have questions

Before you go through with the discogram, have you thought about getting a second opinion from a spine specialist in a different group? Since this doctor is a neurosurgeon, you might want to look for an orthopedic spine surgeon for confirmation that a fusion is the only treatment option to resolve your issues.

A surgeon for a professional football team might not necessarily be the best surgeon for you. Doctors who treat professional athletes almost always opt for surgery quickly because they need to get their guys back on the field, or back to their sport quickly. He might be less used to thinking about other options that might be available to you.

Fusion is kind of the surgery of last resort. Once its done, there is no turning back or "undoing" it...so you want to be very sure there are no other good options before proceding. It is so commonly done that some people agree to it without really realizing what they are getting into...I wouldn't want that to happen to you.

 
Old 12-08-2010, 08:04 AM   #10
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Re: lumbar fusion after discogram.. Help I have questions

Hes is the 2nd neuro opinion and had 1 ortho opinion.. 2 of them said fusion(ortho & this neuro) The other suggested ADR which is alot of $$.. My ins United HC will only cover a small % of the ADR.. However the fusion will be covered at 100% less 200.00 I must pay. A 100k surgery 200.00 sounds great.. As far as the neuro I'll use he has done 2 surgeries on people whom I know.. The practice has done more PLIF min invasive than any one on the east coast.. They r highly reccomended not only here but nationally.. I feel comfortable with Dr Smith doing the surgery.. I do agree with that most NFL team docs will rush into things.. Carolina neurosurgey I am counting on for great results

 
Old 12-08-2010, 10:53 AM   #11
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Re: lumbar fusion after discogram.. Help I have questions

Excellent. Sounds like you have done your research and feel comfortable with your decision. When are you going to have it done?

Many insurance companies are not covering ADR at all now. It just hasn't really caught on here in the US...to the point it has in Europe, anyway.

 
Old 12-08-2010, 11:38 AM   #12
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Re: lumbar fusion after discogram.. Help I have questions

My discogam is 12-15 and follow up for PLIF decision is 12-27.. He said hes doing surgery 3 days per week each at a different Charloot hospital.. Hes scheduled through Week of Jan 14th now.. I am guessing later in Jan.. My goal is sonn because my baby girl turns 1 on 3-9.. This pain has kept me away already and Im hoping it wont anymore.. We will see

 
Old 12-08-2010, 03:13 PM   #13
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Re: lumbar fusion after discogram.. Help I have questions

I want to congratulate you on being so thorough in your research about your doctor. It's so important to have faith in the guy who has the knife, lol....but seriously, it's a big part of your recovery to know that you have the best of care.

I hope the discogram results are clear and that you are able to have your surgery in reasonable time. Just be sure to follow the doctors orders to a T after your surgery. Those instructions are very important and not to be taken lightly. I know of many people who thought it wouldn't hurt to "just move this a couple of feet, or lift something a bit too heavy and who, unfortunately, did themselves damage. It's difficult sometimes to be patient, especially if you are feeling a lot better, but do nothing without the doctors clearance.

Hopefully, you will post to us after your discogram. I would be interested in the results and how it was done. Please take care and stay in touch.

Blessings,

Carol

 
Old 12-09-2010, 06:16 AM   #14
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Re: lumbar fusion after discogram.. Help I have questions

Thanks Carol.. I will be sure to keep u guys posted.. U guys have been great in your responses and I am grateful for that.. Anyone who reads my post and lives close to Charlotte NC I highly reccomend this group of Neurosurgeons.. Thanks again

 
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