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Old 07-06-2011, 02:51 PM   #1
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Question 4 Level lumbar fusion

I am scheduled for a 4 level fusion in September. When i was 1st referred to a Neuro Surgeon he thought from my MRI it would be a level 2 fusion. He ordered a discogram just to be sure. After getting the results he said he was shockingly surprised. My back was in far worse shape that he thought. It now will require a level 4 fusion. I should have known it wasnt good when one of the tech's present during the discogram asked if that was L5, when he was told it was, his reply was WOW. I have tried everything that there is to try & I have been told that it will continue to get worse without the surgery. I am already on oxycodone 4 times a day for pain. I would appreciate any input on a 4 level fusion.
What should I expect? I have been told this is a very big surgery.

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Old 07-06-2011, 03:54 PM   #2
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Re: 4 Level lumbar fusion

It is a very big surgery and hopefully you have more than one opinion. You have not detailed why the surgeon has said you need to have 4 levels fused. I would always recommend a second opinion on a surgery of this magnitude.
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Old 07-06-2011, 05:37 PM   #3
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Re: 4 Level lumbar fusion

I second what pooby said. I would suggest you also get an opinion from an orthopedic spine specialist. Even though their training is almost identical to a neurosurgeon who specializes in the spine, the two specialties sometimes approach things in slightly different ways.

The selection of your surgeon will be the most important decision you make, so do not rush into it. Spine surgery is almost always an elective surgery...so take your time, do your research, and be sure you have found the very best surgeon that is available to you.

One problem with fusing so many levels is that it puts a great deal of stress on the adjoining segment, which is now taking the brunt of all the movement that used to be spread out over the 4 other segments. So you will need to be very judicious in safeguarding your back.

I had a 3 level PLIF last June, so am just over a year post-surgery. I am extremely pleased with the results, and do not find the lack of movement in my spine to be limiting. But, I do not play golf or tennis, which are two sports my surgeon advised me might be difficult after a big fusion. I really do not notice any limitations in flexibility, etc.

What symptoms do you have now? What type of surgery is he recommending? I assume you will have hardware. Do you have any spondylolisthesis or instability in your lumbar spine?

 
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Old 07-07-2011, 07:02 AM   #4
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Re: 4 Level lumbar fusion

[COLOR="Navy"]I agree with the other posters. No matter how much you trust your surgeon's opinion, you need to get another one-from someone not affiliated with your present doctor.

I am fused from T9-sacrum. Basically, from about your bra strap down to as far as you can go. I find that I have difficulty with twisting to see behind me, and I find I tire more easily. I have found that I can't do belly dance like I used to (yeah not that big a deal). I have trouble getting down to play with the GKs. I can't pick them up like I would like to. I am on a weight limit of 30 lbs. for life. And I will live with some degree of pain for the rest of my life.

I am lucky that I have a good PM doc who is listed in the top 70 pm docs in the country. Without him I would be miserable beyond belief and certainly wouldn't be working 40+ hours a week.

Every time you fuse another level in your back it puts stress on the levels above and below the ones fused. I had a 360 surgery. Open from the front and the back. You expect to see fusion at 6 months and full healing takes a year. It is a long recovery as it is MAJOR surgery. The more levels you fuse the more work that is involved.

You need to be prepared for the recovery. Your surgeon or his PA should be very open about what is involved not only for the surgery, but for ther recovery and what meds will be needed. Your family needs to be aware of the amount of help that you will need after you come home. no BLT will probably be put on you and that really limits what you can and cannot do. Your hubby should be going with you to your appointments and it should be a decision that is made by the two of you as it impacts the entire family if you have been the child raiser and meal cooker etc. I was suppose to be out of work 3-5 weeks. I was out 6 months.

I certainly don't mean to scare you, but too often I hear "I had no idea that it would be this ________(fill in the blank). Once done you can't undo.

Pleaes keep researching and asking questions and reading. Do not step lightly into this type of surgery. Your surgeon may say it's no big deal..and for him it isn't. He probably does many of these a week. But has he ever lived with the results of one? You will live with your choice forever.
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Old 07-07-2011, 07:19 AM   #5
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Re: 4 Level lumbar fusion

Well said!

 
Old 08-15-2011, 02:17 PM   #6
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Re: 4 Level lumbar fusion

I have been in pain for 5 years and it just keeps getting worse. I have DDD, & Spinal Stenosis. I have tried every alternative. I was referred to a orthopedic spine specialist by my PM doctor. After I met with him I went back to my family doctor. He agrees surgery is the only option but referred me to an neurosurgeon who specializes in the spine. He comes very highly recommended, I also know 3 people whom he has operated on, so I am very confident in him. He did a disco gram to make sure he knew what needed to be done. (OUCH) . He will be doing Laminectomy, Facetectomy & Foraminotomy fusion with hardware . He will be doing the surgery at a spine & brain institute. I have been told that a 4 level fusion is a very big surgery & I am so very nervous & scared but I feel it is my last resort.

Thank you for any input you have to offer.
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Old 08-15-2011, 03:28 PM   #7
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Re: 4 Level lumbar fusion

What levels are being fused? And what method are they using? Sometimes they go from the back of the body, sometimes via the abdomen, and sometimes a combination. My L3-S1 fusion (3 levels as it's L3-L4, L4-L5 and L5-S1) was done with a combination of back incision and side incision horizontally on my hip about 5" long and about 3" above my hip area. Since it involved going through the lower abdomen getting my system back to moving (bowels) took a few extra days.
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Old 08-16-2011, 06:55 AM   #8
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Re: 4 Level lumbar fusion

[QUOTE=SpineAZ;4823378]What levels are being fused? And what method are they using? Sometimes they go from the back of the body, sometimes via the abdomen, and sometimes a combination. My L3-S1 fusion (3 levels as it's L3-L4, L4-L5 and L5-S1) was done with a combination of back incision and side incision horizontally on my hip about 5" long and about 3" above my hip area. Since it involved going through the lower abdomen getting my system back to moving (bowels) took a few extra days.[/QUOTE]

They are going in thru the back. They are going from L2-S1. How long does the recovery take? I know everyone is different.
Thanks for your input
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Old 08-16-2011, 07:44 AM   #9
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Re: 4 Level lumbar fusion

The recovery is long.

I was in the hospital 8 days I believe. Often it's around 4 days but going thru the abdomen I was to gradually get back to eating and drinking but ended up doing that too soon so that added 1-2 days. And pre-op I had been on significant pain meds and when they took me off the morphine pump and put me back on my meds it wasn't done with the right timing (didn't allow my system time to build up level of Long Acting pain meds so I went from morphine to 0). That extended my stay another 1-2 days.

Pre-op I was fitted for an LSO brace (lumrbro sacral orthotic brace). This was custom made (even had a choice of colors and patterns). Sometimes it's a TLSO which goes higher on the chest (thoracic lumbro sacral orthotic). The brace had to be worn anytime I was sitting upright. For the first fee weeks only sturdy chairs would work. I was allowed to drive at 3 months but did so minimally. My spine surgeon had said "you certainly can drive as ESPN as you are comfortable and abl, but even if you are in an accident clearly not your fault, the brace may bring questions as to your liability in the accident". Thus I did minimal driving and only when I could control my break through medications. I've been on long acting (LA) meds for years and that doesn't impair my ability to drive as I don't have any limiting side effects.

I wore the brace for 4-5 months. Then when it was removed I had to get used to that. I was nervous to drive now that I didn't have the brace as you never know who will run a stoplight, etc. O'hare Nee pain as my body got used to moving around without the brace. A week after hospital discharge a representative for the Bone Growth Stimulator company came to my home. It was 2 electrode pads I wore 23 hr/day attached to a battery pack. Even after the brace came off I had the BGS on for at least 6 mo from date I was first given the device.

After sufficiently healed I did some PT for core exercises. I would say full recovery to where I could function well was between 6-12 mo. Had I been working I would have needed 6 mo off total but I was not working so I can't pinpoint the exact dates of when I was feeling top notch.
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Old 08-16-2011, 05:31 PM   #10
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Re: 4 Level lumbar fusion

My fusion from L3 to S1 was from the posterior. (June 2010) I was in the hospital 3 nights and was off all meds on the 12th day. I was and still am truly amazed at how well I recovered and how little pain I had. My one level fusion that I had in 2008 was MUCH worse...but it was also my first surgery. Maybe things are numb by now, so it didn't hurt as much!

It took me a good 12 months to fuse and my surgeon was very cautious with me every step of the way. He had to do some reconstruction at L3 as the facet joints had worn away due to an instability that had not shown up on any imaging. We both considered this surgery my last chance to get it right, so we have both been extra careful.

I had a little PT last fall, but there was almost nothing I could do without causing a flare of the sciatic nerve...so I stopped PT and just continued walking. I had no pain as long as I didn't stress that nerve...so I really avoided bending, etc.

I have just now resumed PT and am now doing some basic exercises to work out the kinks I have with the piriformis and SI joint area.

I wasn't working either so can't say when I could have returned. I felt great by six weeks and had quite a bit of energy. I've been traveling and doing lots of things. As long as I avoid certain activities, like housework, any bending, I am just fine. I have good feelings about PT this time, and think I'll be able to work my way over these minor annoyances.

But be advised...recovery from any fusion is LONG and a great deal of patience is required.

 
Old 08-17-2011, 07:20 AM   #11
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Re: 4 Level lumbar fusion

[QUOTE=ibake&pray;4794293][COLOR="Navy"]I agree with the other posters. No matter how much you trust your surgeon's opinion, you need to get another one-from someone not affiliated with your present doctor.

I am fused from T9-sacrum. Basically, from about your bra strap down to as far as you can go. I find that I have difficulty with twisting to see behind me, and I find I tire more easily. I have found that I can't do belly dance like I used to (yeah not that big a deal). I have trouble getting down to play with the GKs. I can't pick them up like I would like to. I am on a weight limit of 30 lbs. for life. And I will live with some degree of pain for the rest of my life.

I am lucky that I have a good PM doc who is listed in the top 70 pm docs in the country. Without him I would be miserable beyond belief and certainly wouldn't be working 40+ hours a week.

Every time you fuse another level in your back it puts stress on the levels above and below the ones fused. I had a 360 surgery. Open from the front and the back. You expect to see fusion at 6 months and full healing takes a year. It is a long recovery as it is MAJOR surgery. The more levels you fuse the more work that is involved.

You need to be prepared for the recovery. Your surgeon or his PA should be very open about what is involved not only for the surgery, but for ther recovery and what meds will be needed. Your family needs to be aware of the amount of help that you will need after you come home. no BLT will probably be put on you and that really limits what you can and cannot do. Your hubby should be going with you to your appointments and it should be a decision that is made by the two of you as it impacts the entire family if you have been the child raiser and meal cooker etc. I was suppose to be out of work 3-5 weeks. I was out 6 months.

I certainly don't mean to scare you, but too often I hear "I had no idea that it would be this ________(fill in the blank). Once done you can't undo.

Pleaes keep researching and asking questions and reading. Do not step lightly into this type of surgery. Your surgeon may say it's no big deal..and for him it isn't. He probably does many of these a week. But has he ever lived with the results of one? You will live with your choice forever.
[/COLOR][/QUOTE]


I could not agree more with this. I had a two level fusion in Jan 2011, and the NS said the same thing to me, "it is no big deal, I do 5 to 7 of these a week." You will be 85% better! Well, like BakeandSpray, I am lucky to have a great PM doctor because at 8 months, I am not 85% better, I am 10% worse! I also work 40+ hours a week and it is pure hell some days. But, I am not trying to scare you either. I would ask myself, (knowing that you may have a very successful surgery and get 85% better), am I willing to get worse or stay the same? Because my friend there are no promises. I wish you the best of luck in your surgery and I pray it will be successful and make you better but, please do get more than one opinion. We all support you and know how debilitating CP is and how depressing it can be. Hang in there and keep us posted.

 
Old 08-17-2011, 07:34 AM   #12
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Re: 4 Level lumbar fusion

I would like to thank everyone for their input. It is always nice to hear from people whom have been thru a back surgery and are willing to share their experience. Thank you all so very much.
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Old 08-17-2011, 08:10 AM   #13
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Re: 4 Level lumbar fusion

I'd like to add that the selection of the surgery, followed by the selection of the hospital where the surgery is performed, are the two most important decisions you will have to make, once you decide to have surgery. I would also encourage you to get more than one opinion.

Before I had my first fusion, I was told that I needed one level fused; another surgeon told me he would do three to five, that he would decide once he got in there and could see what was going on. So you can see, there can be a large discrepancy between surgeons.

Also, it always is best to have ONE surgery and be done with it. Revisions have a much lower rate of success. I was truly among the lucky ones.

 
Old 08-17-2011, 05:07 PM   #14
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Re: 4 Level lumbar fusion

Yes, it is a BIG surgery, and I had one just a little bit bigger in Jan. 2011. Mine was a 5 level 360 T12 - L5 (already fused at L5 - S1). Not meaning to scare you, but at this point if I had it to do over, I don't know what I'd do. My pre-surgery pain is gone but my post-surgery pain is worse than before the surgery. My surgery was to correct scoliosis and so if I didn't have it, the problem would only have gotten worse.

So, at this point I'm doing PT, taking oxycodone, lyrica, and meloxicam, using a 10s unit and ice and still am on a walker most of the time. I can use a cane for short distances like parking in a handicapped space and walking into church, etc. I'm very limited in what I can do but hopeful for improvement. You just don't know what you'll get.

Mine was a 12 hour surgery instead of the 5 hour one the surgeon anticipated and I was in the hospital for a week; I have barely no memories of that time. After that I went to a rehab facility for 3 weeks. My daughter lives with me so that's a great help to me now. I'm 70 but in excellent health except for my back. : (

 
Old 08-17-2011, 05:48 PM   #15
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Re: 4 Level lumbar fusion

We all have to realize that there are hundreds of different spine problems that may require surgery. So we can't assume one person's post op experience will be our experience. My L3-S1 fusion fixed a major problem and I'd do it all over again in a second.

I still use medications and TENS unit for pain control, but my case is unique. I was up and walking day 2 with a walker and by day 6 didn't need the walker anymore. We borrowed one for home use but it never left the garage.
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