I am 73 years old and diagnosed with spinal stenosis. Three orthopedist-neuros have suggested I have spinal fusion with instrumentation (cage, rods, screws, etc.) I am so afraid as my twin sister had the surgery and still has pain after 3 years. Please...Is there someone out there that can advise me as to the pros and cons of this surgery? What will happen if I don't have the surgery. Will I not be able to walk? Will I become paralyzed? Thank you for any suggestions. Shirley11
It is a scary proposition when one first hears the doctor say that surgery may be required. I would like to tell you that your experience will be different from your sister's, so do not let her experience influence your decision.
First, is the doctor talking about fusing one level or more? Do you have lumbar stenosis or is it located elsewhere?
If the doctor wants to do one level, the chances for a successful outcome are relatively high. If several levels are involved, statistically the rates go down...but, it is still possible. My MIL had a fusion at L4-L5 at age 87 and it relieved her pain and was without incident.
Of course a fusion surgery is not easy, and it involves a long recovery regardless of the patient's age. While surgery will resolve most of the pain, it will not necessarily take care of ALL of it. And some people end up exchanging one problem for another.
Regarding a wheelchair: if you are talking about a lumbar stenosis, you do not have to worry about ending up paralyzed. I suppose a really freaky incident could happen during surgery, but it would be highly unusual. The spinal cord ends at about the L-1 level (which is about waist level). Beyond that there are still spinal nerves that run down to the sacrum and then branch out to form the sciatic nerve in each leg...but if one of these nerves is severed, it will not cause paralysis like it might higher up in the cervical or thoracic spine.
For the same reason, without surgery you would not end up in a wheelchair unless the pain when you stand is just too much to bear. Before I had my fusion, I was reaching that point. I was driving down my driveway to collect my mail from the mailbox and I couldn't stand for more than about a minute or two before the pain was just overwhelming, and I had to sit down. I put off surgery as long as I could, but finally I was becoming housebound and I was not interested in depending on a wheelchair when there was a surgery available to me that might help.
Any surgery is a gamble. You do all the research, be sure you have the very best spine surgeon that is available to you, you learn the statistic odds of success and what can go wrong...and then you weigh your options and attempt to make the best decision.
We are here to try to answer any questions or to provide support. Good luck making your decision.
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I think I'm getting to where I can say it was good move for me to get a fusion. I'm only one person, but I DO have less pain. I am NOT pain-free, at least not yet (nearly 6m out) but it isn't as debilitating as it was....fewer tears and moving more like a normal person. Do be prepared for a long recovery....it was really month five before I felt like I was on the "right" side of it. I do tend to heal slow...i'm 34 but with a number of medical demons...but wasn;t fully ready for the length of the surgery (even though I had totally read the six-month time frame for feeling more human).
Also, I say this a LOT, but be careful in your Googling etc. People are more likely to be online talking about a failed surgery. If it worked, they are probably out living instead of dwelling here or on other back boards (frankly, I'm still unmployed and that's a factor in my being an exception). DO prepare for a long haul if you go through with it, but keep a positive mindset and know most people DO have positive outcomes especially if they follow post-op orders to rest, walk a bit to encourage growth, and then use PT if recommended.
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My gosh! How knowledgeable you are. I thought I was reading from a doctor's order.
I made a copy of your reply to my "fusion dilemma," and plan on studying it this afternoon. I appreciate your Google warnings. Thank you for taking the time to provide all the information. Shirley
As you do more reading and thinking, questions are bound to come up, so please feel free to post with them. There are many people on this board that have had fusions.
If you get to the point where you are seriously considering fusion, it is a good idea to get at least another opinion from a fellowship-trained spine specialist. This could be an orthopedic spine surgeon or a neurosurgeon who limit their practice to issues of the neck and back.
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Please wait until the pain becomes unbearable before you have a fusion. The risks are too great to have it before you have no options left. Fusion is a surgery of last resort. It often works fine, but can have side effects that are worse than the original reason for the surgery. If you feel you can't go on without it being done, then prepare yourself ahead of time and forge ahead. But this is major-league stuff. The recovery period is long and difficult. Make sure it is something you can't live without right now. Best of luck to you and I hope things work out no matter what your decision.
I had a fusion. I had been in terrible pain for yrs. I went to a pain management clinic and had trigger point injectiion and nerve block, which all made my pain worse. I finally had a MRI and it show I needed surgery. I did consult with 3 Drs. and they all agreed. The Dr. told me if I didn't have surgery I would be in a wheel chair, that did it for me. The surgery isn't easy and recovery takes time. They make a body cast which is heaven, really. I still have pain because of scar tissue etc. but I can walk which is quite good to say the least. I suggest you have patience during recovery. I was under the wrong impression, I thought I would be completely pain free right away. Good Luck!
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[QUOTE=bracer;4922438]Please wait until the pain becomes unbearable before you have a fusion. The risks are too great to have it before you have no options left. Fusion is a surgery of last resort. It often works fine, but can have side effects that are worse than the original reason for the surgery. If you feel you can't go on without it being done, then prepare yourself ahead of time and forge ahead. But this is major-league stuff. The recovery period is long and difficult. Make sure it is something you can't live without right now. Best of luck to you and I hope things work out no matter what your decision.[/QUOTE]
Dear bracer. Thanks so much for your reply to my worrying about spinal fusion. I'm wondering what might happen to drive me to having the fusion. I'm very scared about infection and having more problems then I can mentally handle. I still think there's a lot the specialists don't know about back fusion.
If I don't have the fusion, I wonder what the prognosis would be. I've heard some patients lose bowel and bladder control?? Now I can deal with the pain by taking drugs, exercising and curtailing my activities, but if I'm headed for a tragic life without the decompression I won't want to live. Thanks again for taking the time to help me. Shirley Brown
Thanks so much for taking the time to inform me about spinal fusion. I need decompression on L-4, L-5. I'm very scared because I have other health problems. I had a heart attack in 2006. Also, my twin sister has had decompression,two laminectomies, and a discetomy (sp.?), and infection following each procedure. Four years of her life have been taken up by poor quality of health. Is it worth it at age 73? Please help me in anyway you can. I appreciate whatever you offer. Shirley Brown
I'm not Bracer, but I am going to add my two cents.
For all the reasons you mention, this is why it is SOOOO important to carefully select the surgeon if you are contemplating surgery. Also, if you are concerned about infection, as we all should be, you will want to check out the statistics for the hospital the surgeon uses.
If you do not have surgery and the nerve compression and or stenosis continues to worsen, the time you can stand will get less and less, and the amount you can stand to walk will lessen...until perhaps you won't be able to walk more than a short time. However, barring some freaky event, this will not lead to paralysis.
The problem is that this inactivity will then affect the rest of your health. You will not be able to get much exercise if you have to sit all the time. The muscles will weaken; the heart and circulatory system will weaken, etc. so you really have to weight this into the equation as well as just the dangers of surgery.
I don't know if you live in the same area as your sister, but I would advise staying away from her doctors and the hospital where she had surgery. There is no excuse to get infection from every visit to the hospital.
Regarding the bowel and bladder issues, and the issue of paralysis as well...the spinal cord ends around the L1 level. Beyond this point the spinal comes come out of the body and bundle together as they travel through the central canal. These nerves control a lot of sensation and function in the pelvic girdle area, including the genitals, and the lower lumbar nerves have an affect on the control and sensation of the bladder and bowel.
There is a condition called "cauda equina syndrome" that develops in a very small percentage of patients that comes from a compression of one or more of the lower lumbar spinal nerves. Most people with nerve compression do NOT develop it...but in a small percentage of patients, CES develops. That's why we always tell patients with lower lumbar problems that if they suddently develop loss of bladder or bowel control, or suddenly develop extreme weakness in a muscle, they should call their doctor ASAP or go directly to the emergency room. This is considered a medical emergency. If it is not decompressed quickly, the damage to the nerve can become permanent.
So you have heard of this problem because it does exist, and we should all know the symptoms and know to go immediately to the ER if we develop those symptoms...BUT, it affects a tiny percentage of patients.
No one can make up your mind for you. There is lots of information online. You can read about lumbar stenosis and you can research various doctors online. Unfortunately there are no guarantees that a surgery will have the desired outcome. A doctor can give you the statistics regarding rate of success, but there are always those events that occur that were not planned...as your sister knows only too well.
Dear tetonteri66: I'm so lucky to find such a knowledgeable contact as you.
I thank you for all your most valuable information concerning my fears of spinal fusion. You have really helped me through a difficult, stressful time. I still don't know if I'll go ahead with it. People have told me not to wait too long as being 73 years, other medical problems can develop that might interfere with surgery. Thanks again for your most helpful information. Shirley Brown
[QUOTE=shirley11;4925549]Thanks so much for taking the time to inform me about spinal fusion. I need decompression on L-4, L-5. I'm very scared because I have other health problems. I had a heart attack in 2006. Also, my twin sister has had decompression,two laminectomies, and a discetomy (sp.?), and infection following each procedure. Four years of her life have been taken up by poor quality of health. Is it worth it at age 73? Please help me in anyway you can. I appreciate whatever you offer. Shirley Brown[/QUOTE]
I'm just wondering, can they do your decompression thru a microdiscectomy? Have you inquired as to WHY they feel a fusion is so necessary? As Bracer stated, I would leave this as the option of very last resort. Well at least if if were me, I would. (and they have thrown this option at me and I have clearly said No, not Now, not yet, I am too young. I haven't exhausted every other option first yet.) I would inquire as to what other options you have surgically to decompress at L4-5. Is it a nerve that is compressed? Through my many exhaustive hours of internet research I have found that truthfully fusions tend to be the 'easiest' way for the surgeon to fix the problem. I found a wonderful research article that a ortho spine specialist in WI had written that almost seemed to be my case to a 'T' and he stated that the surgeons would in general want to 'fuse' but it wasn't necessarily the best solution for the patient. Now I just have to get a Dr here to look at this Dr's research. But anyway, I would question them about a more conservative surgery. You can always go back and have a fusion done. I know it's not ideal to undergo two surgeries, BUT what if the less invasive one fixes it? Just trying to throw out another suggestion and some food for thought. Good Luck, but personally, I would try to go with something less invasive. You might be surprised. It just seems like almost all Dr's just want to fuse because it's the quickest 'fix' and easiest for them, but is the hardest for the patient. I wish you well!!
A microdiscectomy would probably not be the answer for the original poster as her problem is stenosis rather than 0a disc problem. But could she get by with a laminectomy? That might be a possibility.
Again, any patient should always get at least several opinions when considering spine surgery. Sometimes every surgeon will have the same recommendation, but often, there will be a variation from one surgeon to another as to how the problem could be addressed.
Re: Spinal Fusion Ahead for Me???- Joe B Spine Fusion
[QUOTE=shirley11;4921536]I am 73 years old and diagnosed with spinal stenosis. Three orthopedist-neuros have suggested I have spinal fusion with instrumentation (cage, rods, screws, etc.) I am so afraid as my twin sister had the surgery and still has pain after 3 years. Please...Is there someone out there that can advise me as to the pros and cons of this surgery? What will happen if I don't have the surgery. Will I not be able to walk? Will I become paralyzed? Thank you for any suggestions. Shirley11[/QUOTE]
Just had a procedure completed by at the VA Hospital in NYC on East 23rd street. As a 60 % disabled Veteran there were no costs for the hospital stay and sugery procedure. Procedure competed was a L-5 & S1 Lamenectomy & Spinal Fusion (2 rods & 4 screws) due to a herniated disk and PARS defect. It's only been 6 weeks since surgery and I've had no complications or problems. 2 NYU Residents completed the surgery during a 7 hr period and I was up and walking the next day with a walker. I was discharged on 9-Jan-2012 and have been recovering from home since. I've been amazed how well things have progressed and I"m now walking on a treadmill each day about 1.5 miles at a 2.5 mph pace with very little pain afterwards. This was an extreme surgery to have done for the first time but has made a very positive impact on my quality of life due to the absence of muscle cramps at night in both legs from the radiculopathy and sciatica. I'm only 47 and I look forward to getting back to work in two months. Based on my condition and the severity of the pain in my legs prior to surgery, I would definitely recommend this surgery to anyone but make sure you check the history of the number of cases and success rates of the hospital and physician conducting the surgery. Having several opinions is highly recommended. My final decision to move forward was the constant thobing in both legs during prolonged standing or walking and the lack of sleep at night. 3 months of PT and lumbar back injections prior to surgery did not help the condition which was another deciding factor of finally having surgery. Wishing you health and happiness. r/ Joe B.