I recently saw my 5th doctor about my lower back...in the past 7 years, I have had 2 microdicectomies on my L4/L5 disc...and have been trying for the past 2 years to prevent what some has said is in the cards, which is a 2 level fusion (S1-L4) due to DDD. I have seen 3 physical therapy programs, on nerve root block and am still trying to stay active and go to the gym regularly. I am in pain daily, and so far have avoided taking narcotics...but am contemplating it. Bad muscles spasms...nerve on the right side is always buzzing or hurting...right foot has numbness part of the time...and i have these symptoms on the left side approximately 50% of the time now. And I am only 37 years old: (
So, I have yet to talk to one person other than a doctor who tells me that they think I should consider the fusion surgery, which I know is life changing. But faced with the prospect of pain for the rest of my life...I am starting to turn to what most believe is the dark side. The only discs showing ddd are those two, and all of the doctors have claimed me to be a good candidate for a positive outcome (the rest of my spine is excellent with no hints of ddd, I am healthy and fit, I don't smoke, I am dedicated to getting better , etc...), but I can't help that even considering this surgical option is a failure on some level...and that I am "wimping" out.
So I am wondering if anyone who has felt this same anxiety could speak to their experience. I am only beginning the process of gathering information and finding the best course for myself...but I am scared and feeling defeated...so relating to others would defintely help.
I don't recall seeing a post similar to yours before. I guess I don't quite understand who it is that would consider you a failure? It isn't like reckless behavior has caused your body to develop DDD, and that by reversing your bad habits, you will be able to work your way out of this condition. I would suggest that whoever is causing you to feel like a failure if you have to "succumb" to surgery is ignorant about spinal anatomy, spinal degeneration and the process of fusion.
That being said, fusion should always be considered as a last resort. Few of us who have had the surgery entered into it without a great deal of agonizing. The outcome is not guaranteed and indeed, some people do come out worse than prior to having the surgery. I cannot tell you how often this happens, but it is a fact that must be considered.
There are many valid reasons to hesitate prior to having a fusion, but feeling like a failure should not be among them.
There is a current member, Cheryl, who may be able to share her experience with you. I think she is about your age and recently had a fusion. I hope she will see your post and reply!
I think that unless the pain is at a severe level where your activities are severely restricted I would not consider having a spinal fusion. But then that is just my opinion. Cauda equina is an emergency situation when surgery is a must. All other DDD lumbar surgery really is elective. Fusions never guarantee good long term results so use great caution. You are in all likelihood aggravating things by going to the gym. Try resting and laying off things for a while and see if you get some improvement. If not try some good pain management. Probably your friends see you walking and being active and can't see the pain you are suffering. Be extra cautious because there is no going back after a spinal fusion.
Hi there, you are facing a dilemma that sounds all too familiar to me. I'm going to offer a different perspective, but keep in mind that every situation is totally different, so take my words for what they're worth.
Like you, I had two microdiscectomies (one on L4-L5 and one on L5-S1). Both were successful, I was pain-free afterwards and returned to normal activities. But, like so many others, eventually re-herniated both discs. I tried everything...physical therapy, nerve meds, all kinds of injections, but nothing was working. I saw 3 doctors that all agreed that a 2-level fusion was in my future and it wasn't a matter of "if," but "when." That being said, like the others said, it most definitely IS an elective surgery and a huge decision.
For me, it came down to whether or not I could live my life in my previous condition. I was 31 and live a very active lifestyle, so for me, it was somewhat of an easy decision. I went through with a 2-level ALIF about 5 months ago and I have to say, I'm SO glad I did it. I'm not out of the woods yet...I still have some pain and the recovery certainly isn't easy to say the least. But, I definitely see a light at the end of the tunnel and even though I'm not "pain-free" yet, I couldn't be happier with where I am at this point in the recovery.
I certainly won't sugarcoat anything - this is a very major surgery with many risks...and there's really no guarantee that it will improve your symptoms. For me, I was willing to take that chance and I'm one of the lucky ones that is cautiously optimistic about resuming a very "normal" lifestyle again.
Good luck to you - I'm happy to answer any questions! I don't have all the answers, but this board has been a great support system for me throughout all of my back woes over the years - I hope it's the same for you.
I had a one-level ALIF (through the belly..) at L5/S1 in August. I am not fully fused yet but am an track to be. For me, the level of pain wasn't tolerable and I couldn't face 40 years of it. I needed to know I tried everything. I felt like I was way too young for so much back trouble. And felt like I must have done SOMETHING wrong even though the docs (multiple) said it was just random and that DDD didn't have any real cause.
Def exhaust other options first. I did epidurals and a ton of PT. I did feel frustrated that I didn't have success. And be sure you fully trust your doc and that s/he has a lot of fusion experience (mine does them weekly). But I will join DDP in saying I think I made the right choice. I do feel like I'm still healing...and it took about 4m to get on the right side of recovery...but I am not in anywhere near the level of pain I was before.
Do prepare for a long recovery (being young and fit can help but it is still a BIG deal). Do be sure you tried everything. Do get a good doc. But know a fusion CAN be successful and I think it is esp worth it if you are young given the long life you and your back have ahead of you,
I would just like to add that you need to understand that a fusion is not like most other surgeries in other parts of the body. It will not restore the patient to the way he/she was prior to the onset of pain or injury. In most cases it will alleviate most of the patient's pain, but the spine will be inalterably changed forever.
Also being on the young side only gets a patient so far. There are still the same risks that face all surgical patients, and the unintended consequences that no one could predict...such as nerve damage, etc.
Short story, had a 11mm herniated disc L5-S1, discectomy and laminectomy done november 2010, had another MRI done august 2011 showing 3.5mm hernaition...So assuming did not fix the problem...With the herniation left the left lower leg partially numb, from foot to knee...Have no dorsal flexion...Nerve damage seams to be permanent, but is not main concern...Still experience low back pain...Had 2 transforamal injections done in november 2011 and a medial branch block, results showing pain not coming from facet joint...Drs want proceed today to do more injections to see if they will help, but did not receive any relief from previous 2...Mentioned doing a fusion of the one level and getting a discogram, but drs seem to want to approach with more injections to see if they will help...It is a work comp claim, and insurance company not giving any problems with authorizing everything thus so far...Tired of taking medication for low back pain Kadian 60mg a day, 30mg oxycodone a day, lunesta for sleep(was taking ambien), was taking lyrica for nerve pain now taking cimbalta which is very similar...Nerve meds making me have bad memory loss...Want to get input from others with experience on what you would recommend to do next....Thanks for all your help... This was my post, and don;t feel like a failure, am too 37 and contemplating a fusion...The way I see it, can live on with the current pain forever or take a chance on something that may help...I hope I have helped with some input.
I really appreciate everyone's input...this continues to be a difficult decision for me to compute. I just saw my doctor again today with my wife, and it was a very positive experience where we discussed a real plan...which helped me tremendously. I have gone back into a trusted physical therapy program, and I have several conservative options still left to me before a fusion would be the proper course of action...and in reference to my original post, I read stories all the time on this board of people dealing with heavy and awful stuff...and I think the bravery that people have to muster to face their day in constant pain is one of the bravest things I can imagine...hopefully I have the bravery to face what's ahead: )
Based on personal experience, and from reading others' experiences on forums such as this, I firmly believe that the most important decision a spine patient will make is the choice of a spine specialist. I think it is important to meet with at least several so you come to believe the one you have selected is one you trust and can relate to. And it doesn't hurt to have had some experience (contact/relationship...whatever the appropriate word is!) with that surgeon before you ever get around to letting him operate on you.
Often patients don't want to bother trying PT and other conservative treatments because they are in a hurry to "get back to their life." But it is important to remember that a 2 level fusion will not necessarily ever get you back to that point either. If conservative measures fail, you still have options. Once you have a multi-level fusion, it is more difficult to "undo." It can be difficult to even find another specialist who is willing to take a look at your case...particularly if the fusion fails.
On the other hand, there are many people (most of whom are not on these forums, but out enjoying their lives) who have fusion and are very pleased with their results. So it is a difficult decision. I know I waited a good two years before finally agreeing to mine because it just seemed so invasive and I didn't feel I was "as bad" as people I read about or heard about on boards like this! But when it got to the point that I was driving down my driveway to collect my mail because I couldn't even walk to my mailbox...I felt I had to take a chance on fusion.
It is a very individual choice and it is worth giving it a great deal of thought, as you and your wife are doing.
Please keep in touch and let us know how you are doing. I hope your less invasive options work out and resolve your issues!!
I felt the same way before my discectomy and fusion at L5-S1. I was refusing to have the surgery until he told me what would happen of my disc moved any more. Loss of bowel control, bladder control, and the ability to walk. When he said forget about a sex life, I said sign me up. I had anxiety and all the leg symptoms you spoke of. I couldn't even lift my right leg off of the ground. Muscle spasms shook me all night and my legs jerked constantly when I sat. However I did great afterwards for three yrs but am now in chronic pain. At least I can walk and sleep again. Also age is a big factor in how well you do. At certain age your back won't adjust to make up for lack of mobility. The surgery was definitely worth having. My Dr also used new technique that he helped create where they make two incisions on each side of the spine instead of in the middle. They go under the muscle instead of cutting it and your recovery time is ninety days compared to six months to a year. Hope any of this was helpful. If you have any other questions I will check back and will be glad to help any way I can. You might see if you can find a Dr who uses this new technique. You are in PT the day after surgery instead of six weeks after.
Tetonteri makes a great point. The people who are doing well aren't on here whining like me about their pain and problems. Don't think something is a bad idea just because ten people on here are talking about the failure. There may be thousands out celebrating their good fortune.
I know I had a mast tlif... I'm not sure if that's the name. He makes four incisions, two on each side of the spine, and goes in under the muscle. My surgeons name was David Rouben of River City Ortho in Louisville Ky. They insert tubes into incisions and do the surgery through the tubes. My PT thought I was crazy when I told him I had surgery the day before I came to him. He had to send me home and talk to my Dr about how to proceed with therapy.
Dr Rouben created this surgery with one or two other Drs I believe. They go around the world teaching it.
Dr Rouben told me because of my age at time of surgery,39, that my back would not adjust to the loss of mobility which I think he said that would be around seventy percent of your backs mobility. I'm not sure if I remember the number exactly right. Younger people tend to adjust as their back is still growing or changing. He said I would probably wear out other disks because of lack of mobility. He said its not written in the books and most Drs wouldn't tell you that but in his experience he was sure I would be likely to have future problems and additional surgeries unless I seriously altered my activities.
I also have some bulging in the t10 area of my thorassic spine. They won't do anything in that area unless its unavoidable due to the proximity of internal organs. My pain Doc also told me the same thing. Something about risk of infection being too serious. I'll admit my memory is horrible so I could have some of this wrong somewhat in my mind. My wife is a nurse and has talked to Drs at her hospital who agreed with that. I also have some scoliosis above the t10 area which may be causing some issue.
I know I had a mast tlif... I'm not sure if that's the name. He makes four incisions, two on each side of the spine, and goes in under the muscle. My surgeons name was David Rouben of River City Ortho in Louisville Ky. They insert tubes into incisions and do the surgery through the tubes. My PT thought I was crazy when I told him I had surgery the day before I came to him. He had to send me home and talk to my Dr about how to proceed with therapy.
Dr Rouben created this surgery with one or two other Drs I believe. They go around the world teaching it.
Dr Rouben told me because of my age at time of surgery,39, that my back would not adjust to the loss of mobility which I think he said that would be around seventy percent of your backs mobility. I'm not sure if I remember the number exactly right. Younger people tend to adjust as their back is still growing or changing. He said I would probably wear out other disks because of lack of mobility. He said its not written in the books and most Drs wouldn't tell you that but in his experience he was sure I would be likely to have future problems and additional surgeries unless I seriously altered my activities.
I also have some bulging in the t10 area of my thorassic spine. They won't do anything in that area unless its unavoidable due to the proximity of internal organs. My pain Doc also told me the same thing. Something about risk of infection being too serious. I'll admit my memory is horrible so I could have some of this wrong somewhat in my mind. My wife is a nurse and has talked to Drs at her hospital who agreed with that. I also have some scoliosis above the t10 area which may be causing some issue.
I know how you feel and I totally feel for you. I am a 40 old mother of 2 boys ages 4 and 8. I work full time and have been in pain for about a good 6 years. I have had nerve blocks, injections, pill, chiropractors, Upper Cervical doctors...you name it. In April of 2010 on my way home from work I took myself to the ER and begged the doctor to find someone to help me with the pain down my left and right legs. He gave me some pain meds and a Doctors name. I made an appt with the back surgeon and he sent me for an MRI. I had DDD at L5 SI and a large bulging disc that was crushing my sciatic nerve. I had a laminectomy on May 3rd 2010. I was only out of work for 2 weeks and I was pain free for a little over a year. I was pretty happy.
Out of no where the pain came back but it was all in my lower back now. No leg pain.
He did another MRI and said the disc had clasped my spine was not stable. He told me he could do another laminectomy but most likely I would be back in a year or two and have to get a fusion. I did not want 3 surgeries on my back. I went to see another doctor for a second opinion and he told me not to get the fusion. I was out of my mind with stress and did not know what to do.
I finally made the decision to go ahead with the fusion. I knew I did not want to live my life in constant pain so I had to give it a try. I was in pain already so I figured what do I have to lose?
I just had my fusion done on Feb 20th 2012. They also cut away more of the disc that started to bulge out again. I have 3 incisions and 29 staples in my back. I do NOT have the same pain that I did before the operation. I just have pain from the incision and the staples. The staples are coming out on Tuesday and I can’t wait. I still have a lot of healing to do for the bone to grow and fuse but I am very very happy with the results so far.
I finally am feeling like my old self again and the thing I notice the most is that I am no longer walk around with that painful grimace on my face 24/7. You will have many people tell you to do this or do that or you crazy if you do or you nuts if you don’t. It will consume you. You are young and have a lot of life to live so make your decision based off of what you feel. I figured I was in pain now so if it didn’t work I would be the same.
I had to give it a shot and so far soo good. I wish you luck and feel free to reach out to me if you need someone to talk to.
Once again, thank you so much for sharing your stories and your experiences with me...this continues to be a difficult road to travel down. Currently, I still working with my physical therapists who are explaining to me that it might take months for the therapy to yield any results. My doctor has given me a packet of Prednisone, which he said I should take when it gets so bad I can't continue...and his worry is that in a couple months I would need another dose, so he asked me to be cautious deciding when to take it.
Also, my doctor and my plan is to wait at least until I am in my 40's to explore something more drastic like a fusion (2 and a half years from now). I am not sure why to wait until then (maybe some of you could illuminate me on this one), but it sounds like a plan to me.
The pain is no fun, but the lack of ability is even less fun...I have a 4 month old and every day she gets bigger I wonder if my back will be strong enough to lift her when she needs me...not the greatest feeling as a new father.
Again, thanks for all of your insight and wish me luck: )
I understand your concern with surgery. I was 45 when I started having major issues with my neck not my back. I was bone on bone C6-C7 and herniations and bulges above with tears. The OSS said that at some point I would need surgery but was willing to work with me to hold it off as long as I wanted. I tried chiropractor, PT, acupuncture, various injections and medications. Only when my quality of life significantly changed (couldn't use my left arm at all) and was taking major pain meds every 4-6 hours I knew it was time for surgery. It took 5 years to get to that point. I was blessed with an OSS that was not knife happy and very willing to help with every step of the way. i also inquired about artificial disk replacement (adr). I was not a candidate for a trial as I had 2 levels ACDF C5-6 C6-7) that needed to be fused and had too much arthritis. I have informed (LOL) my OSS that if I need anymore surgery, I want to have it early enough that only 1 level is needed so I can have an ADR. Maybe you should talk to surgeon and ask about a disk replacement so that you do not lose any range of motion. They are much more common in the lumber region than the cervical. Good luck.
Hey Jason -- If you were to consult with a different spine specialist, like an ortho spine surgeon if your current surgeon is a neuro, or even someone from a different practice, you might very well be told to have the fusion now. There is nothing magical about turning 40. I think it is just arrived at from statistical data based on how long a fusion is expected to last, etc. (I'm not sure why that is the case, as it isn't as though there is a replacement part that has a useful life of ten years, or something). I suppose they take into consideration the notion that once you have a fusion, it puts more stress on the adjacent discs, with the theory being that they will wear out sooner than if you had not had surgery.
I probably already asked you this...but have you met with more than one spine surgeon? It really is helpful to consult with several if you can.
I have met with 2 surgeons...one who looked at my most recent MRI in October 2010 and said I most certainly needed to have surgery right away...and then I met with a surgeon recommended to me in Pittsburgh who said to absolutely, under no circumstances, should I have the surgery unless I a crawling in excurciating pain to the hospital...that is when I start the first of 3 physical therapy regimens...and in the mean time I have seen 3 doctors, which includes the doctor I am currently seeing whom I like and seem to trust very much...and all 3 of them said that I will eventually be looking at a 2 level fusion at S1-L5. Like I think I mentioned previously, my current doctor thinks that I will be an excellenkt candidate, should the surgery truly become necessary, and we have both agreed that if the pain becomes such that I have to switch to narcos, then it is time.
I have yet to consult with another surgeon, and ADR seems unlikely, since my insurance does not cover it and I would need two levels...which is certainly not available in MN...maybe Germany
This current doctor has a very strong opinion of the surgeon I should consult, although I am sure to shop around should the need arise...but I do feel thankful that I have a doctor that I feel I can't trust (he explains everything to me and spends an obnoxious amount of time answering my questions...and his nurses actually answer the phone!
Anyway...long story short I am still confused....but that seems to be a common theme with people in my situation
