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Old 03-01-2012, 02:35 PM   #1
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Question To have 3 level lumbar fusion in April--scared

This is my first time to post on this board. I'm 76, have had back problems for about 25 years. Have had many different treatments (have tried everything except accupuncture!), 10 years of epidurals, most with good results, but at my last epi (Oct. 2011) the doc said my epidural space is blocked and he would not attempt to give me any further. My back and leg pain has been increasing for months now, causing much disability. Have had 4 opinions--two by pain specialists and 2 neurosurgeons. None of the 4 agreed what should be done. The last neuro believes he can help me with 3-level fusion to correct the worst area of scoliosis and release compression on nerve roots. Proposing anterior spine cages, etc via the XLIF procedure (min. invasive) and posterior compression release and rods and screws. He plans to stage the procedures 5 days apart because at my age 8.5 hours under general anesthetic would be too risky. The surgery is scheduled for late April.

I also have had compression fractures, at L1 and T11. Have stage 3 kidney failure, mild cardiac arrhythmia, mild asthma, etc. The surgeon says I have 100% chance of complications from the surgery, but aside from that, he expects me to have 75 to 80% pain relief plus the loss of function in legs,etc. will be halted. But I'm scared that something may go wrong and I'll be worse off. I told him if I would have 50% less pain and be able to continue living alone in my home I'd call that success. He said there is extremely high chance of that being the outcome. I sure don't want to have to go into some kind of care facility. Standing is extremely painful, walking too.

If anyone here has any suggestions for me, I'd greatly appreciate it. If having the surgery is wise, what to expect in the first few weeks post-op, how long I'll need help at home, pointers on how to deal with the BLT limitations, etc.

 
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Old 03-01-2012, 06:39 PM   #2
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Re: To have 3 level lumbar fusion in April--scared

I wish any of my grandparents had been savvy enough to post on the internet at 76 years-young. Welcome to the boards!

If you look at the sticky "Post-surgery tips", you will find a lot of ideas to make life easier post-surgery and avoid the dreaded "BLT". I don't know if I can give you a lot of perspective on a 3-level fusion, especially with other health problems. I had a one-level fusion, younger, etc.

However, for you to be pursuing treatment actively, it must be one of the most troubling health issues for you right now. It sounds like you have had plenty of medical opinions. Make sure that your neurosurgeon is a spine-only surgeon.

My roommate at the hospital had a hip replacement, and she had very little upper body strength, which is very common in women. As a result, her surgery was the day before mine and when I left, she was still in the hospital on her way to a rehab facility, only because she could not demonstrate that she would be able to ambulate on her own. One thing that may help your recovery is increasing your upper body strength prior to surgery, as you will use your arms to get in and out of bed. And the doctors will want you walking pretty quickly.

I am sure some other posts with situations more similar to yours will post some of their thoughts.

 
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Old 03-01-2012, 11:20 PM   #3
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Re: To have 3 level lumbar fusion in April--scared

[QUOTE=SweetPeainSF;4937459]I wish any of my grandparents had been savvy enough to post on the internet at 76 years-young. Welcome to the boards!

If you look at the sticky "Post-surgery tips", you will find a lot of ideas to make life easier post-surgery and avoid the dreaded "BLT". I don't know if I can give you a lot of perspective on a 3-level fusion, especially with other health problems. I had a one-level fusion, younger, etc.

However, for you to be pursuing treatment actively, it must be one of the most troubling health issues for you right now. It sounds like you have had plenty of medical opinions. Make sure that your neurosurgeon is a spine-only surgeon.

My roommate at the hospital had a hip replacement, and she had very little upper body strength, which is very common in women. As a result, her surgery was the day before mine and when I left, she was still in the hospital on her way to a rehab facility, only because she could not demonstrate that she would be able to ambulate on her own. One thing that may help your recovery is increasing your upper body strength prior to surgery, as you will use your arms to get in and out of bed. And the doctors will want you walking pretty quickly.

I am sure some other posts with situations more similar to yours will post some of their thoughts.[/QUOTE]
Thank you,SweetPea for your hug, and good advice. My neurosurgeon also does brain surgery. So far I've not found a neurosurgeon who does only spine, but wish I could. After 4 opinions, I'm getting tired of going to new docs, and suspect that if I go for a 5th opinion, I'll get a 5th proposal. Just wish I could get 2 to agree--I'm getting the idea that there is no such thing as a good procedure for me!

Am wondering if I should cancel the surgery?
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Old 03-01-2012, 11:56 PM   #4
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Re: To have 3 level lumbar fusion in April--scared

You may also have some luck with spine-only orthopedic surgeons. My surgeon was an ortho at Stanford. With all the other medical complications you have, you might want to look into the nearest teaching hospital that offers spine fellowships. You can specify that you don't want any interns scrubbing in on your surgery.

A large hospital would also give you access to other specialists, in case one of your other health issues became a problem. You can always keep the April appointment, while you think about your options. The doctor's office won't be offended, as long as you give them some notice.

 
Old 03-02-2012, 09:39 AM   #5
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Re: To have 3 level lumbar fusion in April--scared

I would agree with SweetPea's suggestion to get a consultation with an orthopedic spine surgeon. This is not to be confused with a general orthopedic surgeon. Most specialize now, anyway...but you don't want one who does a bit of spine surgery and a few knee replacements, etc. This ortho doctor will have a fellowship training in the spine and will only work on patients with neck or back issues. His training includes all the neural structure so you don't have to worry about that aspect of spine surgery.

Ortho spine docs tend to look at problems slightly differently, which sometimes results in a recommendation of less surgery. I think you will find that another surgeon may not take 8.5 hours to do the surgery, either.

We will have to leave it up to the surgeon to decide if all your other health issues might preclude you from being a surgical candidate. I can tell you that my 88-year old mother-in-law recently had a lumbar fusion and is doing very well...(for what it's worth!)

It sounds like your major problem is stenosis....I know you said "scoliosis" but I'm wondering if it isn't stenosis due to your age and description of your symptoms. If it is stenosis, as spine problems go, this is fairly easy one.

I would encourage you to get another opinion. I know it is a hassle, but finding the right surgeon for the job is the most important decision you will make...and it is really important to get it right!!

Please let us know how you are doing and what you decide to do.

 
Old 03-02-2012, 10:03 AM   #6
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Re: To have 3 level lumbar fusion in April--scared

I am 68 and back surgery would scare me stiff as I almost died after a fusion 30 yrs ago. At 76 with multiple health problems I think surgery would be very risky. Even your surgeon thinks 100% chance of complications. You are not 40, 50 or 60. At 76 you don't want to squander your remaining years on risky surgery. I am sorry but I just don't think it is a great tradeoff. Pain management in my meager opinion is best for keeping you comfortable and well. At 68 this is what I am doing. In my case unless an emergency comes up surgery is out of the question.
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Old 03-02-2012, 10:22 AM   #7
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Re: To have 3 level lumbar fusion in April--scared

Thank you for your kind reply. I do have severe lumbar scoliosis with rotation as well as the severe stenosis. Have bulging/herniated disks in entire thoracic and cervical as well, but only what I consider mild pain in those areas. Any of the spine specialists I've seen do a double-take when they look at my lumbar MRI/Xray films. Some have even refused to do surgery on me--Mayo Clinic for one. But I'm losing function and independence and am concerned that I soon won't be able to get around without unbearable pain. My other ailments are well controlled with medication, etc.

I will look into another opinion (#5 at this current go-around), this time with ortho spine surgeon. My PCP is regarding the neurosurgeon's proposed surgery with much trepidation. I'm also trying some holistic modalities such as prolotherapy and craniosacral therapy--no success so far. I wonder if anyone on this board has tried these.

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Old 03-02-2012, 10:29 AM   #8
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Re: To have 3 level lumbar fusion in April--scared

Thank you again. I live within doable driving distance from Denver--Colorado U. Hospital is a teaching hospital. But I don't even want residents working on me--in the past have had disastrous things happen to myself and other family members with residents who have lot of confidence but too little experience. I don't know if a surgeon will agree to no residents.... Will just have to ask.
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Old 03-02-2012, 10:40 AM   #9
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Re: To have 3 level lumbar fusion in April--scared

Thank you so much for your kind reply. I agree with you how scary this is. This surgeon, of course, as they all do, said I could die from this surgery, but I told him when I'm in bed crying with pain and pleading with God for relief, death doesn't look all that bad. Don't get me wrong, I'm not suicidal; just desperate.
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Old 03-02-2012, 12:46 PM   #10
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Re: To have 3 level lumbar fusion in April--scared

you need to ask yourself how much pain do i have now? I am 47 and have had a 2level spinal fusion it was my third surgery in the same level my pain before the surgery was at a5 now it is 10 I cannot sit or stand for longer than 10 minutes.Everyday is a constant struggle. I have lost my job,and pretty much my life as i knew it. I had to have another surgery after that which brings my total to 4 . I am still the same.I am now looking for some answers from other people that have had the surgery, since my surgen who was suppose to be the best cant give me any. I wish you the best

 
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Old 03-02-2012, 04:14 PM   #11
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Re: To have 3 level lumbar fusion in April--scared

I am so sorry to hear the plight you are in, and at such a young age. Do you know what went wrong? Thank you for sharing with me. I hope you will find relief somewhere.
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Old 03-03-2012, 09:36 AM   #12
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Re: To have 3 level lumbar fusion in April--scared

I'm sure there are other skilled orthopedic spine surgeons in Denver who are not associated with the medical school. I tend to prefer doctors in private practice even though I don't mind going to a "spine clinic" at a teaching hospital for an opinion. Then when I am assured that there is no new technology out there that could help me, and they are suggesting the same surgery as "my" spine surgeon, I always end up going back to him!

The thing that scares me about the neurosurgeon's plans for you is the length of the surgery and the fact that you would be facing general anesthesia three times in a short period of time. The "new" anesthetics are marvelous, but still it is a big assault on your body to be put to sleep three times.

Even though doctors sell the XLIF procedure as being less invasive, etc. it is not without side effects which can result in exchanging pain in one area for pain in the thigh and groin.

Without being a doctor and without knowing much about your general condition, these would be my concerns for you...and something I would certainly want to discuss further with the surgeon.

 
Old 03-03-2012, 09:43 AM   #13
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Re: To have 3 level lumbar fusion in April--scared

I meant to comment on prolotherapy and the other treatment you are having. I had severe stenosis too before my first fusion, and I was told that there was nothing that would have helped me other than going in surgically and cleaning out all the gunk to make room for the nerves.

I had just a pin***** of space left in my central canal and the foramen and the nerves were being squeezed unmercifully. Prolo is great for some things, particularly where ligaments are involved, as in the sacroiliac joints...but I just don't see how it can cause there to be more space for your nerves.

 
Old 03-03-2012, 01:34 PM   #14
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Re: To have 3 level lumbar fusion in April--scared

[QUOTE=tetonteri66;4938281]I'm sure there are other skilled orthopedic spine surgeons in Denver who are not associated with the medical school. I tend to prefer doctors in private practice even though I don't mind going to a "spine clinic" at a teaching hospital for an opinion. Then when I am assured that there is no new technology out there that could help me, and they are suggesting the same surgery as "my" spine surgeon, I always end up going back to him!

The thing that scares me about the neurosurgeon's plans for you is the length of the surgery and the fact that you would be facing general anesthesia three times in a short period of time. The "new" anesthetics are marvelous, but still it is a big assault on your body to be put to sleep three times.

Even though doctors sell the XLIF procedure as being less invasive, etc. it is not without side effects which can result in exchanging pain in one area for pain in the thigh and groin.

Without being a doctor and without knowing much about your general condition, these would be my concerns for you...and something I would certainly want to discuss further with the surgeon.[/QUOTE]
Thank you, Teton, for all your input--very helpful. I must not have made my surgery plan clear--the doc's plan would be to do all 3 levels of anterior spine in the first stage (via XLIF); would use the bone that he excises (to relieve the central canal stenosis I think) to put into the cages, along with a very small dose of bone morphogenic protein. He can use just the one XLIF entry (for which he uses 2 small incisions, which he thinks is safer than only one), as the 3 levels are so badly collapsed that the lines of the interbody spaces converge.

Then, after 5 days of "recovery" would take me back to the OR to do the posterior spine procedure--open up lateral stenosis and stabilize the scoliosis with screws and rods. Delicate work! So there would be 2 bouts of general anesthesia, not 3. The first stage would take about 3 1/2 hours; the second stage, 4 1/2 to 5 hours. I've had a number of surgeries in my lifetime, but I don't think any of them have taken more than 1 1/2 hours, maybe 2 total. Some of those procedures really flattened me for many months, especially the abdominal ones. And I was a lot younger then! So even a 3.5 hr. surgery sounds shocking to me.

Yes, I have been told about the possible side effects of the XLIF, and that is one thing that gives me pause. Trading one pain for a different one doesn't sound like an improvement!

But there is really no other feasible way to relieve my pain and disability. Yesterday afternoon I had to make a brief visit to the eye Dr. as I had something in my eye. Didn't take very long to remove it, but I had to walk farther than I can without severe pain. I wasn't able to use my walker because I could see I had to negotiate some stairs to enter the building--just used cane. By the time I got home I was in so much pain couldn't stand up long enough to make a meal, so just ate some bread and cheese. Not a balanced meal, I know, but that's all I could manage. So in my present condition, life is difficult. And it is steadily getting worse.... Thank you again for your very astute advice.
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Old 03-03-2012, 01:55 PM   #15
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Re: To have 3 level lumbar fusion in April--scared

Envisioning my own spine made me think the very same thing that you said, and I talked to the Dr. about that beforehand. He showed me on the skeleton model where he was going to do the prolo injections--mainly the SI ligaments, which he said normally have no motion (which is a pain generator), and he thought that doing these injections, even if they didn't help, would be somewhat diagnostic re whether some of my pain is from the SI. It was my PCP who did the prolotherapy. The cranio-sacral therapy sounds even more far out to me, but it is done by a physical therapist. Thanks again. Grammie76

 
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