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Old 04-11-2012, 02:44 PM   #1
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2nd discectomy or Fusion

I posted earlier about a second microdiscectomy. The Neuro's office calls and says that I should probably consider an L5-S1 Fusion instead of a micro. Please can anyone help me here? They tell me it is ultimately my decision, but how the heck do I know what to do. Two staff members have different opinions. One says do a 2nd microdiscectomy and the other says do a fusion. I am scared out of my mind. This is my back we are talking about. I just want to leave everything alone and stay home and hide. Of course they tell me that won't work either. Please anyone have any advice???? I do have a second rupture of the L5-S1 disc. First surgery was a micro on Feb 03 2012. Hurt since day one after surgery. Left foot is numb and both legs and back hurt with terrible spasms.

 
Old 04-11-2012, 04:50 PM   #2
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Re: 2nd discectomy or Fusion

It is your decision, but if you have been in pain even right after the first discectomy, it's hard to say if a second one will make a difference.

It's not an easy decision to go with surgery, especially a fusion. You'll have to weigh the pros and cons of both options, consider the risks of a fusion vs not having the fusion, and decide which route will be best for you. Hiding certainly won't fix things, but I understand how you feel. Sometimes you just need to take some time to think about things.

 
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Old 04-11-2012, 05:18 PM   #3
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Re: 2nd discectomy or Fusion

I was going to post on your first thread but will offer the comments I was going to make here.

First, this is not an emergency situation so you have time to consider your options. Do not let someone rush you into any procedure. Second, you would be wise to get at least another opinion from a different spine specialist, perhaps an orthopedic spine surgeon, since you have consulted with a neurosurgeon. They have similar training but sometimes approach the same situation differently.

Discs reherniate in the first six months after a discectomy in something like 5-10% of all cases. Often, if nothing additional is wrong, the surgeon will repeat the discectomy. If the second discectomy fails, then a fusion is recommended. This is because after two discectomies, sufficient bone has removed that the fear is that segment of the spine will be unstable, so fusion will be done at this point.

Since you cannot really just ignore the problem, I think it is important that you get some additional opinions. Hopefully you will find there is a consensus of opinions and then you can make your decision based on the surgeon. You say to staff have conflicting opinions. What does your surgeon say? He is, after all, the only one who has actually seen your spine.

Unless you develop foot drop, bladder or bowel problems like incontinence,
this is not a medical emergency no matter how much it hurts. You have time to make a considered decision.

There are pros and cons for each side of the fusion issue. The question "what should I do" is asked often on this board. You might want to read through some old posts to see how others were thinking about this issue.

What it all boils down to is that the decision is very individual. Your situation is a bit different in that you have one unsuccessful surgery behind you, and it is difficult to imagine that the disc could ever heal on its own since it has now been surgically altered. I would like more information about this -- namely, was there ever a time post surgery that the pain was diminished, or has it remained the same?

 
Old 04-11-2012, 07:35 PM   #4
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Re: 2nd discectomy or Fusion

Thank you both for taking time to talk. I was in pain from the first day after surgery. I may have had one or two good days, but that was it. My foot was numb right out of surgery and still is today. I don't know enough about fusion to make an honest choice. I will take the advice you both gave me and try to take some time to decide.

 
Old 04-12-2012, 07:23 AM   #5
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Re: 2nd discectomy or Fusion

Again, I would suggest you consult with a couple other spine surgeons in different practices, clinics, etc. First read up on fusion -- you can find lots of good information online -- so you can have a discussion with the doctors, ask questions and understand the replies. One may recommend another discectomy, while another suggests fusion...then you can ask why...and will then have something to go on as you try to reach a decision.

Since you have already had one surgery, there is no turning back that page...so it would seem you only have two choices now: live with the pain and try conservative measures to see if it might heal on its own, or, have more surgery.

I think I would be inclined to try another discectomy as you can always have a fusion if that doesn't work out...but once fused, there is no turning back. Might you be a candidate for artificial disc replacement? That would be something to look into as well.

 
Old 04-12-2012, 07:56 AM   #6
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Re: 2nd discectomy or Fusion

[QUOTE=tdiorio;4959837]I posted earlier about a second microdiscectomy. The Neuro's office calls and says that I should probably consider an L5-S1 Fusion instead of a micro. Please can anyone help me here? They tell me it is ultimately my decision, but how the heck do I know what to do. Two staff members have different opinions. One says do a 2nd microdiscectomy and the other says do a fusion. I am scared out of my mind. This is my back we are talking about. I just want to leave everything alone and stay home and hide. Of course they tell me that won't work either. Please anyone have any advice???? I do have a second rupture of the L5-S1 disc. First surgery was a micro on Feb 03 2012. Hurt since day one after surgery. Left foot is numb and both legs and back hurt with terrible spasms.[/QUOTE]

Hello Tdiorio:.

I have the same problem I had a discectomy of my L5-S1 and within three months I had tremendous pan back to the same level if not worse than pre-op. I was told by my pain management doc that per my MRI I had fibrosis and that each surgery will create more. You might want to check on that with your doctors when weighing in your decission. I have been waiting years due to lack of insurance so as others have posted you have time, yes it is annoying, you have no quality of life and can not continue to live in pain or on pain meds I agree that is no way to continue.

They have lots of procedure out there that might help "medial branch blocks", "steroid injections", "nerve root burning" I am not a doctor and do not know the whole situation but I know I would try everything before letting someone re-open my spine just due to the fact that I am prone to "Fibrosis" and it is the cause of two failed spinal surgeries for me.

Fibro def:
More than 10,000 people each year in the United States have "failed back surgery syndrome" caused by scars that form around the outer surface of the spinal cord. Such scarring, known as peridural fibrosis, is common after back surgery known as either lumbar discectomy or laminectomy. Peridural fibrosis may cause recurring low back pain or leg pain after surgery. Operating again to remove the scar tissue often leads to more scarring.

In your case you say you had pain from day one and if that's the case then this probably wouldn't fit but it could contribute to the increased pain. Just a thought.

I agree with getting a second opinion at the least if you can afford it and it is available I would get a 3-4 opion two. Make sure you are comfortable with your doctor and have all your information going in.

Goood luck and keep us posted. I hope you are able to find some relief it is horrible living with back pain and I feel for you.
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C5-C6 tear/buldge
C6-C7 ACDF
T1 - T5 neuroforaminal, lesions, facet arthropathy
Disectomy L5/S1
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