Shoreline

Hey Spondylo, The problem with instability and shifting of vertabrea, is that there is no amount of medication that stops the pain when things actually shift.
I've had 3 back surgeries, the last 2 were attempted fusion, the last from L1-S1, They all failed and I've broken both sets of hardware, sheared the pedicale crews off at the bone line, the screws in my sacrum toggle in holes twice the size they were originally.

I can be comfortable on medication or now with the pump, but when the hardware and vertabrea shifts, which it sometimes does with every step or sometimes does with slight movement, no amount of medication prepares you for the slippage and shifting, It sends a jolt throug my body that regardless of how high my pump is set or what meds are in it, It's not going to mask the pain of shifting and mechanical instabilty.

Meds can certainly manage the pain when your sedentary and stay in the same position, but once moving I never know when things will shift or move and nothing touches that pain. It stops me in my tracks and I break into a sweat.

Unfortuantely the only present answer for instabilty is fusion which surgeons grossly exagerate the success rate of whatever method they use, cages, or pedicle screws, postieror or global, grafted bone or donar bone, There are some new things out there I could tell you about such as new cages, new bone growth enzymes and proteins, but there has never been a statistical comaparison of effectiveness of one method versus another. Docs learn to fuse and continue to do it the way they learned.

Some are interessted in trying the latest hardware and the latest bio agents, but again there is no data on the success rate of one method over another. There s a new cage that doesn't use donar bone, they fill it with a bone growth agent and I can get some info about that if your interested, but cages are implanted from the front after complete removal of the disc. Very invasive.

If you have instability of L5-s1, anteror is defnitely the way to go as far as looking at it from a mechanical point of veiw. The sacrum is softer than vertabrea and doesn't hold screws as well, hence my toggling problem. the area they try to fuse from L5-S1 from a posterior aporach is like trying to glue a wing tip to another wing tip with no overlap. With what I know now, I would have gone with cages and an anteroior aproach, but hind site is 20/20.

You can medicate to manage everyday type pain, but you can't medicate enough to prevent the pain from mechanical disfucntion when things actually shift.

F you have already had a laminectomy discectomy, thpost laminectomy syndrome could likely be the cause of instability. They clip the spinous process off to reach the bulging or ruptured discs and without the interlocking spinous process, there isn't much to prevent movement from front to back, Your facett joints help some but they mostly prevent movement from side to side or slippage from side to side.

Nerve blocks can prevent the slippage pain temporarily, the usually do a medial branch block as a diagnostic test to see if a full block would be helpful, if the blocks are helpful then there the option of RFA, radio frequency ablation "destroying the nerve through RF or with chemicals, however nerves grow back and can can take a different route than previously damaged by such procedures which can cause even more pain if they can easily become trapped or impinged by instability and movement. There isn't an easy answer and several surgeons would likely give several different opinions based on the method they learned.
Good luck, Dave