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    Old 01-29-2006, 11:00 AM   #1
    chodges
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    Microdiscectomy vs. Fusion?

    I have been reading your posted for a couple of days and there are some very well educated people out there who are giving great advice, so I am asking for your help and thank you in advance...

    I will give you my quick overview without the overwelming details:

    I am 34 with a 20 month old daughter. I fell off my porch around 8/2004 when she was just a few months old. Started developing lower back pain soon after and finally had an mri in 3/2005 which showed a herniated disk- L5 S1. I was referred to an orthopedic surgeon and had 1 epidural. It worked slightly after about a month but didn't last long. My family was relocated this summer and so my medical condition was not given much attention...but with regular exercise and not sitting much (which is easy with a toddler) I managed the pain with ibuprofin - 800 several times a day which my primary care said was ok. Once we were settled in to the new house in 8/2005 I was pretty much back to being in full pain 24 hours a day- my back numb like I had spent the whole weekend moving, my right calf totally cramping up and my bottom having shooting pains (right side). So, got a new primary care in November finally after getting my daughter all caught up on her medical needs etc. and he referred me to phys. therapy and a nonsurgical dr at the same time b/c I told him outright that I wanted to get well quickly and hopefully with the aid of probably epidurals- get pregnant again (really not rational looking back on it but I thought I could "tough" through it). I did the ptherapy for about a month and it made things SO much worse and my nonsurgical dr. started me on neurotin and epidurals and nerve blocks and suggested that we try this first and then get back on to the therapy to strengthen my back after the pain subsided. He did the epidural and a nerve block and it did nothing. He suggested a second (of both), which we did the following week, and a third of both the following week and was truly suprised that these did not help. By now I am thinking, ok I know people have these microdiscectomy's all the time, that is where I am heading...but he recommends a nerve test and also a discogram b/c there are other non surgical treatments he can do in house that are less invasive. The emg didn't show any nerve damage the the discogram was painful and he couldn't even get "into" the ruptured disk space. So I suggested redoing the mri, which we did 2 weeks ago. At the follow up- he said right off the bat- you need to see a surgeon. I knew this b/c my disk is totally black and even in my limited education, could see it was sticking way out into the nerve space which showed me it was not just ruptured, but totally herniated! So he referred me to an orthopedic dr who recommended the microdisc. at first. But, I also told him that I realized it would be a while before I could have the second child at this point but that it was very important and that I realized there was a strong chance or reherniation with my active life style after a discectomy. At this point, he recommend the fusion b/c he said if I was his sister, he would take the longer recovery time for the knowledge that the disk would never cause anymore problems, during pregnancy or chasing little ones around. I of course, have a second opinion lined up with a neursurgeon b/c I have heard mixed emotions about each type of doctor. I am torn between wanting a "quick" fix (maybe) or just going for the fusion, but my head tells me not to jump into the last resort with technology changing every day.

    Sorry this turned out so long- but I truly value your opinion with so many of you experiencing such similiar situations ( and my heart goes out to you in worse conditions than me). I also forgot to mention that I am on Kadain twice a day and sleep medicine and the occasional percacet for breakthrough pain although I still feel pain 24 hours a day. I can truly say my quality of life is deteriorating and I am starting to really get depressed about the fact that I think I will have to deal with this my whole life. But, I am truly optimistic that there is a solution which involves educating myself,seeking the best medical care and learning from others experiences.

    Thanks again for any opinions you may have on where I should go from here. I am also curious to see how you feel about the epidurals back to back. As I have been reading a lot of posts and talking to people, it seems so strange that they were back to back. I also didn't mention I took oral steroids in various stages as well that did nothing.

    Last edited by chodges; 02-02-2006 at 09:38 AM.

     
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    Old 01-29-2006, 11:22 AM   #2
    Lilly66
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    Re: Microdiscectomy vs. Fusion?

    Hi there, so sorry for us all that we are going through so much pain. I am awaiting to have my 2nd micro surgery as the first one reherniated. Definitely have the microdiscectomy before even considering a fusion. Have 2 if you need to. Fusion should be your last choice as it changes the mechanics of your back forever and is a major surgery. I am optimistic that my 2nd surgery will take, but if it doesn't, at least I know that I tried anything and everything I could before having the last option...a fusion.

    Best,
    Heidi

     
    Old 01-29-2006, 11:29 AM   #3
    chodges
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    Re: Microdiscectomy vs. Fusion?

    Thank you for your reply. How long ago was your first microdis.? I agree on one hand, that you go with the least invasive and then if you have to do the fusion, but I am trying to determine how long I can "get by" because I feel like it will definitely reherniate (I guess the pessimist in me) and I worry that this could happen during a second pregnancy. Then I wouldn't be able to do anything until I was no longer pregnant.

     
    Old 01-29-2006, 11:53 AM   #4
    Lilly66
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    Re: Microdiscectomy vs. Fusion?

    My first micro was 7 weeks ago. The disc re-herniated 2 weeks ago and I am in excruciating pain. I have had 4 opinions and they are all in agreement that I should have a revision micro. I don't think I am prolonging the ineveitable, I need to believe that surgery will work.

    Re: epidurals. Amongst all of my other trys with conservative treatments, the 2 epidurals that I had only alleviated the pain for 4 days only (each). Again, try everything and anything you can before committing to major surgery.



     
    Old 01-29-2006, 03:59 PM   #5
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    Re: Microdiscectomy vs. Fusion?

    I'm sorry to hear that you are in so much pain. Good luck and thanks for the advice.

     
    Old 01-29-2006, 07:16 PM   #6
    Katinthebag81
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    Re: Microdiscectomy vs. Fusion?

    Heidi,
    I'll jump in here real quick with my story. I had a diskectomy in 1988 (full operation-they didn't do micro d much back then). I've had 18 really good years with it, but 5 weeks ago had to have a 3 level fusion. Just my experience, but I got great relief for 18 years. Yes, I had some minor pain every day for those years, but nothing that a couple of Motrin didn't help.

    They have a lot of new options these days, such as artificial disk replacement- I would research every option known to man before I made a decision. I was not a candidate for ADR, but explored all options.

    Please keep us posted on your situation. If you can, please do a seach on this board for posts by Quietcook. She really knows a lot, and if you haven't seen a spine specialist yet, has some tips for finding the best dr. for you.

    Kat

     
    Old 01-30-2006, 08:40 AM   #7
    Callyann
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    Re: Microdiscectomy vs. Fusion?

    Hi Heidi,
    I agree with Kat,
    I would have a M-D. If every thing goes well (85% of MD's do )you should be talking of a 12 month period at most before you are able to be really active, but only 3 months before you are "back to normal". I read up a lot on the op before I had it 12 weeks ago and the chance of rehernating is only about 10%. ( most of these in the first 6 weeks) The majority of people on the board are having problems,but if I had been one of the 85% who sailed through without any problems, I doubt that I would have found this board. The artificial disks are where I would be looking if I do reherniate, as they are getting more advanced all the time. I think I am correct in saying that if you have a fusion, you can no longer have a disk replacement. If you decide to go for it, read up before hand, and make sure you find a good spine surgeon. I had a difficult time for 10 weeks, but with physio I am feeling really well now.
    Good luck and keep us posted.
    cally

     
    Old 01-30-2006, 10:22 AM   #8
    jeanlyon
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    Re: Microdiscectomy vs. Fusion?

    Hi there - I am 9 weeks post micro-d and doing really well. No pain at all. I was back at work 2 weeks after the op and also driving the car. Best thing I ever did. I am being careful with what I lift and how I manage things, but that's all.

     
    Old 01-30-2006, 04:29 PM   #9
    jam17
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    Re: Microdiscectomy vs. Fusion?

    I'm in the same boat.. I had my First M-D in August '04 and was great following the surgery...up until October '05. I had such a wonderful year. I was able to do so much again, even though I always kept an eye on what I was doing.

    In October '05, my back started bothering me with the same symptoms as in 2004, so made an appt with the Dr who did the M-D.I also talked to a Physician Assistant in the hospital that I work at, who told me to see the Dr that she follows and made the appt with a Neurosurgeon.

    Both sent me for the MRI, and it came back that I reherniated the same disc L5-S1 and the DDD is getting worse.

    I think I'm going to stick with the Neurosurg and have seen him a couple of times. He told me that another M-D would be best, but if I reherniated it once, I have a greater chance of doing it again. He sent me for a Discogram(Which was horrible) and PM Dr who did the test said that "My last 3 discs are shot" and yes that was the quote from the Dr.

    I'm heading to the NS dr again 2/6 to find out what my best chances are. But i can tell everyone.. I'm getting sick and tired of the darn numbness and tingling going through both of my legsand the horrible spasms that take over most of my back. I know that i can't stay on Muscle relaxers and Vicoden ES forever. The good thing is that i only take it at night..but if i don't take it, I can not get out of bed the next day.

    Good luck with your desicion. I wish i could help you out... but just remember that your not the only one with this problem. That is why these boards are out here. For help, Comfort, and information.

    Keep us posted.

    Jam
    PS i'm also worried about how things will be if i get pregnant. Not planning anything yet.. but maybe in a year or Two.. DR said everything should be fine (somehow i just know most of the pregnacy will be on Bedrest. lucky me).

     
    Old 01-30-2006, 07:15 PM   #10
    schragie
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    Re: Microdiscectomy vs. Fusion?

    Sorry to hear about your pain. I am in a similar situation with an L5-S1 herniation/severe leg pain and have done 3 epidurals, PT and am wearing a TENS unit every day. I try acupuncture this week and was told by the pain doc that I really should see a surgeon. He said that neurosurgeons typically go less invasive (microdiscectomy) and that orthopedic surgeons sometimes lean toward fusions. I have decided to see one of each.

    In the meantime, I must share with you that I had a fusion 8 years ago in my neck (2 levels) and within a couple of years I had another herniation right above it. As it was told to me (after the new herniation), the removal of the discs caused more stress on the levels above and below (they work harder) and the likelihood of a new herniation is greater than if you didn't have a fusion. Thankfully, I managed the new neck herniation with physical therapy and the pain is not too great unless I get on a long plane or car ride.

    Back to the back, though -- I'd be interested in hearing what you decide to do. I still have no idea what I will end up doing and am fantasizing that I won't need surgery, but it looks like it is in my near future. I have heard so many good things about microdiscectomies, as well as fusions, but you only have one back so you want to find the best surgeon you can and research him/her as well as you can. Recovery from surgery can be hard no matter what kind you get, so do make sure you get help with childcare. Good luck to you!
    Schragie
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    Old 02-01-2006, 10:18 AM   #11
    chodges
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    Re: Microdiscectomy vs. Fusion?

    THANK YOU ALL FOR YOUR INPUT! It is really great to know there are other people out there who don't just take what the doctors say as "law" and who educate themselves on all the details and options. It was interesting (can't remember which one of you mentioned this) the fact that the ortho. surgeon leans towards the fusion and the neuro leans towards the microdisc.- that makes sense. I have my 2nd opinion next week (don't you all hate waiting for these appt's and the fact that you have to book so far out!!!) with the neurosurg so I will see what he thinks. I am leaning towards the microdisc. at this point with all the technologies including the artifical disk and this new "glue" technology I have heard about becoming more "mainstream" in the near future.

    In terms of the reherniation, for those of you who have had the microdisc.- how long do you think I should plan to have family and friends help after? Do you think 3/4 weeks of not carrying my daughter is sufficient, or would you try to hire a caregiver for a longer period?? Not that money isn't an issue, b/c it is, but would it truly give me a better chance at healing faster and "better"? Thanks!

     
    Old 02-01-2006, 10:23 AM   #12
    chodges
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    Re: Microdiscectomy vs. Fusion?

    Jam- with regards to the pregancy...I definetely wouldn't try unless you feel like you can get through your everday pain level without something greater than Tylenol!! B/c that's all you can take I know you said maybe 1 or 2 years, but I would be careful just in case

     
    Old 02-01-2006, 02:55 PM   #13
    Callyann
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    Re: Microdiscectomy vs. Fusion?

    Hi,
    I had my Mom with me for 3 weeks after the op. I really needed the help. I was told strictly NOT to carry more than 1Kg ( milk carton!) for at last 6 weeks after, so to avoid reherniation I think its better to stick to that rule.I bought myself some light weight pans and plastic jugs to make cooking easier. I also found I was unable to drive for a longer period than I thought, and if you dont have groceries delivered, you will need someone to shop for you.I have seen a great list somwhere on the board for all the things to remember to organise before a back op. Good luck.
    Cally

     
    Old 02-01-2006, 05:16 PM   #14
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    Re: Microdiscectomy vs. Fusion?

    Thanks, that's what I thought I would hear, but how can I not carry my child for 6 weeks- it seems impossible!!!! I'm sure I'll get through it but - aghh!!

    On the medicine front, I am curious for those of you who are in similiar situations to me, what are you taking and what do you think are the worst side effects for you? I am on Kadian (20 mg) and Lunesta and I hate to say Percot occasionally (I'd like to be all the time- I really am joking, but it does help). Also the ibuprofen as needed. If anyone is on the Kadian- do you feel like it makes a big difference? I told my doctor I could still definitely feel leg cramps at night to the point of waking me up and he simply stated that I would feel a lot worse at this point if I wasn't on it- i.e. I could tell if I wasn't on it big time...I really am not a drug person, I hate this dependance!

     
    Old 04-17-2006, 11:24 AM   #15
    betdan
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    Re: Microdiscectomy vs. Fusion?

    [QUOTE=jeanlyon]Hi there - I am 9 weeks post micro-d and doing really well. No pain at all. I was back at work 2 weeks after the op and also driving the car. Best thing I ever did. I am being careful with what I lift and how I manage things, but that's all.[/QUOTE]
    I had a micro d 3 months ago and if you talked to me last week, life was back to normal and I was feeling terrific, no pain at all. I too was back at work after two weeks and also driving. 3 days ago I went to put on my socks, twisted the wrong way and re-herniated my disc. The pain is worse than it was before surgery and no pain medicine is taking it away! Reason for this message is "Even though you feel great, always be aware that you had surgery and at anytime you can twist or bend the wrong way"

     
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