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How do I know if spinal fusion is the right surgical procedure?

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Old 11-30-2006, 11:52 AM   #1
Join Date: Nov 2006
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oufan1974 HB User
How do I know if spinal fusion is the right surgical procedure?

I have been lurking around the board for tle last several months, but this is the first time I have posted. To give a litle background about my situation...I herniated two disks back in 1999 (L4-S1). After a weekend spent moving, I woke up one day with pain in my back that I never had before - not incredibly painful, but certainly uncomfortable to the point where I knew something was wrong. After seeing the doctor and having x-rays taken, he determined that I must have just pulled a muscle...told me to go home and wait it out. It got better over time. About a year later, I woke up one morning and could barely crawl out of bed. My GP immediately referred me to an ortho, who sent me for an MRI and confirmed the herniations. I spend about a year after that in PT and on every anti-inflammatory med known to man - the PT consistently made me feel worse, and the meds never touched my pain. Over time it got better, but over the years I would have occasional flare-ups for months at a time...but the flare-ups would go away and things would be better for a while. However, things have changed. My most recent flare-up has lasted almost 2 years with no letting up. The pain is getting progressively worse to the point where I have to spend about 3-4 days a month in bed, as it is the only position I can find comfort in.

About 3 months ago, I was referred to a very reputable neurosurgeon in my area who examined me, sent me for another MRI, and feels very strongly that I am a good candidate for a 2-level TLIF fusion. Other doctors I have seen in the past have hinted that this surigical procedure would be an option eventually, though only as a last resort. However, other doctors I've seen over the years have also spoken very pessimistically about this procedure...indicating that the chances for failure are about as good as the chances for significant improvement. Still, I trust my current of my good friends is a former patient of his and the procedure he performecd on her has made an amazing impact on her life.

However, this surgery is a very big deal and I can't help but wondering whether it would be worthwhile to opt for another less-invasive procedure first with the hope that it might have an impact on my quality of life - without the extensive recovery time and the limitations on what I am able to do during that time. I've discussed some of the other procedures I have read about with my Dr., and he is not willing to consider anything but fusion. According to him, less invasive is generally less effective in the world of spinal surgery. He is renowned for the TLIF procedure, and I can't help but wonder whether his surigical recommendation is based more on what his expertise is as opposed to what is best for me. I am going to see the chief of neurosurgery at one of our local hospitals for a second opinion next week. I believe that I have exhausted all other non-surgical options (including nacrotics which barely take the edge off) and that a surgical procedure is eminent...I just don't know whether fusion is the right one for me.

Has anyone else here grappled with this issue? I am curious to know how you weighed your options and made the decision to either have spinal fusion or some other procedure. For those that opted for another procedure, have you learned anything from that decision that might be able to help me out with my decision?

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Old 11-30-2006, 01:16 PM   #2
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Re: How do I know if spinal fusion is the right surgical procedure?

Hi there. The decision isn't easy by any means. I had exhausted all methods too including steroid shots,pt,pain killers,chiropracter,etc...
The pain managment doc finally told me what I needed to hear-he said if it was him he would have the fusion as my doc was one of the best he had ever known. He told me to "get my life back". That was it. I had stopped gardening, going shopping except groceries, wanting to have sex with my husband, driving to my parents to visit....I had stopped having my life. I am only 46 years old and I wanted it back. I the same surgery you are talking about on July 19th of this year. I am at work 40 hours, shopped 6 hours the other day with my daughter, cook dinner more often and my husband and I are back on track. I still have some pain-I still take Neurontin while the nerve pain calms down, but I am feeling MUCH BETTER than before surgery. Its a tough recovery but with a good support system you can do it! It never occured to my surgeon it would fail. He transferred that positive attitude to me and it is fusing. I can't believe how far I have come. Others have too but they have left the boards behind them. Some of us check in more often to encourage the ones who, like us, sought out answers from others who KNOW our pain !!
Let us know how your second opinion goes!

Old 11-30-2006, 03:41 PM   #3
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elmoJ_1974 HB User
Re: How do I know if spinal fusion is the right surgical procedure?

The decision is very hard to make. I'm in the same position. But it boils down to quality of life. If you spend 3-4 days per month in bed than you have to think to yourself, is it worth it. Now fusion by all means isn't guaranteed to take away all your pain but will probably get you to a somewhat normal way of functioning. Some people go thru their recovery peroid and end up just needing an NSAID every so often for pain once they are fused. I would at least talk to your Dr. and write down all your questions and concerns. Basically you have to ask yourself, "Am I leading life the way I want to?" Good luck with you decision.

Old 11-30-2006, 06:20 PM   #4
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sheri42 HB User
Re: How do I know if spinal fusion is the right surgical procedure?

I am 35 and 9 months post op L4-S1 TLIF. I waited for 10 years to have surgery. Before surgery, I could no longer cook dinner or vacuum or stand for longer tha 5 minutes. I am much better now. I just cooked thanksgiving diner and cleaned for 2 days before. I am not 100% pain free but was never promised that either. I am on a good day, 85% better.

When I over do it and flare. I am in bad shape. I am learning that I need to rest my back by lying down at least once if not twice a day and that seems to keep the flares at away.

Old 11-30-2006, 06:30 PM   #5
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carol632 HB User
Re: How do I know if spinal fusion is the right surgical procedure?

Hi, oufan, and welcome to the board. I'm glad you quit lurking and decided to join us here.

No one, but no one, can make this decision for you....not the dr., your friends, your family....only you. Because this is a decision that will affect the rest of your life. You didn't mention leg pain but I am assuming that you have it since no reputable surgeon will recommend surgery unless you do. I think it is wise to get a second opinion but in your case I think you may need three. Why? Well the first one is from a neurosurgeon as is the second you have an appt for and I think it is good to see an orthopedic spine specialist (one who has a spine fellowship) to get his take. Of course, again, that is your choice.

Many fusions fail. Many more succeed tho it would seem the reverse. Those people who have successful fusions aren't spending time on support boards because they don't need us.

Have you yourself researched other types of surgery....such as Artificial Disc Replacement? It's worth taking a look at. I can tell you that my first fusion was a success. I was back to working 50 hours a week, and taking care of my 4 kids as a single mom. An auto accident changed everything, but people do have fusions and go on with their lives. Take your time and think carefully.

I hope that whatever decision you make, it will be the right one for you. Please stay in touch.

2 lami's, 3 fusions
bone spur removal
cerv. fusion, 1 level
morphine pump

Old 11-30-2006, 09:31 PM   #6
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Justoneofus HB User
Re: How do I know if spinal fusion is the right surgical procedure?

First off, welcome. Well it indeed sounds like you've made the decision to have the surgery and now just trying to figure out which is best for you at this point.

As the others have said, there are no guarantees with any surgery and most of our odds are often 50/50. The more levels are fused.. the odds go down for success.

I only had one disc at l4/l5 needing surgical intervention. I was a candidate for ADR (artifical disc replacement) and it was actually scheduled. Right as I was suppose to be going to the hospital for my preadmit stuff, I get the denial to cover from my insurance group. My doctor spoke to them, wrote them a letter, and still denied. We then were left with fighting them under appealing, or do a fusion. I didn't have the luxury of time to fight the insurance group.

I did as much research on many back procedures and disc surgery types and asked about them all. And I actually found my current surgeon by searching for him that was experienced with ADR. The only two types I was really a candidate for and was available to me was ADR or Fusion.

Since the ADR wasn't looking promising, I chose fusion. I was also adament that I did not want a bone harvest, as I had heard more horror stories than good about the pain from the donor sight long after the surgery and some continue to forever have pain there. So since fusion was the choice, I made sure that this doctor was going to use BMP instead and he actually was going to recycle the bone that he took out of my back and used that along with the BMP and placed it into the disc space for an ever great succesful fusion rate.
I guess it worked, as my CT scan done a fews back.. shows my fusion as being solid and I am 7 months post fusion.

I have definitely had some bumps along the way in the healing process, and I am still healing, but I really feel that I am a success story. But, I will continue coming here to help others, as they have helped me. It's important to me to give back.

As Carol stated, only you can make the choice and after getting a few opinions and weighing what you learn, etcetera and where you lay your trust in which surgeon.. you will then render your decision on which to go with and then be at peace with it.

My current surgeon told me that it really is a crap shoot. He said all he could do was do his very best with the surgery. The rest of it was up to my body and the powers that be. He couldn't have spoken the truth any better.

I wish you wellness. Again, welcome. Tammy
"believe in the beauty of your dreams"- E. Roosevelt

L5/S1 bulging @ 18, now 46; still there (but no pain)
Fusion at L4/L5 Apr -2006
Solidly Fused Nov-2006
A Success, but still improving!

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