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    Old 01-12-2014, 05:44 PM   #1
    tradeof1jack
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    Help! No idea what to do!

    Hi board --

    I've posted before on some of the troubles I've had before and always appreciated the responses. I have to make a decision -- below are the options before me.

    I have a dessicated disc l5-s1 and 6mm bulge impinging S1 nerve. Back pain is awful but I've come to handle it with painkillers - but the nerve pain in the leg is debilitating and my leg has atrophied significantly. Any physical activity results in horrible leg pain/cramping, etc.

    I'm 32 have had numerous epidurals/injections, PT, and other non-invasive procedures with no relief.

    The doctors have basically left it up to me to decide my course. They have all made recommendations - here they are -

    Option 1 - Disc Replacement. Pro: Less invasive than fusion, quicker recovery time and since my surrounding discs are in good shape should help buy me a few years of pain relief. Con: risky to do ADR at L5-S1 many surgeons won't, Adr removal is very dangerous and little to no chance it will hold up the rest of my life. Worst case - 2-3 years - best case 15-20 years before failure and need removal and fusion.

    Option 2 - Fusion L5-S1 - Pro: in theory solves the problem, removes the problem disc and should eliminate pain. Con (lots) : major surgery, and little to no chance it will hold the rest of my life and most likely will need l4-l5 before too long.

    Option 3 - NONE OF THE ABOVE. Avoid surgery and continue to attack with pain meds, epidurals, and PT.

    Any opinions welcome.

     
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    Old 01-12-2014, 07:25 PM   #2
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    Re: Help! No idea what to do!

    [QUOTE=tradeof1jack;5257330]Hi board --

    I've posted before on some of the troubles I've had before and always appreciated the responses. I have to make a decision -- below are the options before me.

    I have a dessicated disc l5-s1 and 6mm bulge impinging S1 nerve. Back pain is awful but I've come to handle it with painkillers - but the nerve pain in the leg is debilitating and my leg has atrophied significantly. Any physical activity results in horrible leg pain/cramping, etc.

    I'm 32 have had numerous epidurals/injections, PT, and other non-invasive procedures with no relief.

    The doctors have basically left it up to me to decide my course. They have all made recommendations - here they are -

    Option 1 - Disc Replacement. Pro: Less invasive than fusion, quicker recovery time and since my surrounding discs are in good shape should help buy me a few years of pain relief. Con: risky to do ADR at L5-S1 many surgeons won't, Adr removal is very dangerous and little to no chance it will hold up the rest of my life. Worst case - 2-3 years - best case 15-20 years before failure and need removal and fusion.

    Option 2 - Fusion L5-S1 - Pro: in theory solves the problem, removes the problem disc and should eliminate pain. Con (lots) : major surgery, and little to no chance it will hold the rest of my life and most likely will need l4-l5 before too
    Option 3 - NONE OF THE ABOVE. Avoid surgery and continue to attack with pain meds, epidurals, and PT.

    Any opinions welcome.[/QUOTE]

    Hi, tradeof1jack. I've had problems with my L5-S1 and have done all of what
    you have tried to no avail, with exception of pain killers. I had partial removal of disk L5 because of fracture and collapsed with cadaver bone and spacer inserted. Rods and pins inserted (cage built). This kind sounds like your option 2.

    I am now 6 months post op and am successfully growing bone over cage. My pain is minimal and I seldom need my nerve pain meds or Tramadol. Even though I know that the certainty of me needed another surgery is likely (l4-l5) I hope and pray not. My neurosurgeon/orthopedic spine specialist did an excellent job in taking my pain away. I am a 43 yo 3rd grade teacher who was almost bedridden with the pain, so I understand. It's scary to make a decision. No two people recover the same way from any kind of back surgery. However, I can tell you that option two worked for me in the present and as I look toward the future I figure I will decide what will happen if and when I start to have problems again. Glad to have my health back in my back.

    I wish you the best in your decision and keep us posted. Prayers and hugs.

     
    Old 01-12-2014, 07:29 PM   #3
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    Re: Help! No idea what to do!

    What about a 4th option-a microdiscectomy. This is minimally invasive, done from the back rather than front, only the protruding portion of disc is removed, recovery is quicker than fusion, and fusion isn't necessary unless there is movement or instability with the spine. It gets the disc material off the nerve and the pressure relieved on the spinal canal. Was this option discussed at all? If not, I would ask about it. You are too young to just keep suffering with this and taking pain meds. This is fixable. Unless your MRI shows something unusual, you should benefit from partial disc removal approached posteriorly without fusion.

     
    Old 01-12-2014, 07:35 PM   #4
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    Re: Help! No idea what to do!

    Thanks for the replies.

    Ladybud -- trying to go from doctor speak to laymen's terms - but I was basically told that since my disc is completely dead and flattened the microdiscectomy is not a good option. From my basic understanding - if you had trauma or something that caused the protrusion then you can slice it off and the remainder can actually heal. Not an option for me.

    I actually have a close friend who just had one a couple weeks ago. That was his situation the disc is otherwise healthy just the protrusion so they're hoping he'll completely heal.

     
    Old 01-13-2014, 05:29 AM   #5
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    Re: Help! No idea what to do!

    Very difficult decision;-( As both operations are risky or major surgery, without you knowing the outcome in advance, I would choose option 3. But I guess the eventual choice is different for everybody.
    Did you see doctors who are specialised in pain management / pain clinics?

     
    Old 01-13-2014, 07:37 AM   #6
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    Re: Help! No idea what to do!

    One other option to buy you some time to figure this out and perhaps get more opinions if you've only seen one surgeon is a radiofrequency ablation of the nerve. It is done like an epidural but the nerve is burned and provides about 6-12 months of pain relief in the leg. If the atrophy is from lack of use from pain, that could get better. If the atrophy is from the disc pressing on motor aspect of the nerve, it won't improve. If you aren't quite ready to make this decision, it could give you some time and relief, but is not a long term fix. I've had 2 fusions, one from the back (not fun) and one from the side (better) but I don't know if the side approach can be used for L5-S1 since it is so low. You might at least ask about those 2 ideas.

     
    Old 01-13-2014, 10:26 AM   #7
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    Re: Help! No idea what to do!

    XLIF cannot be done at L5-S1, and on some people L4-L5 isn't possible from the side either.

    There is a procedure mainly done for stenosis where a spacer is put in between the two discs. One example is the "X-Stop." The advantage of it over ADR is that it is easily removed if fusion becomes necessary. In the meantime, it relieves the pressure on the associated nerve

    X-Stop is made by Medtronic if you want to read about it.

     
    Old 01-13-2014, 06:56 PM   #8
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    Re: Help! No idea what to do!

    Hi jack, When i was almost 32 after having lumbar lam at L4-5, L5-S1 @ age 26 i reherniated disc at one L5-S1 & had a standard issue, non microinvasive discectomy because the lamina had been previously removed earlier however the herniated disc portion was removed & while he had a birds eye view performed foramenotomies or ectomies & the radiating pain & nerve deficits were all relieved with the decompression & my ns said there was no need for fusion at the time because i was so young & i wondered if this was an option, a regular lumbar laminectomy with discectomy, that was offered by any of the spine surgeons? Or if a laminotomy could reach the herniation at L5-S1? Im afraid that by just continuing pain mgmt by meds only & not addressing the problems caused by nerve compression that your leg symptoms could worsen but am just a patient not a dr & hope the right solution is found by the drs to help you soon!

    Last edited by gmak; 01-15-2014 at 12:48 AM.

     
    Old 01-13-2014, 08:18 PM   #9
    tradeof1jack
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    Re: Help! No idea what to do!

    Thanks all -- I will ask about that X Stop for sure. Again -- I don't really understand why but the one thing that all of the surgeons have agreed on is that laminectomy/discectomy is not a good option. I don't really know why, a lot about the additional damage surrounding the disc as well as the disc being completely dead. There is no healthy tissue left in there.

    On the MRI it looks just like a flattened pancake -- while the other discs are nice and full and healthy.

    I was convinced for a while to just do the fusion as it seems like all signs point to needing that eventually so I think I'm just gonna do it now.

    The emotional part of this is I have 2 very young children. I take the pain meds so that I can be active and play with them without hesitation.

    With that said - if I get a fusion and that means I have to restrict activities BUT I can live a healthy life pain med-free -- its worth it to me.

    I'd rather be slow moving and stiff but pain med free instead of masking the pain with tons of painkillers.

    But -- is there ANY hope that at 32 I can fuse L5-S1 and live the rest of my life without having additional fusions?

    Thanks all for the replies -- it is incredible appreciated.

     
    Old 01-14-2014, 06:29 AM   #10
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    Re: Help! No idea what to do!

    At your age and with normal healthy discs above, you could do quite well with a fusion for many years. A lot depends on genetics, type of work, body mechanics, etc. I would not expect any restrictions on your activities after about 6 months of healing time from the surgery. You may be pain free and more flexible than you expect. One caveat-many people get less than 100% relief. The leg pain should be gone, but your low back may ache a little or bother you at times, but nothing like it is now. Just best to have realistic expectations. Trying to avoid heavy lifting, prolonged sitting, and using good body mechanics in future will help prevent further problems.

     
    Old 01-14-2014, 09:50 AM   #11
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    Re: Help! No idea what to do!

    Even in my absolute best case scenario I don't anticipate being pain free. My dream scenario would be to live the rest of my life with just the 1 surgery and be to a point where I only need pain medication as needed, not constantly and around the clock like I do now.

    Where I can live my life without the dominating force of this pain like I have now.

    Thats why even after being convinced the ADR was the best idea I'm leaning back towards just doing the fusion.

    I mean, the neurosurgeon I see that is an "ADR Specialist" doesn't even give a chance that I'll never need anything additional. He said best case 15-20 years but yes eventually I'll need a revision/fusion. More likely 5-10 years.

    With the fusion at least there is the hope - the chance - that I'll never need anything else.

    I think.

     
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    Old 01-14-2014, 04:42 PM   #12
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    Re: Help! No idea what to do!

    [B]But -- is there ANY hope that at 32 I can fuse L5-S1 and live the rest of my life without having additional fusions?[/B]

    Being perfectly blunt, my guess is maybe -- but probably not. So much depends on things beyond your control...genes, quality of bone, overall health, etc., and then things we do have some control over...nutrition, lifestyle choices, not smoking, taking care to avoid things that we know are hard on the spine, etc.

    I don't know anyone personally who had a fusion at your age, but I do know a couple guys who had fusions in their early 40s...and after giving themselves time to heal completely and to let the new bone "cure" and set up strong, they went back to pursuing hobbies like kayaking and mountain climbing.

    Your chances will increase if you do not pursue activities that feature jarring or pounding, repetitious movement, and where the spine is twisted when force is exerted like tennis and golf....also movement that requires the spine to be in extension (arching back). No one will tell you that you cannot do these things...but you can preserve what you do have by avoiding the things that common sense tells us are "bad" for the spine.

     
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