It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Spinal Cord Disorders Message Board

  • debating surgery for spondylolysthesis

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 08-21-2014, 01:48 PM   #1
    katepaints
    Newbie
    (female)
     
    Join Date: Aug 2014
    Posts: 5
    katepaints HB User
    debating surgery for spondylolysthesis

    Hello, I'm nearing my 60th birthday debating surgery for spondylolysthesis. I've had pain in the small of my back for 25+ years when standing for 1+ hours, which I would relieve by bending over. I think this was a prelude to this. I finally went to get things checked out in March when electric nerve pain made my left leg start to collapse and it started to endanger someone else. This had been going on for about 7 months but got progressively worse after shorter times on my feet. The X-ray showed spondylolysthesis with L-4 hanging out over L-5, and an MRI showed a 60%-70% narrowing of my spinal canal. I saw a surgeon Aug. 1 who said he would do a minimally invasive fusion surgery, and replace the disc between L-4 and L-5. I forgot to ask what the material would be for the disc. I also need to find out the degree of shifting. The surgeon told me no lifting, bending or twisting for three months after surgery. I'm thinking about a brace to keep me from doing stupid stuff.

    I had my second injection on July 3 and six weeks out the electric nerve pain-collapsing leg came back briefly. The first injection was excruciating but I think it's because I was so inflamed. The second one was a snap, and I think it's also because this radiologist was better at it.

    At this point I'm gathering supplemental insurance. I am going to another spinal specialist who consults and no longer does surgery, so he has no vested interest in telling me if I need surgery.

    What makes surgery almost feel inevitable is that I know that the older I get, the more likely healing will be slower. I'm an active person in that I walk a lot and take care of the house. As a painter I'm lifting canvases, standing on my feet, etc. I don't want to be at 65 or 70 going, whining, geez, why didn't I get this fixed when I was younger? Now I can't do it!

    If anyone has any comments to suggest about making the decision, any questions to ask the doctors, as well as any tips about recovery, that would be great!

     
    Sponsors Lightbulb
       
    Old 08-22-2014, 08:25 AM   #2
    Moonstar22
    Senior Member
    (female)
     
    Moonstar22's Avatar
     
    Join Date: Jun 2014
    Location: South Florida, USA
    Posts: 161
    Moonstar22 HB UserMoonstar22 HB UserMoonstar22 HB User
    Re: debating surgery for spondylolysthesis

    Hi Kate,
    you sound like your doing all the right things in gaining knowledge about you condition which is awesome. I did the same thing before I had my back surgery in Dec 2013. After having neck surgery I felt it was necessary for me to gain knowledge for everything I possible could before opting to have such a Big surgery as mine was.

    For me, I chose the surgery basically because I had no options left. I was on meds, did the injections, could not do PT because the pain was too bad. I was hunched over grabbing anything I could along the way, kept working but started missing a lot of time because of the awful pain. I could not stand up straight let alone stand at all. There was no fixing me.

    From L1 to L5, I was bone to bone, my disc's were gone. So I had the surgery at 53 years old. Turned 54 in June.

    I am glad to know that you are consulting with another spine specialist, it's always good to get a 2nd opinion. Please let us know how that goes.?.

    Choosing to have surgery now or when your older is something I thought about, it went through my mind that is. But the pain I was having I would do anything at that point. I couldn't live like I was anymore. I would have chosen Not to have surgery if my pain was manageable! Simply because having surgery does not mean that the pain would be gone or even be better. Everyone's outcome is different & there's Always risks with any surgery. Surgery should always be a last choice in my opinion.

    Unfortunately, my surgery did not go well & I'm having a lot of problems with nerve damages, pains in different areas, bowel & bladder problems, and more.
    Not that anyone else may have the problems that I have and I still would have chosen surgery because I couldn't take the pain any longer and did all else I could do at the time.

    I hope I helped some by giving you my thoughts & experience's.
    __________________
    ACDF C4-5 & C5-6 Dec 2011
    DLIF L1 to L5 Dec 2013
    Jul 2014 MRI, C3-4 hern/comp, C6-7 disc protr/spurs, Thor T6 cyst, T6-7 disc protr on thecal sac, T7-8 spurs/mild on sac. Oct 2014 Diag-Osteoporosis

     
    Old 08-22-2014, 08:35 AM   #3
    teteri66
    Senior Veteran
    (female)
     
    Join Date: Nov 2010
    Location: USA
    Posts: 9,152
    teteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB User
    Re: debating surgery for spondylolysthesis

    Welcome to the board. I was facing a similar situation back in 2008. I only had a Grade I spondy, which is from 1 to 25% slippage but I had nearly complete central canal stenosis and the foramen showed only the teensiest opening. I went to 8 different spine surgeons for opinions because I kept believing there had to be some newer procedures than a fusion.

    I was wrong. The only current way to stabilize the spine is by a fusion procedure. I was told that I didn't need to have surgery immediately, that it was a matter of how long I could live with it. In hindsight, I wish I had had the surgery sooner. It is good to be cautious when facing spine surgery, and to find the very best surgeon available to you, but the longer one waits, the greater the risk of permanent nerve damage.

    Be advised, for most people this is not an easy surgery and recovery is long. Since your options are limited, I advise you just make up your mind to make it the best experience you can. Regard it as your job for the next year. Accept that it is a slow process, that you do not want to have to repeat it, so promise yourself you will not push or try to rush things along.

    Most likely, your surgeon will say the time period involved will be shorter than it is in reality. And just because the surgeon tells you it is OK to do something does not necessarily mean it will be for you. You must learn to listen to your body.

    My first surgeon's philosophy and only advice was "If it hurts, do not do it." The problem with this is that you do not find out it hurts until after you have done the activity, movement, etc. I feel it is much better to err on the side of caution so you do not re-aggravate the sciatic nerve...etc.

    I am traveling right now and am writing this in small segments with major interruptions...so I apologize if it is incoherent. I am happy to answer or try to answer any of your questions as you move forward....

    One thing to ask is how does the surgeon know he is completely taking care of the stenosis (decompressing the nerves) using MIS technique?

    Are you seeing neurosurgeon or an ortho spine surgeon?

    Last edited by teteri66; 08-22-2014 at 08:39 AM.

     
    Old 08-22-2014, 12:04 PM   #4
    ChuckStr
    Veteran
    (male)
     
    Join Date: Apr 2014
    Location: seattle wa USA
    Posts: 406
    ChuckStr HB UserChuckStr HB UserChuckStr HB UserChuckStr HB UserChuckStr HB UserChuckStr HB UserChuckStr HB UserChuckStr HB UserChuckStr HB UserChuckStr HB UserChuckStr HB User
    Re: debating surgery for spondylolysthesis

    60-70% narrowing is quite a bit and the instability means it's possible for the vertebra to slip further and cause more impingement. Did the MRI indicate spinal cord compression (unless you have an unusually wide spinal canal there is likely some), or foraminal compression? The severity of that may help inform the decision. As my surgeon says though it usually comes down to symptoms unless there is such gross instability and/or compression that not having surgery is dangerous. If the symptoms are intractable and bad enough then surgery is an option. I think there is also an argument that due to the slippage, even if symptoms improve you may have to have surgery later, and later when you're 60, may lead to further complications.

    I have grade II spondy at c5/c6 but luckily only moderate canal stenosis. In my case, I've chosen to try to stabilize this through PT. There is some evidence that certain strengthening exercises can help prevent further slippage in cases of mild to moderate cervical spondy. I don't know if there is any evidence of that for lumbar spondy. I'm not sure I made the right decision, but I am mostly pain free and my lost strength is slowly coming back.

    It's a tough decision and I would definitely get more opinions from surgeons. The idea of going to a surgeon who no longer does surgery is an interesting one. In the small sample I had, I found that ortho spine surgeons tended to be conservative while neuro ones tended to favor surgery earlier. If you get the same advice from everyone that would be a good clue.

    Concerning the minimally invasive surgery, I would also find out what technique the surgeon intends to use. There are MIS lumbar techniques that come from the back, the side and the abdomen. Only those from the back are proven to be effective and reduce complication rates compared to traditional open surgery. In terms of recovery, complications etc. let's just say that surgeons tend to be supremely confident in their abilities. I had one neurosurgeon say he'd do a 2 level cervical fusion, give me 6 weeks off of work but I'd only need 2 and could take a month vacation! I guess I'd rather they were confident than not, but I would be a little skeptical of the recovery times and expectations like teteri66 says.

    Good luck and let us know how you get on.

     
    Old 08-23-2014, 12:07 AM   #5
    katepaints
    Newbie
    (female)
     
    Join Date: Aug 2014
    Posts: 5
    katepaints HB User
    Re: debating surgery for spondylolysthesis

    Wow! Thanks Moonstar22, teteri66 and ChuckStr for your great replies. I must tell you I worked as a CNA on a Orthopedic floor so I saw lots of back surgeries, and I know the folks in the most pain were the ones who donated their own bone from the pelvis for fusions, and the ones who had surgery from the front. And after seeing so many people in Voc Rehab where I used to work, who had multiple back surgeries, I know that back surgery isn't necessarily a panacea. And it wasn't something I ever wanted to entertain until this year. I just want it to go away. The way the surgeon explained it for the MIS, he would go in from the back, on both sides, at a 45 degree angle to the spine. So bundles of muscles aren't cut up, etc. Hospital stays are shorter and healing is quicker. That works for me!

    I must have been a deer in the headlights when I saw the surgeon because I just didn't think to ask, what's the material for the disc replacement? What's the degree of slippage, etc....I will probably see a neurosurgeon to round things out. The explanation I got for the narrowing was that it was in the spinal canal, no mention of the foramen. And looking at the MRI that's where the narrowing appeared to be. But now after reading everyone's input I now have some questions to ask every doctor I see! I live in a rural town and the nearest city (110,000) has two medical centers. But it's nothing like St. Louis or Kansas City. I have a sterling recommendation for a surgeon in St.Louis from a cousin who is a surgeon. He did spine surgery on her fiance (also a surgeon) but it doesn't look like he takes my insurance, and I'm not sure that a 2 1/2 hr. drive is a good idea after fusion. The 45 min. drive as it is now might be a stretch.

    I'm sensing that I'm having to gear up for a year long deal. I keep reading about the majority of people for whom this gets better with a little exercise, and an injection or two, maybe some NSAIDs. I really don't want to be popping acetominophen the rest of my life (been told I should avoid NSAIDs since I'm allergic to aspirin) since I don't want to trash my liver. But this has been progressive and I don't have any activities such as football to eliminate. I agree, you don't find out you hurt until you push yourself! Hopefully not too far!

    Walking hurts, as does getting up from sitting for a while. I wised up several months ago and got a wonderful straight back wooden rocking chair at Goodwill that actually makes my back feel better, as well as an extremely hard foam chair for my studio. Overall, things simply don't feel like they are improving to me.

    I'll let you all know how things are going, and what the 2nd opinion doc says. Be well!

     
    The following user gives a hug of support to katepaints:
    Moonstar22 (08-23-2014)
    The Following User Says Thank You to katepaints For This Useful Post:
    Moonstar22 (08-23-2014)
    Old 08-25-2014, 07:18 AM   #6
    teteri66
    Senior Veteran
    (female)
     
    Join Date: Nov 2010
    Location: USA
    Posts: 9,152
    teteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB User
    Re: debating surgery for spondylolysthesis

    Once again, cervical and lumbar spondylolisthesis do not have similar outcomes, and what one recommends for one is not necessarily the same for the other. Please do not confuse the two. Kate, you are dealing with a lumbar spondy so that is only what you need to be concerned about. It does not present with the same "dangers" as does the cervical spondylolisthesis.

    I too had an L4-L5 spondylolisthesis and severe stenosis in both foramen and central canal. In my case, due to the curve of my spine at this point, and my slippage, whenever I was on my feet the pain was excruciating. The downward force of gravity pushed the vertebrae to the point that there was almost a right angle as my lumbar spine bent into the sacrum. My percentage of slippage was not a great amount but it just about completely pinched off the L5 nerve when I was standing. I got to the point where I could not stand long enough to chop an onion, and I was driving down the driveway to collect my mail.

    The disc is not always removed and some sort of spacer put in with every fusion. In my case I did have a cage, using BMP for the graft material. In my revision surgery, from L3 to S1, the discs at L3-L4 and L5-S1 were left in place. The graft was made from the bone that was removed when the nerves were compressed, and from cleaning out the foraminal stenosis. It was ground and pulverized and combined with a bit of a biologic product that formed a slurry, which was placed along the sides of the disc area. Then pedicle screws were placed at each level and it is tied together with two long rods.

    I first began having leg pain around 2004 but held off surgery until the beginning of 2008 and the pain got progressively worse during that time. I was becoming almost housebound as my walking became so limited that I was canceling most activities. Finally decided this was limiting my life so much that I just had to go for it. (Surgery). In hindsight, I wish I had done it sooner!

    People with spondylolisthesis do not get better. They just maybe, if lucky, do not get worse. If the nerves are compressed, chances are, they will remain compressed until surgery occurs.

     
    Old 08-30-2014, 09:22 PM   #7
    katepaints
    Newbie
    (female)
     
    Join Date: Aug 2014
    Posts: 5
    katepaints HB User
    Re: debating surgery for spondylolysthesis

    Thanks for the input. Your statement that spondylolysthesis doesn't get better certainly hits home for me. As the days are going by the pain just really isn't going away. This week was the first time I cried from the pain. I don't want to live on acetominophen since I don't take NSAIDs. And really, those things don't really get the nerve pain. I have started the exercises in earnest, but at times some hurt so I back off. What was dismaying last night was being in bed and having nerve pain from adjusting myself in bed. That was a first.

    I decided to consult with a top notch hospital and physicians group in St. Louis. I discovered they do carry my insurance. With the doctor who treated my cousin's fiance, I have to send all the MRI, x-ray and injection reports to review before he decides whether to call me for an appointment. He's one of the top spine surgeons in the US and seems to want to deal with people who need his help the most (tumors, spinal reconstruction, etc). So we'll see. I won't wait forever. There are other surgeons there. Unfortunately last night I realized I had put the wrong fax number on the releases So I need to apologize to and alert the person who will be receiving them, so she can send them to the right doctor.

    But what I am hearing from you is that waiting doesn't always make sense. It's a balance I guess. Not jumping into it, but not waiting so long I damage nerves. I need to remain physically active, and this disorder doesn't lend itself to that! I did find out from my last dexascan that the lumbar area was least affected. Yay! It's made me worried about how a fusion would take. I've started walking longer at least 30 min. on one of the dog walks I do. Not that I feel terrific afterwards, but I know it will only help. I'll keep you posted. Thanks!

     
    The Following User Says Thank You to katepaints For This Useful Post:
    Moonstar22 (08-31-2014)
    Old 01-18-2015, 10:06 PM   #8
    katepaints
    Newbie
    (female)
     
    Join Date: Aug 2014
    Posts: 5
    katepaints HB User
    Re: debating surgery for spondylolysthesis

    Hello All,
    I wanted to report to you what I chose to do for spondylolysthesis surgery. I ended up seeing a third surgeon two and a half hours away, and I'm so glad I did. He is renowned for reconstructing spines, especially when tumors are involved. So having a laminectomy to clean out the spinal canal, decompression and spinal fusion at L4-L5 was pretty direct. My in-laws had been after me to go to a neurosurgeon, but since this doctor is a professor of neurology as well as orthopedics I felt I was in good hands. I learned about this doctor from a cousin who is a professor of surgery at this university, and my doctor had operated on her fiance, who is also a surgeon. When I went for pre-surgical stuff I learned that patients come from Denmark, Germany and other countries around the world, so I knew this medical center was different from others. The hospital was amazing. They are forever seeking feedback about patients' experiences and they really listen to see how to improve things.

    Everything about this specialist was different. The examination and discussion were the longest I'd experienced with surgeons. I was equally impressed by the Fellow who was working with him. Before I left the first visit they handed me a 38 page spinal fusion booklet, so I knew what I'd be looking at. I was told I couldn't bend, twist or lift more than 10 lbs for a year after the surgery. I had the surgery on Dec.30 and was released Jan.3. Probably the biggest problem, besides learning to do the log roll to get into bed, was finding out there were so many muscle relaxants and pain killers I couldn't tolerate. After I got home the nurse practitioner and I discussed it and she prescribed meds that I had tolerated well in the past. The response time to my calls has been excellent and no question was too dumb. I was sent home with 9 pages of discharge papers-2 sets-one for me and one for my primary care doctor. BTW, my primary care doctor discouraged me from going to the spinal orthopedic dept at a nearby medical school because the University Hospital never sends records or discharge info to her. And this is where she went to medical school! Pretty sad. I'm so glad she mentioned this to me. It told me not all hospitals are created equal.

    So far: I haven't required pain meds in the last couple of days. I use the walker at night in the house and when I'm walking outdoors for a stretch. So far the donor site for bone graft material has been quiet. With so little pain it's easy to forget I can't bend or twist. It's amazing how many times we twist in our daily lives! I'm able to climb stairs slowly but getting out of cars is still kind of a process. I am very grateful to the wonderful helper I've found who is taking care of laundry, house cleaning and organizing. I'm very blessed cos I know my husband just doesn't do that stuff.

    Several things pointed me to surgery. 1. Things weren't getting better. 2. My quality of life was really diminishing. I didn't want to live like this the rest of my life. 3. The older I get the greater the chance for complications. 4. Today's medicine has better technology and experience to create better outcomes for this, so the odds were good that surgery would be successful. 5. I listened to my gut and wasn't satisfied until I spoke with the third doctor, who I knew really had the skills to perform this surgery. Taking the time to research really paid off. Spinal surgery is too important to leave to doctors who don't have the best experience or skills. Once I decided on surgery I worked to get myself into the best shape I could. I was ready! I'm hoping that my follow up appointment on Feb 9th will show that things are as they should be.

    Take care,
    Kate

     
    Old 01-19-2015, 07:26 AM   #9
    teteri66
    Senior Veteran
    (female)
     
    Join Date: Nov 2010
    Location: USA
    Posts: 9,152
    teteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB User
    Re: debating surgery for spondylolysthesis

    Great post! I am so glad you really did your research and found someone you trusted and that you knew had the training and experience to satisfy your expectations. Too many people enter into spine surgery without having a clue what they are signing up for!

    I gather you are not wearing a brace....

    Please keep posting during your recovery.

     
    Old 01-19-2015, 08:31 AM   #10
    katepaints
    Newbie
    (female)
     
    Join Date: Aug 2014
    Posts: 5
    katepaints HB User
    Re: debating surgery for spondylolysthesis

    Hi Teteri66,

    Actually I do wear a brace at times. It was offered to me when I saw the nurse practitioner. I went with it to remind myself to not move the wrong way. It's got tons of velcro strapping. But I was told to not wear it too much because my back muscles could get weaker if I wore it all the time.

    I was so glad to hear about other peoples' experiences here so I had a better idea of what to expect. And the doctor didn't candy coat it either. He said that the first four weeks would be pretty uncomfortable, it would gradually get better and full recovery would take a year. In this year I can't bend, twist or lift over 10lbs. I think this long period of restrictions probably adds to his good rate of success. I also think that I went into this with a good attitude and that made a difference. When the second injection failed within 6 weeks I knew I had to do something else. I'll keep you all posted!
    Kate

     
    Old 01-20-2015, 06:56 AM   #11
    teteri66
    Senior Veteran
    (female)
     
    Join Date: Nov 2010
    Location: USA
    Posts: 9,152
    teteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB User
    Re: debating surgery for spondylolysthesis

    I am happy to hear your surgeon is straight forward about recovery. In my opinion, too many give a very unrealistic timetable, which causes people to feel their surgery has been a failure when they don't feel wonderful at six weeks.

     
    Closed Thread

    Tags
    fusion back pain leg sciatic, sciatica pain, spondylolisthesis, surgery



    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 03:14 PM.





    2019 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!