Hi avery & welcome to the spinal boards

I can not help you with this decision - sorry. I myself can not have surgery, so I have very little knowledge of options with a injury such as yours.

However I am sure some other members will respond and be able to help you out.

I'm afraid no one can make this decision but you. It is a good idea to meet with a number of fellowship-trained spinal specialists and to gather as much information as you can.

It is not a matter of "who to believe" as you state, as well-qualified spinal surgeons can and do disagree as to the "best" approach to a particular set of problems. What one sees as your primary pain generator may be viewed by another as a secondary problem.

I am not clear from your post exactly what is wrong with your back. If the DDD and arthritis is anything more than a minor mention on the MRI, I would think that a discectomy would at most be a temporary solution. It might take care of the pain for awhile, but as the DDD and arthritis develop, it will probably result in some stenosis and nerve compression.

You are correct that discectomies are more successful at relieving pain when the patient has most of their pain in the leg...something like a 95% rate...and it is more difficult when pain is in the back. That is only because it is more complicated to find the pain generator when the pain is in the back.

There is much valuable information on this website, including articles giving advice on how to select a surgeon. I am providing a link to an article on disc herniation and DDD treatments:

http://www.spine-health.com/conditions/herniated-disc/herniated-disc-tre...

You will need to do some research on your problems and on the surgeons that you are seeing for a consultation. Try to talk to people who have had surgeries. Talk to PTs that specialize in orthopedic patients to see what they think. The most important decision you will make is the selection of your surgeon. When you are getting conflicting opinions, it becomes that much more difficult!!

Sometimes one ends up choosing a surgeon based on more subjective things when their skills and training are more or less equal --things like how the office is run, how long you have to wait for appointments, how well you get along with the doc, his ability to communicate with you, etc.

Feel free to post with all your questions and comments. People are very generous in sharing their experiences and knowledge.

Good luck with your decision.

Gwennie

I am only able to offer my personal opinion based on my experience. I would opt for a microD before opting for a fusion. Fusions do not have a very high success rate and sometimes even make things worse.

I had a microD 2 years ago. It was radical in that most of my disc was removed. It did help the leg pain but not the back pain.

Did you get even temporary relief from the injections? Where did you have the injections? Facet joints?

The reason that I ask is because arthritis of the facet joints can be very painful and most of the pain is in the back. DDD pain is also located in the back.

Have you ever had a rhizotomy (nerve burn) ? Docs will often try this if you have any relief from the facet injections.

I really do understand how badly you want some relief but do try and be as sure as you are able that surgery will actually bring you relief.

I had my microD for an annular tear and it really did help the nerve pain in my leg but if your leg pain is only slight I don't understand what pain the docs are hoping to relieve with a microD? I would find all of this out before making a decision.

Also get at least 1 more opinion from a qualified spinal specialist.

Good luck and please keep us posted.

Keep in mind that if there is any spinal instability then often a fusion is the best choice. This is often the case with diagnosis such as spondylolisthesis. If there is no instability then you can indeed consider both options.

Don't let the option of a fusion scare you simply based on your age. Many people in their 20's and 30's have successful fusions. It's more about what your total spinal medical picture is and if a discectomy is a long term solution.

Consider my situation: I had two surgeries for a so-called 360-degree fusion at L4-S1 for back pain, disc herniation, moderate stenosis and facet joint arthropathy. One year later, I'm in worse pain than before the surgery and remain out on disability.
The surgeon said I'd be back to work in two to three months. My pain management doctor says that in reality, it takes two years to recover from a fusion.
There are no definitive medical studies showing that surgery produces better outcomes over the long term than non-surgical approaches.
The so-called Swedish Lumbar spine Study Group in 2001 found that the surgical group fared better than the non-surgical control group after six months, after which the difference decreased.
With so little data supporting surgery for low back pain, it's amazing that so many surgeons perform so many fusions and so many patients agree to have their spines forever altered by rods and screws in procedures that each cost upwards of $100,000.
Just go online and do a basic search for lumbar fusion outcomes. I encourage you to do your own research before jumping into surgery.
I wish you all the best with your pain. It's agony. I know.
-PG

Unfortunately your case is more the rule than exception. I have lots of instability in my spine and will not have a fusion. I reacently read an article that said a study was done of spinal patients that showed in a 5 year study most that had any kind of back surgery were in the same or worse pain than those with the same conditions that had no surgery.

Hi Avery,

I can't tell you how similar your story sounds to mine - lower back ache for ages - told it was only 'this or that' by doctor - finally found someone who'd take you seriously!

You said, "Who do I believe?" Well you believe the one who you most respect and the one who makes most sense out of your condition. Your best bet is to read everything you can find on the subject, including articles and posts from this site, then see the doctor, armed with knowledge about your condition. I wish I'd done it like that and wish I'd found this site before too.

Good luck to you!

Bye, Val

I would try to find out what is going on in your spine. Fixing a herniation is one thing- fixing the problem that caused the herniation is another.

I had a PLIF over a year ago and I can say I am glad I did... It was the right choice for me.

Incidently a friend of mine had a microdiscectomy at the same time (same area). She has been in PT the entire time and it recently re-herniated. She is now preparing for a fusion. Now she is going to have even more scar tissue.

Reality is that more fusions are successful than not... They stop the movement that is causing the problem. However some of us just have "bad spines" and either genetically or enviromentally we just have problem spines.

With my PLIF I went back to work after about 3 months and by 9 months I was feeling better than I had in years. I was solidly fused at a year. I still get sore if I over do things but being able to walk with a smile beats walking with a grimace and a cane.

My NS gave me an 80% success rate for the PLIF and 95% for the upcoming ACDF.

I said to my self- do I want to continue taking pain meds and not enjoying the activities that are a core part of my life or do I want to jump back in the game? It is a no brainer for me.

Good luck with your choice.

Yes, the best advice is to read, read, read, and then decide what you think will be best for you. I had a three-level fusion a year ago. Looks like you would be up for a two-level. I can tell you that you will notice the stiffness. I often feel as though I've been nailed to a board, but all-in-all, I'm glad I did it. The pain beforehand was horrific and would often stop me in my tracks and I couldn't get moving again for several minutes. Most folks have no idea I've had surgery. I move fairly normally, but I can't just bend over to pick things up -- I have to squat, etc. In my case, I had spondy, DDD, arthritis, and scoliosis, so I didn't have much choice. The bottom of my spine looked like a train wreck.

Linda