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Having surgery soon...Terrified!!!! Fusion or Disc Replace??

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:22 AM in Back Surgery and Neck Surgery
Hello,
I'm a 38 yr old female. I'm having surgery on L5-S1. I need help making up mind about which surgery to do. I've been offered one of these by my Dr. (I'm not sure my insurance covers ADR.) I can't live with the pain any longer. But am terrified of being cut open through the front & having my insides moved around including major veins. I guess the parts that scare me the most are bleeding, death, having major problems after the surgery, because of the veins. I have 2 kids that I don't want to leave them mother-less.

So, please give me your insight of which surgery you had. How long it took to recover, back brace, are you still in pain, have any new pain and anything else I forgot.

Thanks a bunch!!!!!!!!!!!



DDD L5-S1, x-rays, MRI, Melyogram, 2 CT Scans, Discogram
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1

Comments

  • Hello Charmed.

    A serious choice. Do you have a supportive partner?

    I have had 2 surgeries now, Dyneyses and PLIF S1/L5 and removal of dynesis to pedicle screws and fusion of L4/5. I am 6 months post 2nd op and still in pain - but I am unlucky. I am an unstable spondy and ddd so have numerous problems to sort out.

    I was at the end of my rope and felt the risk was worth taking. It is a long recovery and varies for all of us. With a suppostive family around it will be easier for you.

    The results are not guarenteed and you kinda have to be in a place where you have nothing to loose. What is the quality of your life now? Can it get worse - I mean is there room for you to suffer a bit more? (hope not but you need to think).

    Ask your surgeon what results he hopes and what your expected problems may be...for example if you smoke your at higher risk of non union, DVT if you are overweight you may have problems with wound care. Its not an exact science, sadly!

    When I went in the nurses did a risk score on me. As I am young non smoker no health probs my score was low. But on my second operation, my score was high risk just because my previous surgery. This will make me think very hard next time (hopefully not) but i would want to know the expected gain versus the risk of problems.

    I lost 1500mls blood last time and felt quite weak afterwards. But i ate a good diet, pleanty of steaks and green leaves (vit c helps iron bind to red blood cells)and I felt ok after a few weeks.

    Its a tough one. Good Luck and keep us posted. :H
  • I too had to consider all my options. Surgery was a last resort. I tell you, I was almost surprised when I actually woke up after surgery - my first thought was. 'I'm still alive, thank you.'

    I also had complications post surgery and had to have a second surgery 2 days later. I had not lost a lot of blood in the first surgery, but needed 2 units in the second. I am left with a new symptom - a numb right leg. But my left leg shooting pain and bladder issues are gone. I'm happy with my outcome so far. I know numbness is lower on the healing scale than pain (pain means you at least have feeling), but I'll take it.

    It's a big decision and only you can make it for yourself. But I also have a dear friend who has been suffering severe back pain for many years. It would be the greatest thing in the world for me to see her able to feel better. Sometimes surgery really is the only option.
  • I had PLIF 2 weeks ago, am doing well so far. My surgeon prefers ALIF, but I was not a candidate due to my unstable spondylolisthesis. With an anterior surgery they will have a general/vascular surgeon there just to be in charge of/protect your great vessels during the operation. I have been told the recovery from ALIF is much easier than PLIF. Those posterior muscles have a harder time healing than our abs apparently. So it is actually a plus that you are a candidate for an anterior approach, scarey as it is. Any surgery has risks, and these must be weighed with the benefits of possibly being pain free again. I know I struggled up to the minute I went into the OR with my decision, and so far I am happy I went through with it. Best of luck, Sue
  • I have just had to make this exact same decision myself. I'm 35 years old and I have decided to go ahead with the fusion. The ADR hasn't been around long enough for me, and as my last surgery was still "experimental" and has now failed on me, I need to do something that has more of a guaranteed result.

    Due to my old hardware having to come out, I'm having a PLIF. My surgeon told me that he prefers to go in from the front, because there is less chance of bleeding that way and also there are less muscles to actually cut through in order to get to the spine. They literally just move the intestines and stuff aside out of the way! Sounds horrible but apparently it's less risky. So I hope that eases your mind a little bit!

    Good luck with your decision, I know how tough it is to make it. Let us know what you decide to do. Hugs, Spicey :)
  • I just had a talk with my Neurosurgeon today about ADR vs fusion. She told me that the doctors in this area don't do them anymore because they are not secured to the vertebrae, and can slip back and forth. She said if they slip out, you need a major, major surgery to fix it. I was told that they have no proof that ADR puts any less stress on the surrounding discs than fusion does, but ADR carries more risks and is too new for them to have any long term studies. She also said most insurances won't cover ADR.. I think partially because it's so new.

    I asked about the loss of mobility, and she said it was about 10 degrees for l4-l5. l5-s1 is less than that, so you'd most likely not notice much difference, and should be fine playing with the kids :)

    I'm also going in for a fusion soon, and I wish you the best of luck! :)

  • Hello Charmed -

    I understand the position that you are in. I had to make the same decision two years ago. I am 36 and chose to have a two level Chartie artificial disc replacement as my surgeon said that he would not perform a fusion due to my young age. I had the first surgery on 09/08/2006. Unfortunately for me, almost immeditately my pain got worse instead of better. My doctor kept telling me that everything looked great on the x-rays. I finally asked for a second opinion and was told by a world renown back surgeon in Baltimore, MD that both of my disc L3/L4, L4/L5 had migrated one by 5 cm and that if I did not want to die, that both devices would need to come out. The devices were actually causing my spine to develop scoliosis. Both my surgeon and Vascular surgeon in Baltimore explained that this removal and revision surgery was life threating. I really felt like I had no option. I am married and have two young children at home. The second surgery was in May 2007.
    After 7 hours they removed my two artificial disc, almost aborting the procedure on several occasions.Because of the scar tissue from the first surgery 8 months prior, it was
    like my surgeons were operating in the dark. My Inferior Vena Cava was cut causing me to require a blood transfusion of six pints of blood. My left ureter had affixed itself to
    one of my artificial disc and when they tried to remove it, it broke in half. After they opened me up in the front and finally finished the removal and anterior fusion with cages, they opened me up in the back where I had two rods and 9 pedicle screws put in to help stabilize my spine.
    I ended up with a 360 degree fusion and two additional surgeries to correct the problems from the removal of the devices. It is a bit ironic that my surgeon had me wait for 8 years on this new technology in lieu of the fusion procedure in which he refused to perform and in the end I ended up with a 360 degree fusion. I am still in a lot of pain and on morphine for almost two years, although thankfully on a low dose now. I just underwent a bone scan today as my docs are still trying to figure out why I am still having so much pain.

    My advice and I must stress this is my advice, If you must have surgery, I would stay clear of the disc replacement option for the low back. Also, get at least two opinions from doctors in different practices that have lots and lots of experience. I made the mistake and trusted my first doctor because he had a great reputation. Unfortunately, little did I know that at the time his reputation was based on the tried and true procedures of fusion. I wish I had chosen fusion as my first alternative. If you only knew what my family has gone through from all of this mess.

    Please feel free to send a PM anytime. I would be glad to
    answer any questions. I wish you the best of luck.




  • Before worrying about which surgery to have, chat with your insurer to see which they will cover you for as that may make the decision for you.
    I had a lot of problems and a big op- several level.

    But I ended up having 2 units of blood post op which was fine as i needed it and have continued on Iron tablets & C since as my HB is still a bit low. This has make me more tired then usual but that is not a bad thing as I have rested more- see a silver lining.
    Now remember that these Drs do these surgeries all the time and they constantly cut people open and move organs around so it is not like you are going to be an eaperiment. If they weren't practiced in this they would not be allowed to practice.
    Maybe your Dr could do a PLIF which is entry from the back?

    Also if you do decide to go ahead and have either surgery- you really have to get your head straightened out first. If you go in really scared it will be much harder for you so start thinking of the wonderful life you will be able to have after the surgery.
    Sure, it is hard and the recovery is long but I for 1 am so glad I had it done. I feel like I have a life again >:D<
    Blessings Sara
  • Well, up until now..I've made my decison on disc replacement. After reading your story, Timothy, I'm horrified!!!!

    First, I just want to say I'm so sorry, you had to through all that h*ll!!!

    At first before, I even went to the dr about my back...I was already checking out stuff on the web...and thought I had to have ADR. It sounds so much better than fusion.

    I have spoken to my Dr about both. I asked if he were me which one he would do & he told me due to his age (50's) and size (very tall & big, but not fat) that he would have fusion. I asked if he were me and my age & not over weight (134 lbs) & 5' 7" what he would do & he wouldn't tell me. He did say that there was success in 85% in ADR & 90-95% success in fusion.

    My part that worries me for fusuion is that it puts wear and tear on your other discs causing more surgeries in the future.

    Kristie



  • Hi Charmed!

    Well as you know this is a major decision. As for which one is best. Personally a fusion at L5/S1 is going to last a long time. If you get the ADR approved and installed and it fails the revision is for fusion. I have been told although I have my doubts that at that level by the time you are in your 50's there is limited movement of the L5/S1 joint. Get several opinions and then decide what works best in your world. Also when you make an informed decision with plenty of knowledge your apprehension regarding surgery may ease.

    Paul
  • Thanks everyone for you comments. My fears are starting to ease.

    I still haven't fully decided which one to go for, but I'm calling my Dr today to ask more questions.

    Good luck to all!!!!
    Kristie
  • Hi I am in the same boat as you. Just found out today that my Dr. will do surgery, but I have to have an MRI done once insurance approves it. He said he prefers the disc replacement, but there is not enough info yet if in the long run disc replacement is better or not.

    I do have low back pain that radiates down my left leg to my foot. My left foot is numb, and part of my leg. I have a hard time walking etc.

    I was also wanting the disc replacement until I read timothy's post, now I am worried about it. I am 33 years old and overweight so I'm not sure what's best.

    My Dr. will decide which one he thinks is best after the MRI. He said I might have too much degeneration (I have DDD) to have a disc replacement. He even said that if we decided to have a disc replacement and the MRI showed it was possible, he said he may change his mind during surgery and I may wake up with a fusion. I just want whatever is best in the long run for me.
  • 33 is pretty young... If your ADR fails or they find out they don't last long, you'll probably be in for a lot more surgeries in your lifetime... Whereas if you went with the fusion, it's been done for a LONG time, and there are not many unknowns there. I'm 22 and going in for a fusion soon, and my way of looking at it is that maybe it will put more stress on the surrounding discs... But who knows what technology they'll have by the time I need more surgery, if I do. They may have more info on ADR by then... They may have perfected it. Until something is proven and tested and had enough clinical trials, it's a total shot in the dark. My doctor refuses to do ADR, and there are none in my area who will. I don't even think the doctors a few hours away in Boston do them, and Boston is FILLED with state of the art technology and specialists.

    It's ultimately up to you... But I think it's better to be safe than sorry... Ya know? Either way, let us know how it goes. Not sure when I'm going in for my surgery, so until then, hearing from other people keeps me chilled out.
  • My NS said that the ADR that are out now are "not safe"-his exact words. I have a top notch surgeon because of risks-I have a tumor in L4 which is one of the areas I had fused-A lot of docs would not touch me so I got refered to a university team-best in my state! Anyway-that is his opinion.
  • Said that they are not safe. Which is why everyone in that practice refuses to do them.
  • Seems weird that so many people are getting them if the NS thinks they are not safe. Is it OS that are using them?
  • The first ADR approved by the FDA was in 2004. If people want to take the risk, that's their choice... But there are MANY doctors, INCLUDING the best doctors in any given area that refuse to do them. It's whatever that doctor believes regarding them.

    Even simple things like XBOX's don't come out good in the beginning. Then through trial and error, over time they fix all the bugs. Which is why right now, most of the doctors around here in my area refuse to do them, until later on when there are enough studies and recorded data on them. I don't blame them.

  • Hello Shay7721 -

    Unfortunately, a lot of doctors both NS and OS are being duped by the sales reps that work for some of the ADR companies without doing their own due diligence on some of these devices. One particular ADR device that recently got FDA approved did so with after only one clinical trial that lasted two years in which the comparison was with an already outdated Bak fusion technique that many docs had long since written off as a failed procedure. The first 25% of the trial results were excluded from the final results because it was said that the doctors were getting their feet wet practicing on patients. The first part of anything new involves a learning curve and it is understood that this is when the complications usually occur. So why would they be allowed to omit those failed results from the final end results? You guessed it, it makes their device look sucessful and thus helps it gain FDA approval. If you do your research as I have done, (unfortunately, I did not do as much before I had artificial disc surgery as I have now) you will be sickened by what you discover. Let me remind you that the big selling part of the ADR device that I had was that it preserves motion. I have the same motion with my two level fusion that I had when I had my two ADR devices. There has been no clinical trial done that specifically states that ADR does not put additional wear and tear on the disc above and below the disc replacement. There are definately a lot of reasons why more and more doctors are not performing ADR. If after your research, you still are determined to move forward with ADR, get your doctor to put a statement in writing that he/she is not receiving compensation from any of the manufacturers of ADR.

    Please understand that I am not trying to be discouraging in any way I am simply providing my opinions based on my research and ADR experiences of my own as well as other people that I have met that have had all to similar stories.

    If I can answer anybody's questions, please feel free to send me a PM anytime.
  • I've been researching such things for over 2 years. I've spoken to MANY, MANY people about it, doctors, specialist, etc...

    The point is that it is NEW. Anything that is new should be handled with very careful consideration and caution. Personally, I'd rather not risk having what happened to someone else and nearly dying, just so I can save myself a few degrees of mobility... WHICH most people don't notice, or notice they have MORE mobility after a fusion, because the movement no longer hurts, and they have a greater range of mobility.

    Forget the name, but there was some medicine that they were using YEARS ago that had only been researched for a few decades, and then later on, come to find out it made women unable to have kids... People want to run to the newest great idea just because it sounds good. Some people may luck out, but being careful is a lot more important. Your life is worth a lot more than being able to touch your toes.

    To each his own... But it's better to be safe than to be sorry, and anyone who disagrees with that statement should seriously reevaluate their outlook on life.
  • I know I'm a Guinea Pig. The Prestige Disc is FDA approved but I am still going to (or am suppose to) be contacted. Maybe it's just the hospital itself, IDK, but eventhough this doctor has done many of these ADRs, they are still taking down the research and information on the patients. By the time they figure out anything the newest and most comfortable ones will be giong through original studies here I'm sure. I am sure they will have some new breakthrough one day and we will all be like....dang...if I could only have waited this much longer, that looks nice, etc.

    Even more as a Guinea Pig, I'm sure the doctor does believe that this was a better option for me. He didn't try to pursuade me either way, he told me it was my choice, but at the same time, I know it helps that I did get the ADR because the residents got to practice on me I'm sure. Or at least watch (which I have to keep telling myself they were just watching, not doing, ya know to help me feel better) the surgeon do his job. Either way, if they couldn't get it to work, then they would have to do fusion afterwards.

    Regardless, to me it was easy. I was given the option to try newer technology that not everyone gets the opportunity to try. With either choice, it was a promise of a better life. I guess I am more open to it since I got PRK surgery for my eyes. It took a lot out of me to go ahead and do it, convinced that it still hasn't been around long enough for enough research to convince me, but I started thinking, hey, I could see for a little while and need glasses again is still nice. Plus being in the military, I don't have to pay for it, they will do it if you are a good enough candidate. So, yea, I'm a great Guinea pig. I had PRK for my eyes, I had ADR at C5-6 and I'm getting braces put on right after I'm recovered enough from this surgery (and yes that is going to be done by a dental student). I gotta take what I can get while I can.

    Point being I guess, is that if I hadn't started to take the chance before, I would never have opted for ADR. It is all a personal choice. Whatever you believe is right for you, you will know it.
  • Can I add to that ...being that I think our FDA is just slow as all heck. It takes so long to approve something, and after they do, a few years later, studies show its all jacked up?! :T Anyone else notice that?!?! There are pleanty of drugs that are like the one Lo is talking about here. Certain drugs they use to use on pregnant women, and then the child would have birth defects, that one was FDA approved...and I'm pretty sure there is more than one in that category. What was that weight loss thing..Phen Phen or something..wasn't that FDA approved?? Didn't something go wrong with that too?
  • good luck charmed on your decsion.

    ya know eve1 is different. some do well with adr some with fusion so it is a tuff call.

    i would also ask why they want to go through the front??? especially for a low level like that.

    going through the back (from my surgeon is less trauma to the body) u do not have to move all that stuff around.

    having c sections and back surgery i would opt personally to go through the back. but all drs are different in the way they like to do procedures.

    surgery was not half as bad as i thought when i went in.
    sore yes from the incision , ya know rolling out of bed like the first 2 times. but they kept me well medicated with a pain pump etc. i remember nothing of the first 2 days. i had a cath in for 2 of the 4 days. OH WHAT HEAVEN not to have to go potty =))
    when i got home i pretty much took care of myself. except for having help in the shower etc as it was very hard to stand still that long. felt like ur body was going to give out.
    so shower chairs are good i guess. i just opted not to get one.

    this is a huge decsion believe me. but i am happy it took away my orginal pain!!!!
    i did not fuse but those are the cards played. some ppl do some do not.
    so i am re doing it in a few weeks and going in with full forse and positive attitude..

    HANG IN THERE
    we are all here to support you.

    HUGS
    terri >:D< >:D< >:D<
  • I wish you the best and hope you come through with flying colors. :)

    Best of Luck to you,
    Christina :)
  • The way my doc explained it, they do not have to cut through muscle when going thru the front, but they do from the back. Once the muscle is cut, its (obviously) never quite the same.
  • I had a nine level fusion with 3 entrances in January. I lost a lot of blood, and they replaced it!! I am doing great. My pain is gone and I can do more all the time. I am careful and religous about my PT. I think if you have a great surgeon and know that it is rough, and slow going, it is a great procedure. Good luck, Wendy
  • Well I was going with the ADR, but since my insurance won't cover it, I'm going with fusion. I could appeal it, but it would take alot of time, and still may not be approved. I know they have been doing fusions a long time. So, I feel content with that.

    My Doctor tells me that he could do it from the front or back. I decided to go with ALIF, from the front. He says it looks like they go in through your stomach, but they don't, they actually move the stuff to the side & go in through your side to get to your spine. They also have a vasular surgeron to do that part & to move the 2 veins that go down to your legs, because they lay on top of your spine. As with the back approach, they have to cut through your muscles, it was more painfull, takes longer to heal.

    I'm kind of freaked out about the major leg veins, though.

    GOOD LUCK TO ALL!!!!
    Kristie
  • Well I was going with the ADR, but since my insurance won't cover it, I'm going with fusion. I could appeal it, but it would take alot of time, and still may not be approved. I know they have been doing fusions a long time. So, I feel content with that.

    My Doctor tells me that he could do it from the front or back. I decided to go with ALIF, from the front. He says it looks like they go in through your stomach, but they don't, they actually move the stuff to the side & go in through your side to get to your spine. They also have a vasular surgeron to do that part & to move the 2 veins that go down to your legs. As with the back approach, they have to cut through your muscles, it was more painfull, takes longer to heal.

    I'm kind of freaked out about the major leg veins, though.

    GOOD LUCK TO ALL!!!!
    Kristie
  • Kristie, is their some reason why your doc is not suggesting a microdiscectomy?
  • So far it's the best thing I've ever done!!!!! It wasn't easy by any means, the stomach took about four days to wake up and let me tell you did it hurt. The first week the stomach actually hurt more than the back. 2weeks and a couple of days and I'm walking a mile plus nightly and only taking meds at night to help with sleeping. I researched ALIF and ADR for two years. Here are my result. ADR has been done in Germany and afew other countries over the pond with great success for 20 years plus(90% plus), as for the FDA, well everyone on this site knows that our GOV. is slow for medical stuff. The best way I can put it from two years of data is this. Adr people return to normal activity quicker, have less pain, and have less of a chance for adjacent DDD.
    That's what I found out, and that's what help me make my choice to go with the Disc. I'm 37 years of age and hope to return to a very active lifestyle as I try to keep up with my two young daughters. My dr. has said that I'll be able to do everything on my wish list but Jog long period of time and when I asked if I could still play football he said not no but hell no. I have met several people that had one level ALIF and they are doing very well. It seems that it takes an average of about 6 month longer than Disc people that I interviewed to feel good though.

    Hope this help and good luck with it all,

    Charlie

  • Good luck with your decision. All I can do is add my input. I had the ProDisc installed in L4-L5 ans L5-S1 on Jan 11,2008 and it was the best decision I ever made. My surgeon would not install the Charite disc because he considered it to be poor design and could move. I suffered through 2 years of conservative treatment ( PT, injections, and even a spinal chord stimulator) with no positive results. Finally the FDA approved the 2 level ProDisc and my WC approved it also ( another small miracle) The design of the ProDisc with a Keel stablizes the device in the vertabrae. I had two bad days in the hospital getting off IV meds onto oral pain killers but no back pain.Three days later I was home and had no pain what so ever. I have not taken 1 pain med since I left the hospital. I am back to full time work, riding my bike and playing golf. I would recommend this surgery after reading alot of horror stories about fusion and especially about problems developing 5 - 10 years after the procedure. Good luck and I pray that whatever decision you make, it works out for you.
  • I just had a ALIF/PLIF surgery 6.5 hrs on the table and I have the 2 cages and 4 screws it was done just 5 weeks ago and its a different kinda pain. I hurt worse on my stomach scar then my back scar now note I'm 35 and 6'4" 220lbs a little overweight. Before the surgery I couldn't lift 5 lbs and stand without assitance and I had to walk with a cane. I asked my doctor if I would be able to dance now that I had my surgery he replied yes, yes you will. I said good cause I couldn't dance before I had it! :P

    In late 2005 I was injured working on Armoring Trucks for the Troops in Iraq. In Feb 2006 I had multiple ELIS they did nothing my doctor requested for a Discogram the insurance company refused to treat me past the shots. Then the Department of Labor forced the insurance company in Aug 2008 to pay for the Discogram it showed problems in L4-S1. I had a much needed surgery just 5 weeks ago.

    Meds: Oxycodone 7.5 every 4 hrs and Flexeril 10mg every 8
    hours.

    Can anyone tell me whats the heal time and will I be able to return to a medium to heavy lifting job cause I'm a Plumber by trade and a DoD Contractor in Iraq by choice?
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