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Surgery or medication?

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:25 AM in Back Surgery and Neck Surgery
I saw my PM doc yesterday, who told me that according to the discogram, two discs (L4/L5 & L5/S1) are involved in my pain. The discogram really irritated nerves, and I was in worse shape than ever before. I had so much pain in my right leg, from the hip down to my feet. My knee was in excruciating pain and I could only walk with a limp. The PM doc gave me the okay to increase my dose of Opana-ER, and she gave me a Medrol pack. So today, I am finally feeling normal again.

Anyway, she said that the surgeon would probably suggest disc replacement or fusion surgery. I see the surgeon on Monday.

Now, with the 20mg Opana-ER that I am feeling better. But I'm not really doing anything, just lounging around the house. So, I don't know yet if the meds would make it so that I can return to my normal, pre-pain level of work and activities. But if the meds can do that, should I consider surgery at all? I sort of dislike the idea of having to take pain meds for long term. But surgery is also extremely risky.

I'm very conflicted about this. I have been in constant pain now for 2 years. What are your feelings on this? The pros/cons of each option. Granted I will know more when I talk with the surgeon, but as the PM doc put it, she has nothing to offer me except meds (and injections which haven't worked).
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Comments

  • Make sure you get a second/third opinion. You would not to wait if you risk the chance of permanent nerve damage. I was in your boat and I finally couldn't take enough medication and still work and drive let alone be a wife to my husband. Meds make you someone you aren't, they blocked my emotions and spaced me out sometimes. The steroids in those injections also concerned me. I was needing to many and then they stopped working thus leading to increased pain meds. I finally met the right doctor who did my surgery. I had an L4/L5 fusion with an anterior disc replacement on 11/10/2008. I know it is early but I feel really good! I was out of the hospital the next day and never looked back. I got better everyday, although the first day I was pretty sore. Whatever you decide, Good Luck
  • I'm glad you're feeling better with the increase in meds finally. I agree with Pika on getting 2nd and third opinions before surgery. That's a difficult decision to make. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • And you may need to talk it thru with your surgeon a couple of times before you decide, I know I did.

    I can only speak to my own experience, which is that I've been treating my pain conservatively for a year now, and I made the decision some time back that I would not do the surgery unless my situation declined, or my quality of life was compromised.

    Being 38, with hopefully a long life ahead of me, taking 5 meds a day, side effects from the meds, still having pain, all contributed to my decision. However, I know that surgery is no guarantee, and it is a risk I have decided I will take, as I am otherwise a strong and healthy person.

    Every situation is different. What are the elements going into your situation? (Any other health issues? Insurance? Okay to take the time off from work? family or friends support right now?) I scheduled my surgery in November for January, in part because I ha some work issues to take care of, and meds could hold me over. Can meds hold you over until you are ready to make the surgery decision with conviction? Something to think about.
  • If meds take away the pain, then stick with the meds. Fusion should be the last option. Narcotics really don't take care of nerve pain... So unless you have weakness and numbness then I wouldn't worry that you're at the point of having permanent nerve damage. Sounds like you just need meds and continuing physical therapy. That's just my opinion. Surgery isn't a guaranteed fix, and with surgery, you still may be on pain meds for a while. I'm almost 3 months out and still on the same amount of Percocet I was on pre-op. And I go through phases of not doing much, and then doing lots... For me, it doesn't change anything. Still need the pain meds or I can't stand up straight.
  • Geez, there is so much to think about, isn't there.

    So, I will get all the information the surgeon can give me. Ask if he thinks I would be better off waiting or having surgery sooner. And of course right now, I don't even know exactly what he recommends.

    I guess this is really the first time that I have even had medication get me to the point of feeling this good. So it kind of surprised me. And after reading some surgery information on this site, it is a little scary and overwhelming.

    As far as family, yes I have my boyfriend to help me and look after me. I could probably also get my Mom to come down to help me out, she is retired. But she has a hard time getting up and down stairs, she is overweight, she had a knee replacement last year and her other knee sometimes causes problems.

    As far as time off of work, I think that my boss would be all right with it. He is a physician, and has been extremely accommodating and supportive. I have some sick time, and vacation time right now. And as of now, I don't plan on taking any time off for the holidays. But I could probably wait until I was able to accumulate more time. Then there is FMLA, I need to find out more about that. We also have a program where people can donate their unused time off to people who have need (I can find out if I qualify for that program - it might only be for the hospital staff, not the university staff).

    Thanks for the advice and opinions.
  • It's a shame you had to suffer with insufficient meds before the discogram. Ask if you wait longer for surgery will that compromise nerves or any damage to tissue. I don't know if you have numbness or pain in you limbs? Good luck. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Pain management gives you the option of waiting until the time is right for you to have surgery, if that is what you decide you need. You probably will need the surgery, so figure out when the best time is in iterms of support, insurance/finances etc. For me, my pain was getting worse and worse earlier in the day, until it was waking in the middle of the night with pain - that made me decide on the surgery. My regret isn't having the surgery, its not planning better for it. Oh, and BTW some insurance companies might start not covering fusions for discogenic pain - Medicare made that ruling a couple months ago and likely other insurance companies will follow.
  • I am 4 weeks post-fusion--

    The recovery is very hard. The hardest part is not the pain--the hardest part is not knowing whether or not it worked. I don't like uncertainty. Today, 4 weeks post-op, my pain is worse then it was on my worst day pre-op. However, there are others who come out of surgery without any pain. Mind you, the doc and PA tell me I am sailing through with flying colors--so if they say I am doing great...that doesn't give me a lot of hope. I would look at the axial lif. I wish I had given that procedure more consideration. As I posted elsewhere--it is FDA approved for two levels--it is 1/4 the cost, and minimally invasive. At least check it out.

    Chuck
  • This is one of those things where you have to get all the facts and then weigh you options. Taking pain medications for a long period of time can have some unpleasant reactions. I personally had to make the decision for surgery because my quality of life was horrible. I feel like I have failed as an employee, mother, wife..etc. I am so limited in what I can do and the only relief I get is from bedrest. I am 39 years young and before I had back issues I was an active person, always on the go. So I had to ask myself do I want to be a walking pharmacy or do I want to take a chance on getting well. For me, I chose faith over fear and I am scheduled for surgery in 5 days.

    As far as the insurance company goes....I had to fight. My initial surgery date of 11/5 was denied by my insurance the day before. My surgeon did a peer to peer with my insurance's doctor and it was denied. My 24 hr expedited appeal was denied. It wasn't until my 3rd appeal where I gathered all records for failed non-surgical routes (chiropractor, physical therapy, steroid injections, pain management) where my surgery was approved. So there is a lot to think about. I hope this helps. I'm sure you will make the right decision for you. >:D<
  • I suffered for 7 years and when the injections stopped working for me I had to turn to more pain meds. After having to take 5-6 pain pills a day I decided it was time to throw in the towel and have the surgery. Now I wish I hadn't waited so long. My surgeon had been doing this for 27 years and he did a fine job. I got my quality of life back and now do everything I use to do when I was younger. I still avoid things that I think might hurt me but all in all things are great. The folks that have surgery and get better move on and don't return to the forum so don't let some of the things you read scare you. Find the right Dr. that you believe in and do it. I was out of work for 14 wks then returned to my job which is in production. Hang in there and good luck.

    Keith
  • Keith,
    What was your recovery like. I am 5 weeks post-op and my biggest issue is moving from one position to another--I feel like my spine is going to pop and is unstable. Then there are the pain episodes throughout the day that make me want to die. When did it get better for you?

    Chuck
  • I took my pain meds every 4-6 hrs for some time and layed on an ice pack alot which helped. I was then put on Lyrica 75 mg 3 times a day that also helped alot. Walking is one of the best things for you so walk at least 2 times a day and hit the ice pack as much as you want and it should get better. Stay positive and get plenty of rest and things should start getting better soon. I can't remember what week things started getting better but whe it did everyday was a little better from that point on. Good Luck

    Keith
  • Well, I saw the surgeon Monday. He confirmed that my diagnosis is DDD (from the MRI, discogram, x-rays, & CT scan), there is no stenosis or herniation (no pressure on nerves visible by MRI). Two levels are affected, L4/L5 and L5/S1.

    He gave me two options:
    1) Two level fusion: ALIF or minimally invasive TLIF
    2) Hybrid: TDR (total disc replacement) at L4/L5 and ALIF at L5/S1

    The hybrid option is because he thinks there may be evidence to suggest that the so-called domino effect of adjacent levels degenerating after fusion, may be eliminated with disc replacement. And since TDR is not FDA approved for two levels, he suggested having TDR at the top level and fusion at the lower level.

    After doing some reading, thinking, and discussing it with my boyfriend, we both believe that the hybrid surgery is worthwhile and the choice for me. Now, my insurance won't pay for TDR, and the surgeon said it will be ~$8000 :jawdrop: . But we feel that my health and well-being are worth the extra cost to us.

    The disc replacement that he said he would likely use is the Prodisc. He has also done Charite (sp?) disc replacement, but I don't know what the difference is, and why he would choose one over the other.

    I now have some additional questions to ask, now that I have had time to think.

    -For the fusion - what type of graft material will be used (my own bone or BMP)?
    -Prodisc discs come in 2 sizes, I would assume that if the smaller one doesn't fit then he would do fusion at both levels.
    -What is the expected lifespan of the Prodisc?
    -Is there anything I can do before surgery to make recovery easier or faster (exercises, eating)?
    -With TDR, how often do they need to go back in because the disc moves out of position?
    -I also want to get a better idea of recovery - how long with restrictions?, before going back to work?, climb stairs?, wear a brace and what kind?, PT?
    -Will my boyfriend be able to be with me all the time, in the hospital?

    The surgeon said that recovery would be 3-6 months, but I'd like to know how long before I could reasonably be expected to go back to work (I know that every person is different, but I want to know more than just a vague 3-6 months). Because now I am concerned about my job. I can apply for FMLA, but that will only protect my job for 3 months (and it doesn't even have to be the same job).

    My workplace has a donation vacation program, where people can donate vacation time for people who don't have enough time off of their own to get them the point of long term disability. For me this means getting to 4 months. The other stipulation to the program is that the employee needs to have at least 1 month of their own leave first.

    Based on all of these various concerns, I am thinking of scheduling surgery for the end of March or April. By then I will have 6 weeks of my own vacation time. I will apply for the vacation donation program, for extra time off (hopefully enough to get me to 4 months and long term disability - if I need it that long). This will also give my boyfriend and I enough time to have the funds necessary for living expenses if I am not getting paid (the $ for the TDR will have to go on a credit card).

    I did find out that I can do some of my work from home, so I am hoping that might be enough that my boss will keep my job open for me. Even if I don't get paid during the entire time I am gone, I could continue to do some work for 10-15 hours a week. It would give me something to do, to relieve boredom.

    But I need to look at the big picture. I am not, not going to have surgery for fear of losing this job. At present, I don't even do all that I was hired to do, my job has been scaled back to administrative work because I couldn't handle the stress on my back from the lab work. By having the surgery, I can go back to my full profession, even if it has to be somewhere else.
  • I haven't had surgery as of yet but have done a lot of research on the ADR surgery, It appears they have been having a lot of issues with the disk migrating out of the disk area and causing issues with other back area. Also, if they have to go back in to remove it, there have been issues with some major blood artery's sticking to the ADR which causes extreme danger in removal and possibly no removal if too dangerous for a surgeon to pull it. Either way, they would then have to do a fusion anyways.

    Even after all that, I myself am still interested in the disk replacement more than the fusion but will wait awhile until more progress is made.

    PS: They are developing a ADR disk that has a silicon like surface which will prevent the blood vessels from sticking.

    I didn't see in your post you mentioning if you have short term disability at work. Usually company's who offer long term have the short term kick in first, for your sugery.
  • Short term disability is a voluntary program, and unfortunately I didn't sign up for it.

    It sounds like maybe I need to do more research on disc replacement.
  • i had a discectomy and 2 level fusion. i also had sacral tumor that was biopsied. I was on narcotics for 2 1/2 years and all I wanted was to get my life back. Using BMP increases fusion rate to 95 percent. That was good enough odds for me. my dr removed discs and rreplaced them with bone and bmp. Not easy surgery, mine was almost 8 hours. But have faith in your Dr. Have faith in yourself and a good support group and you will do fine. My pain was not found until discectomy. I had to fight the insurance company and was denied twice. The second timne I was denied I called the CEO of my health ins co. Got things done then. Let me know if I can be of help. Good Luck
  • I had a couple surgeries and feel awesome, but I'm still around. Not everyone uses the forum while they're feeling crappy and then says peace out soon as they feel good. Lol :) I'm not going anywhere.
  • I also had BMP with my fusion and was showing signs of fusing at 2 months post op! :) BMP is an awesome thing. Except when Drs use it in the Cervical area, for which it is NOT FDA approved. Silly drs. Ugh. Haha.
  • dilaurodilauro ConnecticutPosts: 9,722
    is something that many people are looking for a formal and one time answer. Unfortunately, the spinal column and its relate problems is not black and white.
    There are so many different variables when it comes to disc problems, nerve problems and more. No member on this board is qualified enough to give you an answer that is fool proof.
    You hear opinions based on personal experiences.
    You need to go into lengthy discussions with your doctor(s) about this. Waying the pros and cons of each, what happens if you just delay surgery, what else could happen, etc.
    Then the final answer will have to come from yourself, once you have everything laid out on the table
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Hi Treefrog,
    I will add my opinion too.

    Ulimately the decision is yours but with hindsight i would say this.
    I think surgery should be a last resort, only as I am a walking example of some of the complications. My first operation was 23 months ago and I am still not out of the woods. This is a huge chunk of my life, on hold while I hope for a better place after recovery.
    I was not offered pain pills. My surgeon sad they would not work. I don't know, but I do take them now and they take the edge of it.
    So, unless you have a mechanical problem that will cause serious issues, Like CES, I would push myself as far as possible on the medication.

    Either your symptoms will settle or they won't. There will be a break through point on the medication and a trade off with side effects. Can you tolerate them, yes / No?

    You may decise you don't want to be like a zombie, you may find you can take the pills with out too many problems. You may buy yourself a few more years. You may not.

    One day you may say -"enough, I can't go on like this" and that, imho, is when surgery is your next step.

    I hope that makes sense. It is very hard writing it.

    Good luck!
  • My doc recommended the ADR for me but was pretty sure he wouldn't be able to fit it in (he couldn't). So I had a fusion at L5/S1. He was one of the trial docs for the Charite and he said the "data sucked" on the Charite. Apparently, they had a lead wire or something that stuck out and was really hurting people. He said the ProDisc is the real deal. He told me that I did well by waiting 6 years--so the technology would improve, and it did improve--I gained BMP and a more minimally invasive approach. I also gained ProDisc--although, I didn't use it. However, my doc said waiting any longer would not help me much--in other words, there are not any big break throughs on the horizon according to him. He told me he personally was going to have the L5/S1 fusion and the ADR with the ProDisc at the next level. However, he hasn't done it yet and I will believe it when I see it. It does cause you pause that three of the docs I saw have major back issues--even worse then mine--and yet they have elected not to have surgery yet because they know firsthand how bad these surgeries are.

    I feel that a person should be practically disabled before they have a fusion or ADR. I know in my case, I didn't like having pain every day of my life--some days worse then others. However, we all get older and our parts wear out. Today, I am 6 weeks out and I am still not happy I had this surgery. If I could go back and un-do it, would it? I don't know--because there is the other side--it is done, the implant is in, the bone is hopefully growing, and maybe, just maybe, I will have less pain in the future. It's a tough decision.

    Chuck
  • When I lost my quality of life and was terribly depressed I knew something had to be done. My Dr also said to wait as long as you can because technology was improving in the spine area. I waited 7 years and the last year I fought with my insurance company for a 2 level ADR and was turned down at every stage of my appeals process. My Dr said he could get my quality of life back with a 2 level fusion and leave my L3-L4 disk alone since it wasn't causing any pain yet. I was sick of taking so many narcotics daily to get by working. I now am almost 11 months post op and feel 100% better and can now do things with my family again instead of laying around all day long. It is a painful surgery and a slow recovery but I would do it again in a heart beat.

    Keith
  • I made my decision to have surgery twice based on trying to fix the problems. I feel in hindsight that I was a little naive about back surgery. I believed in what I was told, regarding recovery time. I was hoping I'd be on my feet and feeling better than I did prior to either surgeries but things haven't work out. Now I wonder what else is there to do and is it viable for me.
  • My boyfriend's uncle used to work for a company that sells parts for surgery (all instrumentation used for spine surgery and even for things like knee replacements and other "replacement" surgeries). Something he told me is that artificial discs are not researched or advanced enough to be using yet. There's lots of complications and many have to have surgery again to correct the issues. I was highly recommended against it. I even asked my surgeon about it and he explained basically the same reasons as to why their practice isn't using that method and sticks to PILF/TLIF/ALIF for fusions. I'm going to be having a two level fusion - ALIF with PLIF instrumentation. Took me a while to be comfortable with it, but I'm also lucky enough to have all of it be covered. I would definitely get a second or third opinion about this! I really think that disc replacement isn't advanced enough yet. That's just my opinion, but I've heard it echoed from others as well.
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