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SCS vs. L4-L5 L5-S1 fusion

LostYouthLLostYouth Posts: 8
edited 06/11/2012 - 8:27 AM in Lower Back Pain
I had a surgery in November 2008 for a herniated disc at L4-L5. I also have a herniation at L5-S1, but it was not causing any of my pain symtoms (not pinching a nerve). I had another MRI on January 12th 2009 and it shows a re-herniation at L4-L5 and obviously the herniation at L5-S1.

My OS is sending me for a couple of steroid injections. If those do not work, my options are a Spinal Cord Stimulator or a 2 level fusion from L4-S1.

Anyone have any experience with either or both of these procedures and which one might be the better choice at this point?


  • 2 fusions at L5-S1. The first surgery went poorly causing the 2nd fusion being required to fix the problem. However, my nerve pain never improved. While my back was stabilized, my nerve pain was not improved. Today, my MRI's show a fusion success and no impingement of the nerves. Just constnat 24/7 burning pain. The EMG showed I have permanent damage.

    I have had my permanent SCS now for 2 weeks and I am really happy with it. It blocks the pain signals from getting to my brain. If you have permanent nerve damage, the fusions won't help. Have you had any nerve tests, such as nerve conduction studies or an EMG? Have you had a discogram to prove which disc the pain is coming from??

    I would definitely have a fusion if your back is unstable. If not, it would be a really hard choice. My nerve pain is what has driven my choices this entire time, AND I was left with the same nerve pain. But didn't find out it was permanent and not related to current back issues until a year ago.

    In the very beginning, my nerve was impinged and I delayed 4 months in getting medical treatment. Since then, the nerve has looked fine on Xrays, MRI's, and CT scans, BUT my back was dangerously unstable until my 3rd surgery in Dec. 2006.

    If I were you, I think I would get further testing before I made the decision. Many people go in with the "obvious" fusion at a certain level based on MRI only to find their pain continues. A discogram later shows an entirely different level causing the pain, conflicting with the MRI.

    Good luck - it is a tough decision.

  • Jay:
    I recommend you carefully look at the spinal cord stimulator option. It is a minimally invasive procedure and gives results as god as or getter than reoperation in a Johns Hopkins University study. Patients in that study were happier with the stimulator.

    I have experience putting stimulators in, and patients were almost universally happy with the results.

    I'm now retired from interventional pain practice, but you can find someone in your area who can do it.

    Live well!

    Ken Noel
  • hi there you and i have had the same operation .and i .like you have considered a scs but!! i have a lot of scar tissue and my pain consultant said that i scs would not be of any use because of the placement of the leads could be very difficult and the scs would not work where we want it to work.
    i have had the epidural injections and facet joint injections too ..but no good for me !..i am waiting for another MRI{12 Feb 09} and then we will see what if anything can be done..good luck with what ever you decide
  • A fusion is something that cannot be "undone", an SCS can

    A fusion can fix instability, an SCS cannot

    A fusion is "hands free" with no real limitations, an SCS has limitations

    An SCS treats the pain but does not fix the problem

    A fusion you can "forget about" once you are healed, an SCS you can never "forget about"

    I have an SCS and love it! If there was a way to fix my neck so that I didn't need the SCS, I'd have them fix it in an instant!

  • Thanks for all the replies. I guess I would lean more towards the SCS at this point simply because if it does not work, a fusion can always be done later and not vice versa as haglandc pointed out.

    Straker, I too have a lot of scar tissue as well. That gives me another question to ask the OS about.

    Cheri, thanks for the info on getting further testing done. I had no idea these nerve tests existed and I am wondering wy the OS has not informed me of them. Maybe he will, after the injections.
  • The only constructive advice I can add is to use the typical due diligence in selecting who does any nerve testing (like an EMG). I've experienced some pretty rough tests while dealing with my issues. One that should not have gone so "bad" was my EMG. It was completely due to the doctor who I had perform it, not the test itself! I was very angry not only as to how the exam was done, but I doubt the accuracy of the results too.

    Good luck - Jeff
  • That is quite a decision. It depends on the type of problems going on and the extent of the problems. Also, you will have psychological testing to see if you can handle living with an implanted device in your body. And of course you will go through a 3-5 day trial where they implant only the leads and the unit is taped to your back. If you get at least a 50% reduction in pain, it will be considered beneficial.
    I had a 2 level fusion for instability and recurrent herniation and laminectomy for nerve compression. The surgery was technically successful and the fusion is good, but I continue to have chronic back and nerve pain. I have the option of having an SCS or a pump put in later on. I hope you have enough information and read many experiences to make an informed decision that is tailored to your specific needs. Take care
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