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surgery or no surgery?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:27 AM in Back Surgery and Neck Surgery
I'm looking for some information on having a fusion verses not having a fusion. I would love to get some opinions/advice from the "pros" (all of you back sufferers) on whether this type of surgery is so risky, it just isn't worth the risk.

I had 2 laminectomies - one lasted 20 years, the other, well, my back gradually got better for 4 months and then the pain came back. My dilemma is... I only have a small amount of scar tissue showing without disc re-herniation. The thing is, the pain drives me crazy. It is on my right S1 nerve root, so the pain radiates down to my toe. It is worse some days more than others. Some days, I think it will get better. Until all of a sudden, there it is again, strong as ever. Every little movement (squatting, twisting slightly, walking, sitting) aggravates the pain. Shopping is especially painful.

I just received a call from a minimally invasive surgeon who said that he would not go back in to my back. He said there's nothing he can do for scar tissue. I have the option of seeing him for $300 out of pocket or moving on. He's the one I've really been hoping could help me. I thought he'd have some new techniques he could use for the scar tissue.

I've also been seeing another dr. here in town. He's very attentive and has discussed fusion with me - but with hesitation. I guess I'm just leary if fusion is my only option. And I'm just trying to see, before I make another mistake, if this is really something to consider. I only have about a 1 - 3 pain level most of the time. But my activities are limited. I am 42 years old and am active when I can be. Does anyone feel that if this doctor offers a fusion, I should refuse it? Or go for it?

I know we're not "experts" or surgeons, but I sure would like to hear from you.



  • Hi csp ~

    This is such an individual decision. I know you must be very disappointed with the outcome of your appointment with the new doc.

    If I were you, I would wait awhile before making a decision. Even though I'm sure it seems like you should be fully recovered from your May surgery, there still might be some room for improvement. Have you tried any of the more alternative treatments?

    Your pain level is such that I would think twice before having fusion. But, that's just me. I waited 3 years before finally agreeing to surgery. I kept hoping a better solution would be found...but finally, I just couldn't wait any longer. I guess only you can decide how much the pain is hindering your lifestyle. As you know, there are always risks associated with surgery. Fusion doesn't always turn out as we had hoped....
  • Csp,

    Even though your post was fairly detailed, you have not provided enough information for me to give you proper advice, though Gwen is correct, it is an individual decision.

    In my case, I had on-and-off pain for 19 years, including constant pain for the last year (probably a 3 or 4 pain level). The cause of the pain was a moderate disc bulge at L5/S1 that was displacing a nerve root.

    The decision to do a fusion was not based on the above finding. It was due to the disc being partially collapsed. The disc was in bad enough shape that there was no way it would ever recover on its own. The realistic choice was either fusion now, or a discectomy now and fusion in 5-10 years, with a high probability of the bulge returning within 2 years of the discectomy. Either way, I was looking at a fusion in my future.

    I chose to do the fusion immediately because I didn't want someone messing with my back more than once, but also because I figured due to my age and health status, I had a better chance at a full recovery from surgery now than if I waited 5-10 years.
  • I guess you're right - not enough information. I hate to go on and on, as I feel I'm being selfish thinking about myself all the time, but here's some more info.

    My fist laminectomy on L5-S1 was in 1987. It was great for 20 years. Now...20 years later:

    I re-ruptured my L5-S1 disc in March of 08. My 1st doctor (neurosurgeon) did my L5-S1 laminectomy surgery in May 08. It felt gradually better for 4 months. Then, wham... a bad day. And that day never ended. Now, I have pain with each movement. It's mostly at a 2 pain level, but I have it whenever I move. Sometimes it's a lot worse and makes me feel exhausted. MRI showed scar tissue only on S1 nerve root. Myelogram showed clumped nerves above, and a dent in the S1 nerve root. (No re-herniation, but moderate DDD at L5-S1).

    2nd opinion doctor: He's my favorite. He's spent so much time with me. His P.A. spent a half hour with me this week and the doc spent 1/2 hour with me 2 months ago. He put me through physical therapy, which I love. HOWEVER, the leg pain is still there. In fact, it made it worse for awhile. But, now I'm doing only certain exercises that strengthen my core and I love them. This doc. wants to do an injection to make absolute sure the S1 nerve root is causing my pain. Then his P.A. discussed fusion as possibly the next step, but didn't go into major details.

    3rd opinion doctor: I only sent over my reports to him via fax. He's a minimally invasive surgery doctor from a nearby college - I believe, probably one of the best. He only went by the reports of my MRI and myelogram - didn't see the pictures. He said he wouldn't want to go back in.

    Here's my thoughts... If my 2nd opinion dr. wouldn't have been so thorough, I wouldn't even consider fusion. But he pointed things out on my myelogram that weren't even in the report. He showed me the indent in my S1 nerve root where my pain is supposedly coming from. The P.A. said that by doing a fusion, a plastic (??) disc would be put where my "human" disc is now in order to raise the space back up to where it should be. This would allow more room for the nerve roots (he said). I have DDD, but moderately only at this level. My thoughts again: If the scar tissue AND the moderately degenerated disc reduce the space for the nerve, the fusion may help this.

    If I opted for a fusion, it wouldn't be until June anyway. Then my son and some other people in my life could help me out. Plus, being that it would be summer, I could walk walk walk after surgery. Also, I would have 4 more months to see if my back would get better first.

    I guess I feel like... I never wanted another laminectomy. I didn't understand why this neurosurgeon who did my surgery would do the same exact thing over again. Now, I have the chance of re-herniating that disc again. If I had a fusion, the disc wouldn't re-rupture from that point on.

    Does this make sense? Hopefully, this is info. is more helpful. I just feel like I'm waiting to re-herniate an already damaged disc, and fusion is, eventually, inevitable.

  • Your thinking makes sense. It sounds like you have examined your options and feel the surgery would provide the best chance for "success." I have no experience with an artificial disc, so will leave those comments to others.

    You will have from now till June to get in good shape for the surgery, and you will have helpers to smooth the way, so it all sounds good.

    I'm sure you have done your research and feel this surgeon is the best one for you.

    Just be sure to enter into the process with realistic expectations. Know that this surgery is done for pain relief and will not return you 100% to the way you were years ago prior to the onset of your back pain/injury.
  • Yes, I've been thinking about things. However, I'm not sure the actual doctor is going to want to do a fusion. His P.A. is the one who talked to me about it, and at first, he acted like there was no hope. But then, he started talking about a fusion AFTER I asked him what the point of having an injection was. He said is would give us an exact diagnosis. And then I asked him what good would that do if I just go back to having pain. He started talking about fusions at that point. But, I feel I had to drag it out of him, even though that wasn't my intension. I just didn't want to have an injection for no reason. Little did I know, he wanted to be sure of the nerve being pinched/pulled. I'm hoping I'm not just having an injection so the dr. can make money. It's costing me $1000 out of pocket, because I have a high deductible. :(

    Also, I don't plan on having no pain after a fusion. I just want this stupid leg pain gone. It drives me nuts - constant pain all the time. The more work I do, the more it hurts. I'm tired of having to always lay down, I guess. I've had major restrictions since I was 20. I don't expect anything to improve that. But the leg pain has to go.

  • I wonder if the plastic "disc" the doctor mentioned is actually a cage/spacer. Fusion and disc replacement are 2 completely different surgeries.

    My surgeon put a hard plastic cage in where the disc used to be. I actually gained approximately 1/4" in height! The cage contained a small bag with BMP in it to help with the fusion process.

    Your mentioning the plastic item to get the space back to a normal height tells me that your disc is slowly disintegrating. Most likely, at some point in the future (could be 5, 10, 20+ years), if you don't have something done, you will eventually have a bone-on-bone situation. It sounds like a fusion would be beneficial, but only your doctor can tell you that.

    If you are going to have a fusion, June would be a good time to do it. I had my surgery in mid-August and was able to spend a lot of time walking outside. By the end of my first week home I realized how fortunate I was to have the surgery done in the summer. As you can imagine, it would be extremely unwise to walk outside in the winter, with snow and ice on the ground.

    Good luck and keep us posted regarding your decision.
  • I agree that this is personal and that you should have a second opinion from a extremely qualified doctor. I know by now that you must have researched this issue enough so that you can make an informed decision. I would also think about the consistency of the pain levels. When I decided to have a fusion, I did it based on the fact that the pain was constant and I never had a time period of no pain. Then you arrive at point when you say enough is enough and you can't stand it for one more day.
  • Yes, I bet you're right about the plastic cage. He said it would give me more height, which is AWESOME since I'm only
    4' 10 1/2." (Notice I've included the 1/2"... With my height, or lack thereof, I'll take any extra amount I can.) :)
    Also, I thought he said he'd remove most of the disc. So, obviously something would need to go around the center?? Personally, I guess I don't see the big deal. I only wish I would've seen this doctor before having the laminectomy in May. Then, maybe I could've have another option. Who wants to keep having laminectomies?

    Your thoughts about the future are exactly what I was thinking today. My question (to myself) all day has been, "What am I supposed to do? Wait with pain until they decide the disc is flat enough to have a fusion?" Why wait, is my thought. Get it over with, since there is moderate degeneration anyway, and I'm in pain NOW, not 20 years from now.

    Thank you for your thoughts. I'm glad I've found someone else who thinks like me. It's such a hard decision to make, when you hear so many different outcomes.

    Thank you for sharing.

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