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Any comments/suggestions on Spinal Fusion?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:27 AM in Chronic Pain
Greetings all,
I saw the Neurosurgeon last week regarding my recent onset of chronic lower back pain. I was so sure he would offer a solution that I could hardly wait to get to that appointment. Wow, was I ever disappointed. He informed me that the "only" solution for my multiple disorders was spinal fusion of the L4-5 lumbar spine. But! Before that can happen I have to go completely off all pain meds!? I found this quite odd. Has anyone else out there been told this prior to fusion surgery? Any and all advice will be appreciated :S


  • Hard to read into what the surgeon meant without being there. I think no one answers because issues aren't clear - what are the "multiple disorders" he referred to, and the phrase "recent onset of chronic low back pain" is a contradiction, was it recent or is it chronic, or do you mean a flare or worsening of old back pain? I can't imagine a surgeon seeing a patient and recommending fusion without exhausting other treatment options (physical therapy, chiropractor, massage, accupuncture, cold/heat, non-steroidals, injections etc.) unless there was spinal instability or risk of immediate permanent nerve damage or paralysis. I think he was might have been baiting you to test your reaction when he told you to stop meds. It seems more logical to me if he feels surgery is really indicated he would think pain meds are a reasonable bridge to surgery. Maybe he is worried that if you are on high pain meds now they won't know how to treat your pain post-op; or maybe he wants you to have some degree of pain so your natural endorphins kick-in first. Did you ask him the logic behind stopping meds before surgery?
  • The "multiple disorders" I have listed in my history - I assume that is viewable to all, I don't know. Anyway, my recent onset of chronic pain, is more clearly defined as a flare-up. I have been in agony since mid October. I have exhausted every other treatment options - you name it, I've done it! My PCP referred me to the Neurologist because of my flare-up. My PCP prescribes my pain meds. I was going to a PM doctor and when the injections didn't work, they basically didn't want to see me anymore. I have a non-working SCS that needs to be removed so I can have an MRI. The only diagnostic test I have had recently is a CT scan. The Neuro. doc. said he would have to have the MRI prior to any surgery. As stated earlier, I have been trying for the past 6 months to have this damn thing taken out! I do have a BIG problem stopping ALL pain meds! Don't they know if I could, I would?! Who likes paying $150.00 every month for Kadian??? Not me! The pain meds do not make me feel "high" or "euphoric", they never did! I don't take pain meds to get High - that is crazy! As a matter of fact, my PCP wanted to raise my dosage of Kadian and I told him no. I wanted to wait and see if the previous raise in dosage worked. I don't know why Neuro dude would be "baiting" me. This was my first time seeing him. I didn't ask him to prescribe anything. I have asked my PCP as well as my PM doctors about the amount of pain meds I am on in reference to having a significant event occur (such as a car accident - I've been in 2 already) I do worry about things like that. My PCP doctor told me not to worry about that, they would maintain my level of pain meds and treat any new "event" as a seperate issue. Yes, I did ask him his logic. He just said that was his policy! These "specialists" I have seen are so full of themselves they don't feel the need to defend their "policies" to mere mortals like their patients! I am located in Northern KY, USA and I have BC/BS insurance and my husband has BC/BS through his employer, which I am also covered on. We both have to contribute to the cost of these policies.
    Sorry this is so long! Perhaps that's why my previous post was not clear. Also, if others can't view my history, let me know and I will put it in the signature tag.
    Thanks again for your input. T
  • give up your medication !! come on .if you could do that you would not require an operation !!!!!!?? is this in the UK or other??? as i am baffled at that request
  • Most pain clinics want to see some reduction to the overall volume of medication that we take and the notion of any initial reduction is upsetting and difficult to accept. You should have been told why this reduction was requested and although at this time you may not agree with the concept, the whole process is attempting to help you in the longer term.

    As time progresses and the medication we use become less effective it may become easier to increased the amount or strength as a consequence and this then soon becomes our norm. Taken to its logical conclusion we could take sufficient medication to make the pain seem less, although our quality of life would diminish proportionate to the volume we consume. We have been programmed to expect that our pain can be managed effectively and nobody equates the levels of pain we are expected to endure and live our lives. These levels of pain in a hospital environment are managed with more sincerity and we accept pain at higher levels and for longer periods than we should.

    Medication alone is not the answer and those who have reached the extremity of volume find that that in itself become less effective over time, swapping other tools and techniques for medication is a difficult concept and required close supervision support and encouragement and this is what most pain clinics are attempting to do, find that balance for us all as individuals, to a more collective approach.

    I have had a spinal fusion and we should all seek the appropriate treatment for us as individuals and accept the advice from a doctor when they are trying to help us, it is not that we have to agree, just do it. Make a plan of how you will reach this objective, and what you do now and what you will do when the pain increases and you do not have the option to increase volume, we do become dependant and that is understandable, the emphasis is on the measure of that dependency. Many others will and continue to attempt what you are being asked, it does take tenacity and courage and an understanding of how that increase of any medication develops and where we are now.

    I found a doctor who told me the truth, he told me what I did not want to hear, however sad that was, I could have searched for someone with a different opinion, would they have told me the truth.

    Take care and good luck. John

  • This must be such an unfair and viscious circle, and i'm sorry for your circumstances. I was reading in the back surgery section a post from Chuck. Alot of his posting related to meds pre surgery and the impact it had on him after the op... because no one told him he should reduce his meds. Thought it may be of interest to you as you find a way towards your surgery and pain management. The link is:


    Best of luck
    L4-L5 fusion 1998; ACDF C4-6 2008; DDD
  • Hi Diamonde, John,
    Thank you both so much for your comments/suggestions! I saw my Primary Care doctor Friday and he was also taken aback regarding the total abstention of pain meds prior to this fusion surgery. He asked if the Neuro guy had given a reason for this ridiculous request. He said he never heard of such a thing. After much consideration, I have decided not to have the surgery at this time. I will however, proceed with the SCS removal. That is if this new pain clinic decides to accept me (I do NOT need to see yet another PM doctor, I just need this SCS removed). It's kinda like being on some nightmarish merry go round dealing with all of this nonsense! At this point, I have seen FOUR different doctors trying to get this thing out. I'm just tired and weary of fighting this battle with these doctors. Thank God, that debilitating flare up I've had since October has let up! I don't know what happened, but I'm just glad it did! I was able to go out all day yesterday and not be in excruciating pain =D> I will ask for my meds to be lowered at my next visit. I absolutely HATE to take any type of medication! Maybe I will not have to revisit surgery any time soon. Best of luck, and pain free days to all :)
  • Oh i'm so happy that your pain has eased :D you must've been over the moon to get out and about and have such a great day!!! My prayers are there for you that it STAYS THAT WAY!!! =D> ##

    Good luck with the future ;)
    L4-L5 fusion 1998; ACDF C4-6 2008; DDD
  • :))( Diamonde, et.,al.
    I sure am over the moon!!! I have been "really" cleaning my house vs the topical treatment it usually gets! We had friends over and I was able to go watch my little grandkids roller skate! What a thrill! They just Loved the fact that I was there watching. They are 3, 4, and 5. I too pray it lasts! I don't know if it was the increase in Neurontin (3 x per day, vs 1 x per day), or if somehow the nerve is not compressed as bad as it was - I Dunno! I just thank God that it's gone. I can live with the pain I am in and have been in for over 5 years. The meds make life tolerable. I will continue to keep everyone on these boards in my thoughts and prayers O:) Wishing everyone a, Dawn of a Painfree Day.
  • month also, becasue he said it was so he could control my pain post op. I went to another Dr cause he also wanted to do 3 level fusion and it scared me. The other didnt make me, but did advise me it would be harder to manage my pain post op. He did say that it would take a little bit after surgery to tweek my meds for pain releif and would have it under control within a day or so. Well, he was right. I woke up in pain but he gave me heavy duty pain meds and it was bearable. I wish I could have stopped before surgery, but I would have been bedridden. He was awsome in working with me and still is working to decrease my meds.
  • My neuro didn't tell me to cut back before surgery. I woke up screaming in pain in the recovery room. They kept giving me more and more meds without any relief of my pain. Finally I just stopped breathing because I had been given so much pain meds but was still in uncontrollable pain.

    What to do? I'm facing another fusion.

    Right now I'm in PT from the first fusion. So I will keep taking my meds right now while I'm in PT but hope to TRY to cut back before my next surgery. I don't have a clue how I'm gonna do it. But right now, I have to concentrate on getting through this season of my life.

  • I'm not sure who you are addressing your questions to?

    If me, I have two crushed discs (DDD). Yes I saw the MRI. I'm on oxy - not allowed any NSAIDs.

  • Hello you'll,

    It's like Zach says about the NSAIDS. I work in health care selling osteporosis stuff. The bone growth cells work in a ratio with those that break it down for renewal. And NSAIDS are known, with chronic use, to interfere with this ratio. In essence, your own cell chew up the bones and the rebuilders can't keep up. So keep away from those NSAIDS, take your calcium and Vit D. Don't Smoke! But I find it ironic that when BMP causes overgrowth, should you start smoking and stop calcium/vit D? My NS just stared into space after I dropped that one on him!
  • when i had my first fusion 7 years ago, we were supposed to attend a class given by the hospital. one of the guys in the class told us that he was told by his dr that he had to get off all meds before surgery, so he went through rapid detox. i guess the rationalle was that it would be easier to treat pain if you started from scratch. my dr did not make me, but pain dr was concerned that they might not be able to control my pain since i had been on meds for a while. good news, pain was controlled eventhough i have been on large doses of pain meds. i had no problem. i guess it is up to individual drs about going off. rapid detox is best way because it is quickest. if you are weened off, it takes a while to get you off, rapid detox takes about 8 hours
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • Hi I am UK based & have never been asked to reduce medication before surgery. When I had my two level fusion & 3rd level dynamic stabalisation I checked with the anethetist whilst waiting to go down to theatre (2hrs before) as my pain was gettng quite bad & they happily gave me liquid morphine. The only thing they harped on about before the surgery was me cutting down on my smoking as it can affect the bone graft & the fusion. there is absolutely no way I could go cold turkey. DB
  • I am not a doctor and am only talking of my own experience.
    I had an L4/L5 dischectomy and fusion in june 2010. I sustained severe nerve damage and have a partially paralyzed leg,back pain and on more pain meds then I was on before surgery. I put off surgery for 7 years and only wish I never had it.
    Now instead of suffering thru a day of work and being productive I am suffering significantly more but am unable to work. Not the outcome I wanted.
    I think the medical misrepresents the success rates of these surgeries so before you agree to surgery seriously weigh the possible outcomes and make sure you are willing to live with the consequences of your decision.
    If you have only seen 1 neurologist I would recomend seeing at least 2 more to get a consensus on the need for surgery but also the type of surgery you need.
  • Post is from 2009. In case you did not notice. But i was never reduced on meds before surgery. But thats probably cause i am on low dose of meds. If someone is already on very high dose of meds then i could understand dr asking patient to cut back before surgery so the meds they give you after surgery for the surgery pain will have some affect on a patient.

    If someone already taking morphine for years how will it help when they give it to ya right when you come out of surgery. My theory is before anyone should be taking such high dose of meds should of already had some sort of surgery to prevent having to take such high dose. How can these dr,s. Put someone on fentynal and morphine and they done nothing to fix the problem.

    I never did understand it because idea is not mask the pain if it has to be fixed. Only when surgery fails then its a diferent story. But i see many people mention taking morphine and diladid or fentynal without ever even going in to surgery as if these meds was some over the counter meds or something.
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
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