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I got two opinions and am more confused than ever

AnonymousUserAAnonymousUser Posts: 49,670
edited 06/11/2012 - 8:29 AM in Back Surgery and Neck Surgery
I just got back from a second opinion as my NS recommended a L5-S1 PLIF. Well the second opinion doc who is an ortho believes that a one level fusion is not warranted as I have serious issues at three levels and therefore he would do a three level fusion. He also states that doing a one level fusion would only delay the inevitable because the other two levels would need to be fused later. The ortho follows this up by stating that be cause I am so young (37 y.o.) and that I have only mild weakness in my left left ( which requires me to use a cane), if he were me, he would not get surgery at this time even though it could help me. Be advised, I have already had two failed Micro-d. I just don't know what to do now and would be grateful for any input.


  • I like that the OS is being conservative. My OS, whom I trust to a certain degree, wants to fuse me if my second MicroD fails. I am 39. If fusion is proposed, I would get another opinion.

    Can you get a third opinion?
  • No one has ever said "you have to have surgery". I've gotten the speech, well you can tough it out or....It's all up to you as to what you think you can deal with. Leg weakness isn't something to sneeze at. When I came out of my first ALIF fusion on L4/L5 I had left leg weakness that caused me to limp and I couldn't lift it to get in the car..all of that. It finally resolved itself by the time I had to have PLIF 6 mos. later.

    What do your other levels looks like to you on the MRI or whatever tests you've had? Are they bulging already pretty badly?? If I were having L5/S1 fused and the two levels above it were already bulging encroaching on nerve roots or the spinal cord more than mildly, I would opt for a 3 level fusion too. If they aren't bad, then I would only do the L5/S1. I've read that the L4/L5 seems to be the area where there is more stress and torque forces in our movements than the other L's.

    With leg weakness, I'd definitely want surgery to correct the nerve problems there....no matter what! I would not want permanent nerve damage if I could help it.

    You are young. I've had L3 - L5 fused and I'm very surprised at my mobility and movements. I thought I would feel like I was stiff as a board, but I can bend, twist, do whatever. I still have some stiffness from time to time and achiness, but I'm only 5 months out.

    Good luck with your decision. Read, research, think, look at your reports and films, get copies on disk if you don't have them. Be your own advocate and make decisions based on all of the above. Only you know what your body feels like, what you can handle, what you want to do, what limitations you can live with or can't. Be strong!

  • Could you tell us what your MRI shows? What is your diagnosis? At what level did you have your discectomies?

    90%+ of all fusions are done on L4-L5 and L5-S1.

    I would get a third opinion...of course, I'm not the right person to ask, as I saw a total of 8 specialists before I finally convinced myself that a fusion was my only option!!
  • I had two microdiscetomies at l5-s1 in 5/08 and 9/08. I've had MRI and CT scans that show bulging and congentital stenosis at l4-l5 and l5-s1. I've had am EMG that showed nerve damage (without specifying the extent) at the L5 nerve root and the S1 nerve root. I also have a great deal of scar tissue surrounding the S1 nerve root. Teachertx this is a workman's comp injury so I can get as may opinions as I want. Candle99 as of this moment, I've got no indication that the weakness is permanent.
  • that all the nerve root/issues are at L5/S1, I think I would just opt for the fusion at only that level. Some bulging and stenosis at L4/L5 isn't too bad. That is all if you opt for surgery to get rid of your leg weakness. If the EMG showed nerve damage, over time, that can become permanent. Nerves can regenerate somewhat, but it's a slow process, and sometimes painful one.

    Getting the scar tissue off of the S1 would probably do a great deal towards your problems. That might could be done with a minor surgery without the whole fusion idea. You could have a 3 inch incision on your back and be back in working order in a month.

    Another doctor opinion would be a good thing.
  • Have you had a discogram done yet? I found it pretty good at determining exactly where my problems were coming fron - which disc. It also made me feel much better about going 'under the knife'
  • How did the doctor determine that the second Micro D failed? My two microD were at L5S1. I am really trying to stay positives and careful. This is nerve wrecking.

    I wish you the best of luck! Please keep posting about your progress!
  • gwennie17gwennie17 Posts: 2,957
    edited 06/17/2016 - 2:06 PM
     This is only being done for L5-S1 and you might have to travel to find a spinal specialist who is trained in the procedure, but it is a new technique that offers a fairly quick recovery time. Obviously, this would only be done for a one level fusion.

    However this would probably not address the stenosis issue you have at L4-5 and that very well could be the source of your pain.

    Do you know if the stenosis was addressed during your discectomies?
  • I had a discogram a few months back. It is a very strange process & hurt a lot but it was worth it to be more specific on the diagnosis.
  • I'd say definitely do your homework and get 2nd, 3rd, 4th opinions until you are certain that more than one surgeon is on the same page, you need to definitely NOT be "more confused than ever"
  • A fusion is not an easy procedure to recover from and there are no guarentees. Get as many opinions as it takes until you are not confused. In fact, after my husband's first failed surgery I refused to let anyone take him back inot the OR until we had 2 opinions that matched. As patients, we deserve, and sometimes need to demand, much better explanations thatn we get. Good luck, Terri
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