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When is Fusion A Must?

Liz49LLiz49 Posts: 39
edited 06/11/2012 - 8:38 AM in Back Surgery and Neck Surgery
I am 49 y.o. and have had back pain for 20 years. i managed it with chiropractic care. About 18 months ago pain began down one of my legs (right). I did all the conservative treatment: steroid pack, phys. therapy and ten 2 steroid injections. The ESI's helped but I know it's only a matter of time til they wear off. I already feel the leg pain sometimes. My back pain comes and goes but it definitely limits my activities.

When do I know if a fusion is the best option? Both a NS and an OS said they would do a fusion on me at this point. Will my nerve get permanently damaged if I wait? Will it be harder for me to heal if I wait 3, 5 or 10 more years? I'm so scared to get the surgery. I have a 9 y.o. and a 13 y.o. who need me!!

This is such a hard decision. Also, what if my husband gets laid off and we don't have insurance in the future?

Thanks for any advice.


  • It is a big decision and of course you are the only one who can make it. Have you discussed with your docs, the issue of permanent nerve damage yet? It's pretty much impossible to say how long and exactly what it will take to do permanent damage, but the docs can tell you if you are prime for it. Once you do permanent damage, then there's no turning back the clock and you are stuck with the outcome which is usually chronic pain and weakness.

    If your spine is unstable, fusion will stabilize it and prevent further damage to the area. So it may be a case where a bit of time off to have surgery now vs not being able to help your kids in the future. The best thing to do is to write down your questions and talk to your doc and get some straight up answers from the professionals.

  • I spent a half hour this morning writing a post to you and the server went down when I tried to post it. Blah!!

    All of us who have had a fusion have gone through all the questions that you are asking yourself. It is a difficult decision to make. It is important to collect as much data as you can. It is important to find a surgeon whom you trust and whose skills you trust and admire. It is helpful to have a working relationship with him/her as you may end up having a longer term relationship than originally thought.

    You might want to get another opinion just to be sure there is not another simpler procedure that might solve your problems. You must also realize that having fusion will not necessarily "fix" all your back problems. Doctors, at best, can give you statistics on results...and what is considered medically successful may not be your definition of successful. Too many people enter into back surgery believing they will come out "good as new." It is important to understand that back surgery will not return the patient to the way he or she was prior to the onset of pain or injury...except in very rare cases. Some will be more satisfied with their results than others.

    There are three reasons when spine surgery is not considered elective. One is when the patient develops bladder or bowel problems and there is danger of permanent nerve damage. Two, when the reflexes in the foot are severely affected and foot drop develops and three: when the patient can no longer deal with the pain and/or the patient's quality of life has been severely compromised. Otherwise, you have time to decide if this surgery is right for you at this time.

    Regarding permanent nerve damage, this is very difficult to predict. All you can do is discuss this with your doctors and see what they say...and whether you believe what they say. There are varying degrees of nerve damage and no one can tell you when a nerve will or will not regenerate or to what extent. So far, this area is still fairly unpredictable.

    The important thing is to find a highly qualified spinal surgeon, gather as much information as you can, ask all your questions, discuss it with your family and try to make the best decision for you. If for some reason you were told you could not have this surgery, how would you feel?

    I personally do not thing age has a lot to do with outcome. Most younger people heal faster, but that does not mean their have better, more successful outcomes. If your health remains the same, and you can maintain your weight and some degree of conditioning, it probably doesn't make much difference if you have surgery next week or down the road a ways. My 87-year old MIL had the very same surgery I had a month after me and her healing was just a tad slower than mine...and I know she took far fewer pain meds than I!!

    It is a tough decision to make. Please feel free to post with your questions and comments. There are many of us on the board who have been through this and would be happy to share our experiences -- the good and the bad. But, as "C" said, talk with your doctors....perhaps they will say something that will help you make a decision.

    Good luck.
  • My feeling is this- when you decide that you have had enough! My decision came when I realized that there wasn't a moment in my day when I wasn't aware of my pain, it wore me down and I had just had enough. That is the feeling you look for, when you can't live a normal life and you realize your chronic pain has taken over and it has become the biggest factor in how you plan your day. You will know it. I woke up one day and weighed the pro's and con's and realized how exhausted I was from it all. Still not 100% sure it was worth it, only 10 weeks out, but there is hope!!!
    I hope this helped, keep us posted.
  • Both my L4-5 and L5-S1 disc had extensive herniations, and I was in excruciating pain no matter what. I couldn't even walk to the bathroom without a cane, and some mental preparation beforehand. My Dr gave me 2 options. The first was microdiscectomy which would probably give me relief from my leg pain, but probably not my back pain, and it wouldn't be a matter of IF I re-herniated, but WHEN. My second option was fusion, which of course would give me significant if not total relief from my leg and back pain as the offending discs and herniations would be completely removed. So even though I am only 30 yrs old, I went for the one big surgery, rather than multiples over time.

    And it was the best decision I could've made. I'm just a little over 3 weeks into recovery and feel great! I have ZERO leg pain, and really ZERO back pain. I have a little bit of stiffness at the surgery site, but I can't even call it discomfort. I've already weaned myself almost totally off of all pain meds (and only take the 1/2 pill twice a day to avoid withdrawals).

    I will be back at work next week (at week 4 of recovery Dr actually released me at week 2 because I have an office job, but I chose to take 2 more weeks so I could get as much of my strength back as possible.) and have been driving since week 3. The only things I can't do are those within the basic restrictions (NO BLT).

    As others have said, it's about how much pain you're in, and what kind of quality of life you're looking for.

    Hope all everyone's posts help you with your decision.
  • Awalker819:
    Boy am I wishing I was you!! I am 10 weeks out (front and back alif 2 level fusion) and still feel fragile and have back pain often. Still not sure if it is surgical pain or continuation of my original pain. Bet it felt good to go back to work!! Congratulations and keep up the good work. May we all do as well as you!!! (Maybe you could sprinkle some of your wellness around the forum!!! Like pixie dust!!!) So nice to see a good outcome once in a while. Thanks for sharing.
  • Rachel,

    Thank you for your post. I am having a PLIF on 11/23/09, and this is exactly the conclusion that has helped me to be at peace over my decision to have surgery. I may have an hour or so of minimal pain daily, otherwise it is severe with profound numbness in my legs; but that is the only time I second guess myself. Another factor is guilt over having to go on disability from my company. I've always had a very strong work ethic, and that still bothers me. Bottom line though, my job now is to become healthy again, and surgery seems the only option. Just know I can't keep working in terrible pain.

    How are you doing 10 weeks out?

  • I'm so glad you're feeling good, Awalker819. What great news! Just go slow with regular activities. Sounds like you had two levels fused, is that right? Just curious -- did an orthopedic surgeon perform your surgery?

    I also want only one surgery if at all possible. The smaller surgeries can leave a lot of scar tissue behind. Thanks for responding and stay pain-free!
  • Thanks for answering me, mamainpain. I'm so sad you have pain. But you had the courage to have the surgery! That's very brave. I guess you're right -- when the pain is unbearable there is no choice.

    How many levels did you have fused? Was in anterior or posterior? Did they use a peek cage? Was your surgeon an orthopedic surgeon?

    Take care and know my prayers are with you for a good, solid healing!!
  • I am 46 years old and will eventually need a fusion. I chose to wait it out as long as possible. Who knows with any luck maybe a better alternative will come along. I think that there is a very valid reason that age would make a difference. It is the same reason that some surgeons will not fuse people that are young. When you are fused there is a likelihood that the levels above and below will weaken with time and also need to be fused. The younger that you are with the first fusion the more time you have to need more surgery. That is just my opinion from the knowledge that I have gained. It gives you another perspective on things. Good luck on making your decision.
  • I also used chiro's for ten years before opting for fusion. I did not have numbness until the last 2.5 years in my right foot, back pain was intense. A discogram proved that the disk L5-S1 was the pain generator. Fusion in Oct 08. Now less back pain but right foot has permanent nerve damage. Did I wait too long? Who knows, it is done now. I am on as much pain meds as before MS Contin, lortab, zanaflex, & neurotin. Am I better than before, Yes. We are all different so one person nerves do not get damaged where anothers will.
    Only you and your Docs can make the call to do the fusion. Sorry to sound negative, it's just what happened to me. Good luck in your decision. I have three girls 12,14,& 17. they were a big help & I am sure yours will help take care of you. God Bless,
  • Yes, I had 2 levels fused. I had and open TLIF, L4-S1, and it was done by an orthopedic surgeon who is a spine specialist.

    Age was a consideration for me too, as J.J. mentioned, the issue of the fusion making the levels above weaker was something I had to think about. Lucky for me all of the higher levels are in great shape, so with some effort to be careful in the future I may be able to avoid damaging them.

    For me being young (and a former athlete) also played a big role in my recovery. I had great core strength which meant I needed no braces, walkers, etc., and my bones were dense and strong which will probably help avoid hardware issues.

    It wasn't a decision I had to mull over very long, but it was still difficult, as is any decision to have surgery.
  • Thanks for the response, awalker819. You sound like a strong woman. I am leaning toward an OS, spine specialist. What caused your injury to your spine?

  • Your fears are understandable. The other posters are correct. You need to decide when the pain is unbearable and when you feel you don't have good control over the rest of your body. I was beginning to develop bladder problems, I really couldn't walk very far at all, and the slightest movement could have me in tears. I HAD TO do something. It took me a while to find a surgeon who would do three levels, but I found a talented OS who is in a spine center. Did it fix everything? No. But I am SO MUCH better than I was before surgery. I can walk, I can crouch down to get things, and I can sit in a chair for more than 15 minutes at a time. Best of luck to you.

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
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