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Will a spinal fusion help me ?

AnonymousUserAAnonymousUser Posts: 49,623
edited 06/11/2012 - 7:39 AM in Lower Back Pain
Hello everybody,

When I was 16 I injured myself playing badminton. A year later an MRI showed a bulging disk at l4 l5. I lived with the back and leg pain for seven years before the pain became pretty unbearable. At 23 I had a discectomy/laminectomy and was discharged from the hospital in 5 days. I felt fine ...

I went for a short walk the next day (felt really good to be walking without the usual leg pain) and while walking, felt a strange pain in my back very close to the surgery site. I knew something was wrong and that night the pain increased to a point where I was moaning. I went back to the hospital the next day and was admitted for 3 weeks while they tried to figure out what happened.

The doc who operated me ruled out diskitis because my ESR was not elevated. All MRI's showed "normal post operative changes". So they called it a wound sprain and waited for it to get better. By this time I had scoliosis and was tilted to one side, and was pretty much screaming in pain when I coughed or rolled over. All symptoms were consistent with diskitis, but nothing on the tests proved it.

I was discharged from the hospital after 3 weeks without any real diagnosis and I slept in bed at home for about 4 months. Then it seemed to get slightly better, the tilt got better and I could walk again, though that was pretty much all I could do. Any bending or running was impossible, and if I bent I would bend tilted to the side, bending straight was impossible. At this point I was just glad to be up and walking, so I didnt dare expect anything more.

8 months like this and I relapsed with the same symptoms, a forward tilt and horrible shooting pains radiating all over the pelvic girdle. I went to sleep again, telling my parents that it would take 4 months again like last time and then I would start walking again. The doc who operated me had basically disappeared and wouldnt answer the phone !

Other doctors who examined me decided that it was post operative diskitis even though the ESR remained normal, and I was treated with antibiotics (IV) for 3 months. I wasnt sure if they helped, but after 4 months of sleeping it off, I was able to walk, the pain reduced to some extent. I got on with life again, not daring to expect anything more.

Its been 5 years since then, and I've led a pretty normal life since then, been working a job, been out on picnics, travelled and even lived alone a while. It's been allright except that I have had trouble sitting on the floor, and havent been able to run or jump. There is also pain when I make particular movements of the back, like bending a particular angle. The pain increases at night, and though often during the day I am pain free, sometimes, especially when I lie down after being up the whole day, it pains enough to make me groan.

I'm not sure what I should set my expectations to after all this. Am pretty sure that my life would be better without the pain, and that it has affected me and continues to affect me. Just wondering whether I should reconcile to this and give up the idea of being able to run/jump/sit on floor and just be glad that I am not bedridden ? I'm 30 now and while it still pains quite a lot, I'm not bedridden or screaming in pain, and sometimes that seems like a blessing.

I went to a spine surgeon last week with the most recent MRI's and he suggested that the infection remains there, and that the only way to get rid of it would be to clean out the area and fuse the l4 l5 disks. He said I would benefit from a spinal fusion surgery.

That is where I am today. Any thoughts/words would be appreciated. Needless to say, I'm very scared of spinal fusion surgery.

-Nikhil.
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Comments

  • We can provide information about lumbar fusion. There are a number of people on the forum who have had at least one fusion. There are also excellent articles on this website written by specialists in the field. However, I, at least, am not qualified to comment on any infection, or what sounds like a bone infection. I know little about it or how it might affect what you need to have done to correct it.

    I was not familiar with an ESR test. When I looked it up I found it is what in my location we call a "sed rate." It is a test to show inflammation and I know it is used to find certain conditions such as polymyalgia rheumatica...but I don't know why it was used in your case. What were the doctors looking for? What specifically is infected?

    Any time you add something to the body that wasn't there when you were born, the risk of infection increases substantially. I would want to discuss this issue with your new spine surgeon.

    Please give us a few more details about the infection. It sounds like that would be the first problem that needs to be addressed. I would suggest you get several opinions from different spinal specialists to see if they are in agreement as to have to proceed.

    It sounds like you have a complex problem and will need a very experienced spinal specialist to help resolve it.

    Good luck.

    Gwennie
  • Have you considered getting another opinion from a spinal specialist? It seems that you have already found out that they are not all created equal.

    It is very important to get at least 2 if not 3 opinions. If the opinions are all the same that will make the decision easy. If not they may offer other solutions/suggestions.

    You already know that surgery holds no guarantees of success and sometimes even makes things worse.

    You are doing the right thing by researching and learning as much as you are able. I hope that everything works out well and that you keep us posted.
  • Hi,

    I have met with a lot of spine surgeons in the last 5 years, and they have different opinions on the matter. Some say that I'm in decent shape and they wouldnt do a fusion just to ease my pain. I do not have any neurological deficit, meaning, I do not have weakness in the legs or loss of sensation. The only thing I have is significant pain, and even that varies.

    Some of them say that they would not advise fusion because I'm walking about and leading a pretty normal life, i.e., it doesnt debilitate me or put me out of action, but if it gets too painful then it might be worth it to fuse the vertebrae that are causing the problem so that I will be pain free.

    So thats where I am right now, wondering whether its a risk worth trying. Just wondering, how bad does spinal fusion pain get, especially the graft site? How long is the recovery, and in the best case, will it be completely pain free? Anyone here who has had fusion and is pain free ? Would like to hear some success stories ! :-)
  • Your symptoms sound so similiar to the ones I had before fusion. I had spondylolisthesis of L4/5, which causes an unstable spine. Every slight movement in the wrong direction, and the spasms would be incredibly painful. I'd end up in bed for several days. I could barely walk two feet. I had a bulging disc at L4/5, but the MRI didn't show the slipped vertebrae. It was only seen on flexion/extension x-rays of my back. Have you had a set of those done?

    Best wishes,

    Marianne
  • Hi Marianne,

    Did the fusion reduce that pain ? Did it introduce new pains ? How long does the graft site take to heal, I heard somewhere that that is the most painful part of the surgery.

    Thanks,
    Nikhil.
  • marirlpn said:
    Your symptoms sound so similiar to the ones I had before fusion. I had spondylolisthesis of L4/5, which causes an unstable spine. Every slight movement in the wrong direction, and the spasms would be incredibly painful. I'd end up in bed for several days. I could barely walk two feet. I had a bulging disc at L4/5, but the MRI didn't show the slipped vertebrae. It was only seen on flexion/extension x-rays of my back. Have you had a set of those done?

    Best wishes,

    Marianne

    What does a slipped disk look like on an x-ray?
  • marirlpn said:
    Your symptoms sound so similiar to the ones I had before fusion. I had spondylolisthesis of L4/5, which causes an unstable spine. Every slight movement in the wrong direction, and the spasms would be incredibly painful. I'd end up in bed for several days. I could barely walk two feet. I had a bulging disc at L4/5, but the MRI didn't show the slipped vertebrae. It was only seen on flexion/extension x-rays of my back. Have you had a set of those done?

    Best wishes,

    Marianne

    What does a slipped disk look like on an x-ray?
  • I think she means the collapsed vertabrae, which were clearer on the x ray.

    I did get flexion and extension xrays done recently which also I am planning to take to the spine surgeon whom I am meeting soon. I've decided to leave the decision to him since he has a reputation of being one of the best spine surgeons in India.

    I had almost 15 MRI's over the years, and the doctors all agreed in retrospect that I did have post operative diskitis, and they hoped that over the years my vertabrae would fuse naturally, which would be the best possible result. But unfortunately that doesnt seem to be happening, and so this leaves me at the crossroads I am right now.

    Incidently, if anybody wants to know more about the discitis part, I could tell them what symptoms to watch out for. Its the worst pain I've ever experienced, much worse than the pain of the surgery.

    Would like to hear more about the fusion surgery, whether it can bring back my sciatica which the discectomy has gotten rid of (the only good thing to come out of the surgery)

    Thank you all for your replies.
    -Nikhil Kshirsagar.
  • Hi gwennie,

    regarding the infection, the doctors never conclusively proved that it was an infection because the ct guided biopsy that they did did not find any culture, and the CRP and ESR tests did not indicate any infection. My symptoms though were classic discitis symptoms, I was screaming everytime anybody touched my back or moved me a little bit, I had a huge muscle spasm and was tilted sideways in an S shape. The MRI did not show anything then, but now it shows the discitis related changes.

    I had a PICC line put in and received vankomycin, fortum and amikacin IV for 6 weeks, and though I felt better after the antibiotics, the pain never really went away and I suspect that my body was just learning to cope with the pain and work around it, rather than the infection going away.

    All this was 5 years back, and since then I got slightly better, could do a job and seemed like I had it under control, but in hindsight, I see that it affected my mental state greatly, and I was never at peace.

    I am still in considerable pain, cannot bend without pain, cannot run and seems like its getting slightly worse. So thats why I need to think about the next step.
  • I have never regretted getting the fusion done. I am so much better off. It was a very long recovery and I still have some pain, but nothing like before. I had allograft done, so no bone was taken from my hip. I had a "dead" foot that went away after surgery.

    Best to you,

    Marianne
  • You can see on x-ray that the vertebrae don't line up properly. One disc will slide over the top of the one below it.

    Marianne
  • Only you know what the pain is like for you and as you function decline or not may give an indication as to when is the right time, you condition will not change however many opinions you get and as said even if they all agree this is the best process it may well be better at the appropriate time than doing noting. Have you asked what other alternative are possible and any fusion is not for the most part irreversible and you have to have confidence in that leap of faith that it will in some was improve your personal circumstance more than now.

    How long can you last with your condition like this, can you cope on a daily basis and out of ten what is the pain level for you. If your fusion totally improved your condition we would all be pleased and the risk involved as to and continuing residual pain or symptom after any fusion is always feasible and you have to decide if that risk of the medium case scenario is better then what you have now or in the future.

    My optimum moment came when I could not stand and walking effectively, the condition itself dictated this was the right moment to have my own fusion and as mention I do not regret that decision as being appropriate at that time.

    Nobody here can give you any guarantee only hope of some tangible improvement, we all went into our fusions with the same hope and expectation and the spectrum of favourable outcomes better than doing nothing. It may well be that your diagnosis suggest you are only delaying the inevitable and only your surgeon would know that.

    This is a big operation and you have to be realistic about the overall success, if you have a clear diagnosis of your current condition and have evaluated all other reasonable options, then this decision can only be make by you will all that knowledge and information to hand. Would you swap the things you cannot do for the reduction of pain?

    I wish you well on your journey.

    Badminton…. I played for my town, happy days.

    John
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