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To Fuse or Not To Fuse

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:39 AM in Back Surgery and Neck Surgery
Recently, my dad had back surgery to eliminate the pain down his leg with a scrape of the vertebra and partial removal of the disc. He was walking 2 hours after surgery and came home that same evening. He had the same symptoms I'm experiencing. So, when I had my appointment with the spinal surgeon yesterday, I was expecting to make a surgical appointment for the same procedure.

To give you a little history, I had an MRI done in 2000 for back pain shooting down my right leg. It showed a herniation to the disc and so I went through about 3-5 months of physical therapy and shock treatments which seemed to work. Through the years, however, I would continue to experience pain now and then off and on and gradually it would get worse and the time span on the pain longer. It lasted up until this past July or so when it was becoming nearly every day with pain, only it's in the left leg now. After the 2nd MRI, there seems to be deterioration between the L5 and S1 vertebra and the space between them has become smaller, not by much, but enough where it's noticeable.

The first doctor I went to was a retired surgeon which my primary failed to mention. His recommendation was a complete removal of the herniated disc and leaving something behind for a cushion so the bones would not collapse.

So, when I went to the second doctor he highly recommended me to, I was expecting the same results.

No to be.

This doctor said that because there is degeneration of the disc that is obviously present, removal of the disc would only temporarily fix the situation. Eventually, due to more degeneration (may be months, may be years), my vertebra would indeed collapse and I would be looking at permanent nerve damage. So, his recommendation is for the removal of the disc followed by fusing the two vertebrae together leaving a space in between or for a Transforminal Lumbar Interbody Fusion (commonly known as TLIF).

80% of patients have had a successful fusion while there is 15% that have failed (estimate). I don't want to be part of that 15%.

Honestly, I'm terrified of this procedure, but I also know I want my life back. But, there's a chance this might not work and that's what is scaring me the most. What if I get worse? But, in the mean time, I'd be able to walk again with having to rest after like 20 minutes. I can sleep in my own bed (which cause tremendous pain currently - and it's a new softer mattress). And the pain shooting down my leg is most likely to stop happening.

I am a 40 year old mother of 2 beautiful and willing to nurse me back to health girls, ages 12 and 10. My husband is being very supportive. I work at home on my computer almost 46-50 hours a week. I know I can still work but need time for getting up every hour to walk around for a few minutes at a time. Can't go outside for a walk in Michigan in the middle of January unless I wanna freeze everything.

The negatives that are possible? The domino effect could happen over time where the next two vertebrae become herniated and so on and so forth. The fusion might not work or growth doesn't happen within the bones and I'm back to square one only worse cause now I have now disc left. A rare instance but still possible: the doctor makes an error and I'm paralyzed for life.

I honestly don't know what to do. The last two weeks I've been nearly pain free. It's like my back decided to get better or else like a child. I know the pain will be back, it always does, but do I fix it now when I'm fine? Or do I wait and run the risk of possible nerve damage that could be permanent the next time around?

I would really like more opinions on this and if it helped them or not.

I'm begging for help or advice. I haven't been myself since yesterday cause I have a date already scheduled and it's in a little over two weeks (the 28th). I'm scared, yet a part of me knows this is a good solution of preventative maintenance for later in life. But there's that part of me that says NO WAY.

Sorry for venting all this out, but I've always been told no question is a stupid question and you won't find anything out unless you ask.

Thank you in advance for your words of encouragement or discouragement. :)


  • SpineAZSpineAZ WiscPosts: 1,084
    Since you are younger the doctor may partly be looking for what works best and lasts longest in an active 40 year old person.

    Perhaps another opinion would be good. If you've seen a Neurosurgeon then get an appointment with an Orthopedic Spine Surgeon. I would totally discount the opinion of the retired surgeon...he can make all the suggestions he wants but if he's no longer an active surgeon he may not be up to date on the research, outcome studies, etc.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Thank you.

    The first surgeon is part-time and minor surgery now until he fully retires from the practice. He did the reconstructive knee surgery on my husband in 2004 so I hold him in the highest regards for his opinion. I can't help it, he made my husband walk again.

    I do believe the surgeon has the best interest in mind for preventative surgery. And yes, I'm still at a young age (even with the grey hair and all) where the fusion might take better than if I waited til I was 50. You know?

    Thank you though, I do appreciate such a quick reply.

    I wanted to add some information. God knows if it help or just be more jibberish coming out of my mouth. I'm known for that. LOL But, this is a spinal injury from a incident in school back in 1986. I was trying out for the high jump but when I landed, I landed on the bar and it went up my back twisted a couple vertebrae the wrong way. I went through about 6 months of chiropractic therapy, but the pain never went away and I had no choice but to do as my mother told me at the time. That's another long story.

    EDIT: And OOOPS, the doctor who recommended the fusion is an orthopedic spine surgeon. Maybe I didn't say that. I sincerely apologize.
  • I had a two level fusion a year ago tommorow. I had torn diecs so I dont know that my problem is the same. The fusion worked, but I still have alot of pain. I also have to add that I have had 9 surgerys in 2 years, so I am sure healing for me will be longer than the average person.
    I dont know if anyone can tell you what to do. If you dont feel comfortable with your opinions, get another and another until you do. I went for 2 years before they could tell me what was causing my pain. I had every test and scan, until I had one that did a discogram and it showed the torn discs. So I guess, my reasoning is, you are going to have a long relationship with your Dr. If you have a fusion, over a year. Make sure you are confident in what you are doing, or find someone who makes you confident. I did, and although my results havnt been what I want yet, I still have faith that I made the right choice and that my Dr will be with me until I feel much better. That is what my goal is. Hope this makes sense. Good Luck. Love Robin
    PS Check with an orthopedic surgeon and see what they say.
  • Okay - here's my 2 cents:

    Have you had a discogram?? You really should. It can verify that the disc the dr. is planning on working on is really the one causing your pain. It sure set my mind at ease when I had to make the decision.

    I had a 2 level fusion about 18 months ago. I had left leg sciatica and CES (very embarrasing and yucky). I did have complications after my surgery (see my signature) and ended up with a numb leg. But - I would do it over.

    I've not had one instance of CES since surgery. The left leg pain is gone. I get little shooters sometimes, but it's not a daily occurance and it doesn't take me to my knees.

    I worked really hard to get back in shape post-op. I've lost 40 lbs and I am incredibly mindful of proper back mechanics. My L4-L3 is close to going out - I want to make it last as long as possible!

    Other than that, I was 42 when I had my surgery - so not much older than you. My NS also recommended fusion because of my age - fusion is the industry standard for younger backs if I remember right.

    I know it's a scary decision. It's so good that you have a wonderful support system. No matter what you decide - you WILL get cases of nerves where you doubt your decision. My philosophy is to always make sure I'm making the best decision I can based on all the information I can gather. After that I don't allow myself any 'what ifs' - after all, what else could I have done after weighing the pros and cons??

    p.s. I was ready to spend life in a wheelchair if I had to to get a chance at a new life. CES is a bugger.(sorry for the language)
  • Everyone on this forum who has had a fusion faced these same questions, concerns, fears. It is completely normal; and most people who do have a fusion comes to a point of clarity; where it all makes sense to them. Honestly, that point is such a relief. That is when you can move forward and prepare for your future.

    I am only 17 days postop PLIF, so I certainly have no point of reference about a successful fusion. What I can say is to do your research, find a surgeon who performs the procedure frequently, get another opinion if you still have doubts. Make sure that you and your surgeon have mutual goals for you and regimens for postop pain management; and stay on this forum...take your time if you can, so that you make the right decision.

    This is a big surgery, and you are the only one who can make the decision about surgery. For me, I was working in pain daily, it was consuming my life; effecting my work, my family and social life. I had to take a chance; I felt it was worth the risks. I did physical therapy and epidural steroid injections, and felt I exhausted all of the less invasive measures. Time will tell....

    Good luck,

  • Hi there,
    I'm facing the same decision but slightly different.
    I had a microdiscectomy (they remove the portion of the disc that is herniated and pressing on nerve). I am not a doctor but the national statistics indicate that this will be a 90% success rate. Personally, I wanted to try the epidural but my situation was pretty bad (ended up in ER) and this was a good alternative. I still took several days and 3 doctor opinions before I agreed just to this surgery.

    Unfortunately, I re-herniated the disc.
    Interestingly, I am faced still with a decision to fuse or not fuse. My problem is at L5-S1 (common) and I am 40 as well. I have finally admitted to myself that 'normal' will likely be different from now on regardless of the decision. I lost feeling in my left buttocks, back of upper thigh, and left heel to outer toe . . .just to explain the symptoms and compression on the sciatic nerve.

    I was told try the revision b/c a fusion is permanent. But I was told by others (dr) that the revision is not likely to work for long and I should consider a fusion. Well, if the revision will work for 5 years, who knows where technology will be and maybe I'll have more options.

    Some things to think about
    - consider getting another opinion and see if you can find a doctor that encourages minimally invasive procedures (i.e. conservative approach to surgery)
    - consider the fact that a fusion IS permanent and that there is a good chance that you may need another one above/below the point in 10-15 years.
    - consider how large the herniation is and compare disc height to other discs.
    - ask your doctor about hemi-laminectomy. I'm trying to learn about this but from what I understand they remove some of the bone so if in fact my vertabrae collapse, the nerve won't be choked. And, they would do this anyhow if they did the fusion (I think).
    - ask your doctor how they will track progress if you opt for the microdiscectomy (non-fusion)? Typically they see you 2 weeks post op and 6 weeks post op. Ask him how he measures success? If you opt for this surgery, be honest and make sure you are honest about progress speed/or lack of. I was not thrilled at 2 weeks but was off pain meds so thought I was progressing. At week 5, I wanted to go in but waited for my 6 week appt and was very clear things were not going according to my expectation. Doctor even agreed and put me on prednison and saw me in 4 weeks. I should have gone in after I knew the prednisone didn't work. I was very clear and he sent me for MRI which confirmed I re-herniated the disc.
    - if you are considering a fusion, ask him about his technique - does he do TLIF and if yes, have him explain it, have him explain the recovery, the pain management, the realistic expectation about short and long term recovery. Have him explain what he uses when he removes the disc . .. does he use a synthetic spacer or bone from hip or cadaever

    I have been using this board, lots of other reading, speaking to my primary care physician, and am lucky to have a work doctor too to consult with. Use your resources and do not rush into it. This way, regardless, you can make an informed decision.

    A fusion is a big decision.
    I had the less invasive surgery (sounds similar to your dad's) and am considering a retry of it knowing full well if it doesn't work the 2nd time, I will have to do the fusion.
  • Oh thank you so far.

    All I do is sit at my computer and cry in fear.

    My problem with waiting is this:

    Insurance - We have a $500 deductible then 20% of bills up to $1250 then it's 100% paid for each person in our family. This is up the end of the year and I'm over the 500 ded easily.

    We are broke, literally broke and although I surely want to do more research, my husband is sick of seeing me in pain. He wants me to have this done too because of the insurance. He is afraid that our deductible will go up and if it did, we definitely could not afford the bill and I would suffer greatly.

    I do not know why, but I feel perfectly fine right now. I did a test last night and slept in my bed which I haven't been able to in the past 6 months. We bought a brand new mattress to try and help my back, but it didn't. I'd wake up and couldn't move without struggling to get out of bed. My legs felt like they were going to fall off. However, I woke up this morning just fine. I've been walking around just fine. Why in world would I be in pain for 6 friggin (excuse my frustration) months and now it decides to stop? When I have to make a life changing decision?

    The orthopedic spine surgeon told me that there is a change in height between L5-S1 from my last MRI which was in Nov from the first one which was in 2000. It isn't a significant amount but enough to determine that it's probably degenerative and it will only get worse as time goes on. How fast will it progess is my MAJOR concern. The first surgeon (who is retired from major surgeries and has 35 more years exp) told me that I could probably go another 2 years or so, IF I can endure the pain.

    I was able to endure the pain for about 2 months, then it became every day with every movement. It especially hurt right after a hot shower or bending down to get the lunch packs out of my kids back packs or to grab my shoes and go to the store. I could not sleep in bed and I couldn't walk for more than about 15 min before the pain was right back again.

    But like I said before, no pain, just soreness in the buttocks and small throbbing down my leg every now and then for the past almost 2 weeks now.

    Back to the orthopedic surgeon and his procedure to answer DNice. The procedure is the TLIF and he uses part of the bone removed to get to the disc along with synthetics. The nurse I spoke with on the phone yesterday with my questions told me he does at least 1 or 2 of these same procedures a week? In her words "a kazillion of them" and I that shouldn't worry, he knows what he's doing.

    The orthopedic spine surgeon also said, they could do the microdisectomy but because of the decrease in height from the MRIs, it is most likely I will end up with a collapsed vertebrae eventually. He said it could be a couple of months or it could take a couple of years. That's a big difference. He said then you're looking at possible permanent nerve damage. Basically he told me that this is more of a preventative measure so that I won't have to face this later in life with the possibility of a longer healing process (you heal slower as you age). He told me I had good bone structure and this is what he recommends.

    I'm calling my primary doctor today and asking for another spine surgeon's number for a second opinion. When I went and saw this doctor, he seemed very arrogant which right away had me sitting very uncomfortably. He had two students with him and never once did he ask if it was ok for them to be there in the room with me. I kind of thought that was a bit rude. And, the fact he made a decision so quickly kinda had me wondering. But then I talked to the nurse and she said he certainly knows what he's doing and has done so many of these that if he recommends that type of surgery then he's probably right.

    I guess this is just happening so quickly because of this STUPID insurance thing that I can't allow my mind to comprehend what I need to do. I feel like I'm in a fast moving movie and can't stop and think. I'm sorry if I'm babbling, but I'm so scared of making myself worse by having the surgery and then I can't walk with my kids to the Wizarding World of Harry Potter or the store or the park or anywhere or not being to "be" with my husband or sleep right ever again. And then if I don't have the surgery and the doctor's right about waiting and nerve damage, what then? I face having to have permanent damage?

    I'm shaking now writing this and still my heart beats so darn fast. I wish I had a magic answering device that could tell me what I need to do, you know?
  • Just a quick short note, that I have an appt. on Monday with another Neurosurgeon for a second opinion. My heart has stopped beating so fast and the shakes have actually subsided.

    This will help me (hopefully) make a good decision.
  • Yes, good for you - the second opinion.

    Let us know....
  • I hate to be the bearer of bad news, but when you talk to these Doctors, ask them what happens if you are one of the 15%. It does happen. You could be one of the unlucky ones that incurs nerve damage from the surgery. The odds of being paralyzed are slim to none. If something goes wrong, you're more likely to end up in pain for the rest of your life. Don't let money be the driving force behind your decision.

    Think long and hard about what you are going to do. Go with the least invasive procedure you can. If a discectomy might work, I'd try that over a fusion any day of the week.

  • Thank you Dave, funny that's my husband's name.

    Anywho, you are not the barer of bad news but of a good point. I know there's that slight chance at being one of the 15%. That's why for the past 2 days, I've spent ALOT of time on the computer just doing research.

    I think I've watched every video on Youtube and anywhere else about almost everything. I even watched a live operation of TLIF and WHOA! talk about ouch!

    I think I just needed to hear that there are other options out there and if it's meant to be for me to have this procedure (the fusion) and both doctors feel this is the best for me and my long history of back and leg pain, then I guess I will have to adjust my life and get prepared both physically and mentally for a life changing process.

    There is something about this new doctor that will also help. I'm sorry if I offend anyone, but the first doctor is 41 yrs old with 11 years experience. The Neurosurgeon I will see on Monday is 70 yrs old with over 35 yrs of experience and still performs surgeries. To me, someone with many more years has a better knowledge of outcomes and what will happen to me since I'm sure that my case (even though everyone is different) might be similar to someone else with which he can dictate what a probable successful procedure might be.

    Sure, I don't want to go through major back surgery. I don't want to be a burden to my family for so long and not work (I keep hearing sitting in a chair at your computer is a no no in the beginning).

    I've been reading and reading and reading and have heard success stories of fusion and even short recovery times. In a good positive note, I have good bone structure, I know this. I had cracked my foot back in 1990 and healed quite quickly. I still have no repercussions from that. I know, I know, foot is different that back. Well, you walk on your feet all the time. :P

    I've also been reading something that if anyone new or old could bare some news for me I'd like to know first hand. I would like to know of people who have had a successful microdisectomy of only one disc and then be fine after wards. You know? If that's all it was and I knew of others who had that and not have any collapsing vertabra after, I'd be so much more comfortable going that route. I already know deep in my heart all conventional or non-evasive measures will leave me only to be in pain later since this has been off and on for over 20 years (boy do I feel old LOL)

    For reference for anyone who may need to see or want to see or new members with questions, I don't mind sharing my MRI images from November of this year.

    Here are the three that I remember the neurosurgeon who recommends the fusion told me about:

  • None of us non-doctors are qualified to tell you if the MRI is good, bad, or worse than any of our own.
    What I can tell you is that my "cross section" MRI you cannot even see the white on the 'left' (which I guess is the right) side. You can see the herniation pressing in the cross section clearly.

    I see the disc height is different but from what I understand, and I am not a doctor, at L5-S1 it won't be as good as higher up. I guess from what I've been told the disc quality is (DDD vs. healthy) is off of the 'lightness vs. darker coloring. but not sure.

    Anyhow - I know you are worried about insurance but just to be realistic and ease your mind a bit on a "rush" decision, a fusion will carry you well into 2010 with appointments. I'm not sure how fusions work. The microdiscectomy includes 90 days post op on appointments with my doctor.

    My insurance changes next year too and I was rushing for the same reason but I just decided that I'd rather make the right decision.

    Some doctors will help you out. You can ask them about "hard ship". I won't tell you they will all help but some will as long as you pay the deductable they will help you with the 'max out of pocket' or they might even help you with the deductable. I only know this b/c this year my insurance is good and the doctor I wanted was out of network but I couldn't really afford to go out-of-network. But when I explained this to them, they said they would work with me and they did.

    I am glad you are going for another opinion.
    There is a balance between young and older doctor.

    Younger ones are probably more trained on the micro surgeries and newer techniques and the older ones have the experience to give you more insight. It's about finding a doctor you are comfortable with and it sounds like the other one was just arrogant and not your style and that is huge.

    Let us know how your other appointment goes.
    My last appointment is Tuesday and I'm also fortunate to get a remote opinion from a spine clinic through work.

    I know if I go for (revision) microdiscectomy I am likely in for another surgery in the future. But hopefuly technology will advance. If I go for a fusion, that's a long healing process and there is a good chance there is still another surgery (fusion) above the spot in store in the future.

    Someone gave me great advice. The fusion is my decision and no one else's. The day I can't be talked out of it, is the day I'm ready for it. So far, I can be talked out of it. Now in a few days I have to weigh my options and some will tell me my decision is wrong and some will say it's right . . .but it's about what's right for me and my comfort level.

    You need to do what's right for you.
  • Everyone is right in that it is your decision to make about your surgery. I had a double TLIF procedure (Fusion at L4=S1 with pedicle screws and rods,spacers) on 11/16/09. I originally went in for a just a single but ending up having a double. I agree with everyone that you really need to like your doctor and be comfortable with him. Mine was a Neurosurgeon and he spent about 45 mins with me, talking and going over test results before he gave me a recomend of surgery and then explained the procedure.

    I would ask your doctor about his statistical info in regards to the 85/15% success/failure rate.
    My doctor said he specifically has about a 96% success rate in his patients with fusion surgery. Which to me is a big difference of the 85% your doctor advised.

    I am also about your age, I am 39, in good health other than my back issues, dont smoke, and am not overweight. I think those are some big factors in personal success with this surgery. *I hope I don't offend anyone*.

    My whole experience with my surgery was pretty "boring" as some people would say. I have had no complications so far, my back pain is gone except for the surgical pain, I feel better each day and hope that my fusion starts soon. Like you I was extremly nervous about the procedure, and the first week is kinda rough, but after that it got better everyday.

    I hope everything goes well with your new appointment!

    Also, I suffered with pain for years off and on, and like you things seemed to get better before the surgery, but I knew it would get worse again. I did physical therapy, epidurals etc. But I did not have a discogram(could not because i was allergic to the dye). I asked my doctor about the less invasive discectomy but he advised me that it would not work for me becuase of the damage and that fusion would be my best option.

    My doctor told me something that maybe might help you. He said even though you will have successful surgery (he is a positive thinker hehe) this will not fix your problem 100% No back surgery will fix you like you were when your spine was healthy. But it will improve the quality of your life, relieve your pain, and you can go back to doing and living a normal life.
  • Most issues have been covered but I would just like to mention that these percentages of success are, in my opinion, fairly useless. Chances are, the definition of success to your surgeon and medical team is different than it is to you, the patient. If a surgeon sets out to do a one level PLIF, performs it satisfactorily and the patient heals properly, the surgery is a success. If the patient still has pain and/or develops a new pain, he does not feel that he has had a successful procedure...but according to the statistics, it was a success. Being free of pain was never part of the original deal. If you listen, the surgeon will tell the patient the procedure will take care of most of the pain....not that he/she will be free of pain.

    I think this is a concept that many of us who first enter into spine surgery do not understand. We think that spine surgery will be just like any other surgery we may have had -- that there will be a period of pain/discomfort while we recover from the surgery itself, and when this period is over, we will be "good as new." To many, this implies free of pain.

    If this is the attitude that we have when we enter into spine surgery, it will be difficult NOT to be disappointed with the results. Any spine surgery usually ends up being a life-changing event.
  • Wow, you are such wonderful people here with great words and great advice. And I'm taking every word and keeping it in a special place in my heart and brain for my appointment on Monday.

    My heart knows that fusion seems too much at this point. My heart also knows that I really don't want this route. HOWEVER, my heart also knows how much of a big baby I can be and how stubborn I am to find a "way out" of this.

    I'm completely aware of that my pain will never be 100% gone. I guess after dealing with this over so many years, the stiffness and aches I get now in my lower back when I sit for a long time for work or even when I wake up in the morning have become like second nature. It's the sharp pain in the left buttock that radiates down the leg to the foot when I do certain things that is becoming exhausting.

    I think if I can find a happy medium where that pain is almost gone and my back may still ache, I could certainly live with that. I already have been and just work with asking my wonderful husband for a light back rub or even walking around until the pain subsides enough to concentrate on my life and kids.

    I still welcome all the advice anyone can give me. Believe me, I'm not looking for anyone to be a doctor here. I just thought that maybe showing my MRI and giving the images I know there is something wrong, that someone else might see it and go "wow that looks just like mine and the doctor only did this" or "yeah, that's about what mine looked like and I decided with the fusion because the doctor told me it would eventually happen". That's the only reason I put those up there.

    Every time I read a response, people here have been in a lot more pain than me. I'm not to the point to where I can't walk at all. I just have to stop at a period of time and rest. I'm not dragging my leg around. But then again, I do look like I'm about 70 or 80 years old when I walk too. I'm just trying to not be stupid and run or do something that will make it worse. And I guess my husband is tired of me crying and slow. It's stress all the way around, even with my kids.

    I need to find something that will become a happy medium for everyone. I know this decision is mine and mine alone. I know this, but I also know that I want my kids to be happy around me and they are, but they know I hurt a lot. And I really need to sit down with my husband and seriously talk to him about the research I've been doing. He's a hunter and also on the go and even though I spent 4 months taking care of him during reconstructive knee surgery, I know he thinks this isn't as bad as it could be. He needs to see this before pushing me to do it first. He needs to support my opinion too.

    Whew, sorry I babbled again. He comes home today after another weekend hunting. I'm hoping we can have that talk tonight maybe before my appointment and when the kids are in bed.

    I'll be back and let everyone know what this new doctor has said.

    Thank you everyone for being so kind and patient with a stubborn person like myself. It's like I have dear friends here and God is blessing me with all of you. Thank you.
  • There are wonderful people on this board...and you will pick up all the useful tips that you'd never hear from a doctor.

    You have a difficult decision to make. I put up with debilitating leg pain for over three years because I kept reading forums and thinking "I'm not as bad as those unfortunate folks..." The thing we can never know is how bad is the nerve compression and how is it affecting the nerve. No doctor can answer this question and there is no way to quantify it. Similarly, there is no way to predict how the nerve will respond after surgery.

    Frankly, compared to mine, your MRI looks wonderful...but what it needs to look like to signify fusion vs. discectomy I do not know!! In any case, I would think the surgeon will have an easy time working on you.

    If there were some way to gather several more opinions, I think you would feel more reassured in your decision. If not, be sure you do your homework and learn what you can about your surgeon. You want to go to the most qualified person you can find, who has lots of experience doing the procedure that is needed for you. Hopefully this will be a fellowship-trained spinal specialist...either an orthopedic spinal surgeon or a neurosurgeon who devotes his practice to issues of the neck and back.

  • I can't really give you advice,but I sympathise completely. I am trying desperately to avoid fusion surgery. I haven't been given an alternative type of surgery; I am told that I would have a decompression with stabilisation by fusion. The thing is, I have been left to make the decision. I intend to keep trying to manage without surgery. Who knows what the future holds, but for the present, I am struggling on.
  • You have not been given an option other than fusion because you have a grade II spondylolisthesis. I am assuming the surgeon is talking about treating the lumbar problems and ignoring the thoracic ones at the moment.??

    I don't believe there is any way to decompress a nerve without causing additional instability, which in your case would be a big problem.

    How many levels was the surgeon suggesting you have fused?
  • RangerRRanger on da rangePosts: 805
    Hi Renee,
    I am with gwennie on this issue and I also agree with your approach to this matter. You are definitely doing your homework educating yourself to make a sound decision. What ever you decide, do not second guess yourself after the fact. Each and every one of us is different, we tolerate pain differently,
    we tolerate surgery differently, and we all heal differently.
    From my first spinal surgery, I did not get a second opinion although I am not saying that was a wise choice. But I did know my spine is very unstable and still is continuing to deteriorate. I did have a choice, fusion, or risk paralysis and/or incontinence, the latter never was an option. My last surgery
    was more than two years ago and if you were to see me on the street you would never know I have a junk vertabrae and severe OA. Since my fusion I have slipped and fallen on ice and it's a great feeling when I can get back up and laugh to myself knowing I most likely made the right choice for myself.
    Keep us posted Renee, take care, and the best of luck to you!

  • The surgeon said he would fuse L4/L5.
    I different doctor said she thought I might have to have another level or two fused as well because of the degenerated discs above and below.
    When I queried this with the surgeon I saw, he said "If it ain't broke don't fix it". I was just glad to hear that at the time, but now I wonder if I would need further surgery at a later date. At some time I will need to have a second opinion, but for the moment I am working to avoid it.
    He didn't mention the thoracic problems, and at the time I didn't think they were too serious. Now, I wonder; but they aren't giving me too much trouble. I have more pain in my neck; that hasn't been scanned, so don't know what is going on there.

    I wonder if the problems in the thoracic area are caused by the different loading of my spine due to the spondylolisthes. I don't know. I've got an appointment to see my GP after Christmas. I'll mention my headaches, slight occassional dizziness and occassional slight tingling/pins and needles in my fingers on both hands.

    I try not to worry too much about all this, but sometimes I feel quite scared!

    I expect you know what I mean; that's probably why you also tried to avoid surgery for so long.
    I do get a lot of pins and needles in the toes of both my feet and stabbing pains in my toes. I get cramp and spasms in my legs, lower back and feet too, particularly early in the morning while I am still in bed. No foot drop.
  • Great input from so many.
    One of the neuro surgeons I met who wants to fuse me was very honest. He said my satisfaction will depend on how satisfied my nerve is with the decompression. He was very clear that if my nerve doesn't recover, I will not be happy with the surgery but that I won't be happy with no surgery either b/c the nerve has no chance of recovering while it is compressed. So he said any surgery will at least give me a chance of letting the nerve heal.

    Such a big decision.
  • and I'm all for this second opinion.

    I'll give an update later when I come back home as to what was said.

    *hugs to all*
  • Good luck. Now you will have some new ideas as to what to ask the second opinion doc.

  • Well I had my second opinion.

    This doctor said my degeneration looks normal for a 40 year old woman except for the bulge. And because I'm not in the extreme pain I was before, to not do anything at this point. He has told me to get an xray of my back for stability in the spine. I will do that next week. I have an appt in January for a followup with this neurosurgeon and we'll see if the pain has stayed away.

    He recommended the microdisectomy for me if the pain comes back. He said they'd only take out what pushing up against the nerve (shave the disc) or I'd have the risk of fusion in the future. He told me that if I can endure the pain and even if it did come back, to endure it again. If it goes away and comes back, endure it again. Only when I experience numbness or pain to the point I can't handle it anymore, should I consider any kind of surgery.

    He said I need to look out for me and once you start doing surgeries, your chances of having more go up. He said the fusion would probably cause the upper discs to herniate from the strain of the surgery and then there would probably be more fusions in the future. Not the route I want to take.

    I'll keep in touch after the X-rays and possibly to help others who might be questioning themselves. I know how much I needed advice or just a listening ear and if I can do that for someone else, then I've done my part.

    Thanks again to everyone who has helped me. You have no idea how much that means to me.
  • I gather you liked this neurosurgeon? What he says make sense. Just remember to add bowel or bladder problems to the numbness and pain you can't handle any more as a reason why you would need to have surgery. Especially with the lowest lumbar discs, it is very important to be aware of the symptoms of cauda equina syndrome and to seek medical attention if you were to develop any of them.


    My husband ruptured the disc at L5-S1 about 17 years ago. He was advised that he should avoid surgery if at all possible. He went through physical therapy and to this day, does his back exercises every single day. He knows his limits regarding activities that are hard on the back and he did give up playing ice hockey, but other than that, his life has been pretty normal. It is possible for the disc to heal up and for the pressure on the nerve to recede. It just takes a lot of patience and willingness to endure the pain while it is going on.

    Hopefully your pain is on the way out and will stay away!! Glad you're not facing a fusion.

    Take good care,

  • Glad that you seem to have the hope of avoiding surgery.

    Thanks also (in advance)for letting us know how the x-rays go and keeping us up to date with how you get on.
    You are so right about it being helpful to hear other people's stories and be able to ask questions about how they get on.

    Take care
  • Glad you have hope of avoiding a surgery. It is true about knowing your limitations and taking your back seriously to avoid surgery.

    I most happy that you didn't jump into the fusion. It sounds like you have some options . . .conservative treatment before surgery and if surgery, less invasive.

    I'm interested to hear about your x_rays.
    Thanks for keeping us updated.'
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