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Fusion vs. Revision Microdiscectomy (L5-S1) - update

DNiceDDNice Posts: 1,962
edited 06/11/2012 - 8:39 AM in Back Surgery and Neck Surgery
As some of you know I had a microdiscectomy back in August on L5-S1. I never really got relief (maybe a little week 2 as I did come off pain meds). Long story short, at week 10 we did an MRI and it was clear I had another mass of disc pressing on the Sciatic nerve.

I was getting mixed opinions on revision MicroD or Fusion.
Of course pressed for time with holidays and pending change to my healthcare which will greatly impact the cost to ME, I was confused, feeling pressure, and overwhelmed.

Thanks to this board, I took a breath.
I have done a ton of reading, talking, consulting, and had more than my fair share of opinions from doctors. I even called my current surgeon back to tell him of the conflicting information and he spent a good 20 mins on the phone with me to explain why he was suggesting a revision as well as how, if cost was an issue, they could help and how if needed he would transition my case to an in-network doctor.

So ...my patience paid off. Today I met an NS that agrees with my OrthoSpine Surgeon (as well as 1 other NS).

He spent quite some time with my husband and I explaining how he was reviewing my case and situation and what he looks for. He answered a ton of our questions about the "what ifs".

I am really hesitant on a fusion at this point b/c my pain just doesn't seem to warrant it. However, medically I could understand why some surgeons were pushing it. It's catch 22. One will fix my current issue but has a liklihood to create other issues. The other has a risk of not fixing my issue but is less invasive and considering my history, I still have a good chance of it working if I take recovery and modified life style seriously.

I have decided to try the revision surgery. The doctor said he would just assume I plan for January unless my situation becomes urgent.

Even after making his recommendation (which is the one I hoped he would make) he was still willing to answer my questions about the revision and the fusion.

The most important thing is I have a comfort level with him similar to my current surgeon (who is out of network) (and more so his partner who I really wanted to do the surgery). And this surgeon was the first one my husband felt comfortable asking questions to so it's one we both trust.

I will keep everyone posted but I'm going to try the revision. I want to thank you for your help and support.

I will still continue to read/research/etc. but just wanted to update you.


  • I always opt for the less invasive procedure. My thinking is that if it fails I can always go back for the harder surgery but if I don't try the least invasive I will never know if it mat have worked.

    Good luck and please keep us posted.
  • At your age, I think I would have made the same choice. A fusion is so nasty and it can lead to further degeneration of your other discs. So going with the revision sounds great.

    All the best to you.

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • Congrats on making your decision! I made the same choice as well, I'm still waiting to hear back from NS#2 to set it up.

    Of course, let us know your surgery date! It looks like we'll be heading into this around the same time. :)
  • Thanks all and Farmgrll . . .I will totally keep you updated on my surgery. I think it will be mid January unless I have problems before that. I have a re-assessment appt 1/12 and they said he'll likely want more images so he has his own baseline. I suspect I'll head for the revision shortly after based on my conversation with the nurse.

    I'm glad you have similar decision.

    The one thing I also learned is that this is serious and I have to make my back a priority. I am great at listening to my body and can list what works and doesn't work. But I don't always do what works. I allow the pressure of my job push me to working way more hours than is healthy and need to draw the line b/c if I am not careful I won't be able to work at all.

    So I'm relieved to have taken my time. I am most pleased b/c this doctor both my husband and I are comfortable with.

    I will keep everyone updated. You would be happy to know I now have this thing called a Laptop laidback or something like that. . .it literally lets me lie flat on my back and still type away. Love it.

    More updates as surgery approaches.
  • Having to make the same decision but mine is after a revision failed to work longer than 48 hours! Hard choice :(
  • VinVVin TorontoPosts: 5
    Only problem with a revision is the increasing scar tissue and potential for epidural fibrosis as you start stacking up surgeries.

    So, failed Microdisectomy straight to Fusion seems drastic but I suppose it also has a lot to do with the variables going on with each specific patient.  

    My main concerns would be:

    1. Since the initial Microdiectomy failed, why will this microdiscectomy be any different?
    2. 2 failed Microdiscectomy surgeries and then a fusion will produce a lot of potential scarring around the epidural which could lead to impingement of scar tissue on the S1 nerve, in which case, nothing can really be done aside from pain management.
  • DNice, I was 42 when my back issues started and I also did the revision at L5-S1 due to pieces of disc breaking off. That lasted a couple years before it had to be fused. After having the fusions I wished I had fused in the beginning because I was off a lot of time from work over a 4-5 year period and feared of getting let go. It's probably is a good decision to try again as that may fix your problem. I have always been very active and didn't want to slow down which has caused more degeneration up the lumbar spine in my case. I leave you with this, once they do any work you need to make drastic changes in your lifestyle to get the best results. Good luck and I hope relief finds you.
    TLIF L4-S1 2007                                         TLIF L3-L4 2008                                          TLIF L2-L3 2016
  • Adamo1974AAdamo1974 San FranciscoPosts: 3
    I have a herniated disc in my L5 S1.  I have been having back pain for about 8 years though its been on and off.  Now its totally taken over my life.  I've done the cortisone injections, PT, Chiro and Acu to no avail.  I've seen 2 surgeons and they both said Fusion.  From reading some reviews though it seems like some people go with the the Micro or have had that done with success.  

    @Kbragg what was experience after the fusion?  Did you get a fair amount of relief?  Also I've heard it depends on where the pain is which would dictate what type of surgery you would get.  Mine is lower back sciatic as well as running down both legs including glutes.  So maybe the recommendation came because it's lower back as well?
  • Adamo1974AAdamo1974 San FranciscoPosts: 3
    Here is actually some documentation: http://www.spine-health.com/treatment/back-surgery/failed-back-surgery-syndrome-fbss-what-it-and-how-avoid-pain-after-surgery

    "A discectomy (or microdiscectomy) for a lumbar disc herniation that is causing leg painis a very predictable operation. However, a discectomy for a lumbar disc herniation that is causing lower back pain is far less likely to be successful."
  • smartens162smartens162 Manitoba, CanadaPosts: 361
    I had severe rupture at L5-S1, consulted 3 surgeons and ended up with 3 different recommendations.  The NS said discectomy, the OS said fusion, the spine surgeon from Germany recommended an artificial disc replacement.  I opted for least invasive, the discectomy, in December 2014.  I was a model patient, following post-op instructions, resuming walking and aquacise for exercise, and impressed my doctor, my physiotherapist and the surgeon with the progress I was making.  After a few months, scar tissue was giving me grief, but with physio we were managing  it.  Then at almost 1 year, I re-herniated.  That's where my story stalls, 8+ months of waiting to consult with surgeons.  I have heard from Germany again and their recommendation is the same.  If it weren't for the cost (other surgeries are covered by Medicare, Germany is a $50,000 adventure!) I think I would go for the disc replacement.  But I want to know what my original surgeon has to say about why the surgery failed and what comes next, in his opinion.  My gut tells me that another discectomy is only delaying the inevitable.
    The discectomy was not a complete failure.  At least at this point, I can say that the nerve pain is not nearly as severe as it was prior to surgery, even with the re-herniation.  But things are slowly deteriorating, and I'm needing morphine a little more often now (a couple of times a week, mostly at night).   I really hope I can get to see someone soon, because time is not my friend, here.

  • Jules1JJules1 Oklahoma City, OklahomaPosts: 33
    I am 3 1/2 weeks post Lumbar  microdiscectomy and pain mostly in my rear is increasing. I requested another MRI that is scheduled next week. Anyone experience this? Is it possible this is just nerve healing? If it is reherneated - any comments on revision vs fusion?
  • LizLiz Posts: 7,832
    This is an old discussion created by a member that hasn't been  on the forum for a long time so I am closing it.

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
This discussion has been closed.
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