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OPERATE or NOT?!! tough decision, advice please!

missmonroemmissmonroe Posts: 1
edited 06/11/2012 - 8:42 AM in Back Surgery and Neck Surgery
My 47 year old husband has herniated discs at L4 / L5 and L5 / L6 and the disc above them was called 'ropey' by his surgeon. He has constant sciatica in his left leg also. and a bulging disc at cervical level.

His surgeon has offered a fusion of the two discs to the 'ropey' one. We asked him why he wouldnt fuse them all and he said 'because we only do a max of 2 here'.

Now I am not a Doc (obviously) but I cannot see that it would be a good thing to fuse to a 'ropey' disc. Surely this would cause more strain on it and cause future problems. ...am I right in thinking this?! It seems to be papering over the cracks to me. He also said it would be at BEST to expect only a 50% improvement in pain and 70% chance of it being worse.

We have not been able to find a surgeon who offers any surgical procedure except this one, and we have seen 4 top consultants in the last 3 years now. My husband feels this isnt the right operation for him but we have not been offered anything else, ever! He feels a disc replacement would be best but the Docs in the UK say more than 1 disc would mean it was too unstable for a multi-disc replacement.

What would you do? It feels like we would be going ahead with this just for the sake of doing something! I dont know, anyone any experience of fusions, disc replacements...or doing nothing even!

We are stuck here, we cannot get on with our lives...is this it?! Just live with it...any ideas?!

PS my husband is also Bipolar II and quite ill, this isnt helping!


  • Spine surgery is not an easy decision to make. There are no guarantees as to whether or not your pain will improve. I had l4/5 fusion and am better than before surgery, but not 100%. Expecting to get back to where you were before having back problems is pretty much unreasonable. I have never heard of a ropey disc so can't help with that question. One of the main reasons to go ahead with surgery is to prevent further nerve damage. ADR in the lumbar area is not very successful from what I have read here. The recovery from fusion surgery is a long one, will your husband be able to handle that mentally? Best wishes to you both on making your decision.

  • I do not know what the standard of care is in the UK, but here in the US, surgeons prefer to not do more than two levels at one time. The risk of failure increases as the number of levels goes up. However, there are a number of people on the board right now who have had three-level fusions (done in the US).

    Sometimes it is possible to do a combination surgery where two levels are fused and the one disc is replaced with an artificial disc. We also have a couple people on the board who went to Germany to have a multi-level disc replacement and seem quite happy with the results.

    Is your husband's bipolar disorder controlled by medication? Some of the drugs given for nerve pain are also given to bipolar patients, in some cases.

    It sounds like your husband has nerve compression from the bulging discs which is resulting in the sciatic-type pain he has in his leg or legs. It will be important to get the pressure off the nerve or nerves as there is a risk of permanent nerve damage.

    There are helpful, informative articles and videos on this website that will help you understand the various options that might be available to your husband. You might start here:



    Usually when there is nerve compression, doing nothing is not an option. The pain becomes intolerable and the nerve compression can lead to other problems as well.
  • SpineAZSpineAZ WiscPosts: 1,084
    While many surgeons want to do a max of 2 levels, you'd think if the an adjacent level showed problems they'd have to go "outside the norm" and do the third level as well.

    I have seen a few L3-S1 fusions mentioned on this site. I am one, but with the exception that I previously had L4-S1 and this surgery was to add the L3.

    Interestingly 4 years ago I had to have C5-C7 fused and C4 had some problems but he said we should just do two to start. Maybe that surgeon was thinking the same way. And now, I may be facing C4 being added to that fusion (possibly as early as this year).

    If you've run out of surgeon options (as you said you've seen a few) ask them this question "After you do this, if the other adjacent level gets worse and requires surgery, what do yo do then?" And then "What if this were to happen soon after this fusion?"

    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
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