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Should I -----

rugmankcrrugmankc Posts: 131
edited 06/11/2012 - 8:43 AM in Back Surgery and Neck Surgery
-----have surgery now.

59 years old, relatively good health. I have a grade 2 anteriolithesis at l4 and l5 with no disk in between, bone on bone. Mild scoliosis, and some pars fractures at l4-l5. Orthopedic surgeon, good one, wants to do decompression and interbody fusion on l3-l5 with some bone removal at back to make more room for the "squashed nerve". Rods and screws. Two other spine surgeons agree. Have had this condition for many years, but other than some lower back pain on and off no real problem. Last year in March after some out of the ordinary lifting and carrying I had 6 months of severe pain and wanted surgery desparately in December. Due to some medical issues with my wife, I held off. I take Mobic and six 325mg tylenol a day and an occasional vicodin.

Lately the pain is not as bad unless I overdo it. Still have lower back pain, sciatica, groin pain, and foot pain. But, no where near the 6 months last year. Weak legs and very occasional numbness in one leg at a time.

My delemna is whether or not to now hold off until it gets worse again. Will this type of structural damage I have get worse or have I seen the worst, since the nerve is already pancaked at l4-l5.

I have some other possible surgeries I could do, like the thumb and shoulder. Not sure if the groin pain is related to the back, have not had that xray'd yet.

If I knew it was inevitable, I would do it now at 59 while I have access to good Dr's. Also, my wife's issues may return and we can't afford to both be down at the same time. I can live with the current pain levels although they do wear you down long term.

Looking for anyone with similar spine issues who has had them long term with no increase in severity. This is a tough decision when you have up and down days/weeks. The surgery is serious and I could be no better off, or worse after. I am a good candidate and the Dr's I have seen and would do the surgery are highly rated.

Any thoughts, I know it is ultimately my decision and no one knows for sure how things will progress on any one individual. But other insights and personal stories help.

Last issue, is the Dr I prefer for several reasons is about to leave area, so I am now pressed for time. Not good when making a decision like this.



  • You have laid out the dilemma well. With a grade 2 spondylolisthesis, there is always the likelihood that more instability will occur. This will probably result in further nerve compression, which could lead to permanent nerve damage.

    Chances are good that the groin pain you feel is related to the nerve compression that is causing the sciatic-type pain you are experiencing. I'm just guessing here based on my experience, but often when pain is intermittent, it is due to instability. At times the bone slides a bit causing stenosis, which pinches the nerve. The nerve can become swollen or irritated, which increases symptoms. When the irritation goes away, or the bone slides again, the symptoms can go away.

    One thing I would suggest discussing with the surgeon you like best, is whether he sees any new technologies on the horizon that would help your situation...something newer than having a multi-level fusion.

    I went through this same thought process beginning about 4 years ago. I explored all my options for about two years. I was assured by a number of specialists that due to my spondylolisthesis, I would not be a candidate for any of the newer surgeries, and there was nothing in clinical trials that would replace fusion. When my situation got so bad that I was barely leaving the house, and I realized there were no other options for me, I decided to go ahead with fusion.

    I think it is safe to assume that your condition will not get better. Chances are it will eventually get worse. But maybe you'll be lucky and it will just remain the same. Then it would boil down to how well you tolerate the pain...how much your life is limited by the condition, etc.

    You may think the nerve is pancaked now at L4-5, but it is not severely compressed or you would have worse symptoms. You can run a search for a "dermatome map" to see what area the L5 nerve innervates. In this regard, you could get worse.

    Feel free to ask questions. Many of us on the board have had fusion. A number also have spondylolisthesis. Ultimately it is your decision. But perhaps we can answer some of your questions....

  • qwennie17,

    Thanks for the quick response. I was showed the nerve entrapment and it is all black and looks pretty flat. The pancaked term was from my Dr. Squashed from another surgeon. I will google the term you listed. I think your right on instability, my flexion films show some movement. But, I can't just lay around doing nothing. I am halfway convinced it will get worse, the Dr said it will not get better. With the movement and fractures, I do not want to try decompression. I was told by one surgeon it would not help in my case. If I do not decide tomorrow, I may wait till December. Not aware of anything new coming soon to U.S.. Once fused and successful, I understand you can pretty much resume normal activities.

    Hope to hear from others with slips like mine.

  • It's awful when you having to make the decision on whether or not to have surgery.

    I had spondylolisthesis L4-5 and was fused 5.1/2 months ago, and I have my life back again. It was bone on bone and I wasn't getting any better, but wasn't getting worse once I retired. I had a decompression the previous year and it made the instability worse and I thought "I don't want to live like this for the rest of my life - can't do this, can't do that". I'm in my early sixties and thought best to have surgery while I'm still in good health.

    Let us know what you decide to do, and if we can help you, we will.


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • I have very similar problems to you and really struggled with the decision of whether to go for surgery, not least because I was so scared.
    First surgeon told me it wasn't inevitable that I would need surgery, but a couple of doctors/specialists felt pretty sure I would end up down that root.

    Second surgeon said it would definately get worse as degeneration and arthritis had set in. He said I would end up in a wheelchair due to leg weakness and eventually would lose bowel and bladder function due to the severe compression I had on my cord and nerve roots. He gave a 90 percent chane of significant improvement. That made my decision a no brainer.
    I am 2 and a half weeks post surgery now and doing very well. I am looking forward to a much improved life, although I have been told that I will always have trouble with m back (I have other problems higher up). My leg problems are already very much better.

    I am 54 and my surgery was a decompression by discectomy and laminectomy with fusion at L4/L5. He also decompressed the levels above and below as when he saw them, they were worse than he had thought.

    I had asked about emerging new techniques, but a specialist asked me if I would want to be a guinea pig! Especially when there was a tried and trusted way of dealing with my problem.

    Hope that this helps. Keep learning all you can and stay Reading here and asking questions. Let us know what you decide.
  • G'day Ken,
    I'm a 46 year old male in pretty good health too. I decided on fusion for my spondy. and had it done early last Nov. I, like you, wasn't really getting worse but I wasn't getting better. My decision process (since you asked) went something like this: Two surgeons saw me. One said I could put surgery off until I "started pissing on myself" and the other one just said I would need fusion. Flatly, just like that, I'd need it. Now, I could see for myself on the x-rays that something looked bad back there at L5/S1!
    Still, I was working and functioning at a pretty good level, so it was hard to intentionally undergo surgery when I felt sort of good.

    I thought Hmm..I'm not getting any younger. I was healthy (other than a 15% slippage), and have good insurance. The stars were not going to line up any better for me, so I pulled the trigger on fusion. I now have four neat titanium screws and stainless rods in my back. I feel, on the whole, much better, although I still can't lift anything heavy at all without feeling it. I'm still off work due to lifting restrictions.

    Ken, I'm sure I didn't help you any, but I want to tell you that I'd do the fusion surgery again if I had the chance. Yea it's a huge deal and a big decision, but I do feel better. Just be aware, for better or worse, this surgery can be a real life changer!

    Good luck,
  • Our backs were not designed to work, or last, with a bone on bone situation like yours. The 2 bones are going to continue to wear so your nerves will continue to be compressed even more. There is a point where a nerve will not recover from this type on damage and you will end up with what you have. This is up to a Dr. to decide with their somewhat limited bag of tests, knowledge and tricks. Bone on bone is not a OK thing whether you feel good some days or not. Try staying off the meds you are taking to see how you really feel.

    Everybody is different in how they respond to surgery and how they do going forward after surgery. I will say this that once your back starts slipping down the "Bad Back Slope" it will continue. Its just a matter of how fast. This one of the reasons you see/hear of so many people that have to have a bunch of surgerys. A lot also has to do with how your preserve you back and what your type of work is. You should not be lifting now and should not lift after surgery. Most Dr.s will not tell you this as they want you to feel that you will get your life back as it was. This may be true for a period of time but eventually the upper and lower disks will start to have problems. Any type of fusion tranfers the weight of the back onto the upper and lower disks that are above and below the disk that is removed. This is why I say no more lifting. This is extremely hard to do as most of us prior to surgery don't even think about lifting stuff.

    Don't let it scare you into doing nothing. To me that is the worst thing to do. Do your homework and get yourself educated about your situation. You said you are feeling pressure because a surgeon may be moving away. You will need to be followed for a long time after any surgery so I would make plans to go to where ever he moves to to get treated. This certainly is not the easiest way to have to do things but it is way better then having just any Dr. do your back work. Keep in mind that a lot of Dr.s are sweet as pie before and during the surgery process but turn into arrogant asses once they have to deal with meds and any complications that may show up.

    This is just my opinion based on having 4 back surgerys and many 2nd or 3rd opinions. Good luck with your decision.

  • Thanks for all the responses. They have been very informative and have helped me decide to go ahead with surgery. I have done a lot of research and feel it is better in my situation to do this now as opposed to later. I will still have good doctors available. I am retired military and the one I want is leaving for 6 months. But another will be there for a while longer and then goes to St Jude's. They are both fine doctors. There is one off base that is very highly rated that will do followup thru my insurance. Have already met with him too. Just would prefer the base hospital, since my wife had surgery there and I will be in same SIU with a private room. May not have that off base. Unless something changes, surgery should be on the 12th. Still working on that. My job is such that I can stand or sit pretty much whenever I want and no lifting required. Hopefully, not off too long.


  • Welcome to Spine-Health. You'll find a lot of info here and as you already can see, the members are very friendly, knowledgeable and supportive here.

    Everyone did a good job of helping you with your questions, but one thing nobody addressed is of concern to me:
    Last issue, is the Dr I prefer for several reasons is about to leave area, so I am now pressed for time. Not good when making a decision like this.
    If the surgeon you want to use is going to leave the area soon, please keep in mind that you'll need aftercare for at least six months after your surgery. Lumbar fusion recovery is a long road and if this surgeon won't be there for you after your surgery, you might want to consider someone else. I can't imagine changing surgeons in the middle of the lumbar surgery and recovery process. Just a thought.

  • Ken,

    It sounds like a good decision. Please report back on how you do as you already have a bunch of spineys wishing you well.

  • Geez I thought I was quick at getting this medical stuff done. Good for you making this tough decision. Make sure you look at the surgery sticky notes up top. You don't need everything but you will need alot. Guaranteed there are things you never would have thought about on your own.
  • Thanks again to all for your caring comments.

    I have been researching all this for a year and monitored several heath forums including this one and have a pretty good idea of what I need and am comfortable with the doctors that will still be here.

    My wife is here to help and still have a 28 year old son at home and a 38 3 hours away. Can't cover all possibilities, but feel pretty good. My wife and I have had operations before, hysterectomy/angioplasty, so feel "pretty good" about preparation. I strongly believe this would need done at some point with my particulars, so now is as good as ever.
  • Sounds like you have been working towards this decision for a while.

    April 12th! Not long to go. Have you thought and prepared a recovery area in your house, where you'll be able to lie down and watch tv or whatever you enjoy.
    I have a bed in the lounge so I don't feel isolated during the day. It's also nice to have a different place than where I sleep.

    Wishing you a successful surgery and smooth and speedy recovery.
    Do keep in touch, we will be cheering you on.
  • Thanks jellyhall,

    Yes I have, but had to hold off with wife's medical issues. Circumstances as mentioned in my original post have brought me to this decision now, and all the great comments/advice have convinced me it is the right one. I have an area to sleep, firm couch. We have two story. Have thought about a medical bed, but will wait and see. Your signature says 19 days post surgery. Is that accurate and how are you doing. Great I hope.

    It has been good to hear from so many people with similar problems to mine. If I had no slippage with bone-on-bone I may not have decided to do this at this time. Everyones input has been helpful and appreciated.

  • Yes, my surgery was 19th March.
    I'm doing very well - surprisingly so.
    For me, the recovery has been much easier than I had expected.
    I know that I am very fortunate.
    Today, so far (18.00hrs UK) all I have had is 2 Paracetamol at 8.30 this morning.
    I am having trouble with part f my incision which looks like it wasn't closed properly and has an area that is still leaking and not healed. Most of the incision has healed very well. I have an appointment to see the surgeon on Monday for him to check it. When he took the staples out he could see it wasn't lined up properly but said it should heal ok, but slowly. I have also been taking antihistimine tablets due to an allergic reaction to the dressing.
    I am doing gentle exercises twice a day and taking a short walk outside 2 or 3 times a day.

    I was also told that my disc was almost completely gone and nearly bone on bone and that when that happened, the vertebrae would fuse themselves.
    I needed the laminectomy to remove the bone that was severely compressing my cord where the slip had kinked my cord and pulled the nerve roots over,squashing them.

    I am still having some leg symptoms, but nothing like before surgery.
    I am very optimistic that I will make a very good recovery.

    I wish you well :-)
  • jellyhall,

    Thanks for the info, sounds similar to my issues. Glad you are doing well and hope you continue to recover.

    I have heard others mention they were doing better than expected. Maybe most prepare for the worst from hearing about surgeries that didn't go as well and are happy theirs went better than expected. We can only hope. But, you're good recovery minus the stitches is good to here and gives me that hope for a better than expected recovery.


  • Hi Ken. i just wanted to stop by and wish you luck! I also had a L4-5 fusion with a 360 approach, posterior and anterior fusions. A 360 is a difficult surgery ( 2 in 1) but has a 95% success rate.

    I also had bone on bone with severly compressed nerves and the facet joints were also shot with bone on bone.

    My surgery was 5 weeks ago. I had a rough time in the hospital, but I am doing well. Started PT about 10 days after I got out of the hopsital.

    Good luck to you. It sounds like you have it well thought out, with an excellant support system.

    April 12 will be here before you know it. Good luck and keep in touch! take care, Shari
  • Hi Ken---I am glad you decided to have surgery---hopefully it will go great and increase your quality of life.I want to tell you I have had 2 spinal fusions in the last 2 years,and I am so glad I had both-I couldn't walk if I had not.At 3 months post-op I am back to substitute teaching-I still ache and tire easily,but I can walk!I mainly wanted you to hear another success story-and I am 60!It sounds like you are blessed with great doctors,which is so important.Please keep us posted,as we are here for you! Jeannie
  • Thanks Shari and Jeannie for your support. Am happy to hear about so many successful surgeries similar to mine. I will post on my progress after I get home.

  • Surgery was 12 April. Little groggy a and amount fair pain so excuse the typos. 3 1/12 hours on table, what looked to be torture table not surgical. Lot of open spaces and it inverts automatically. L5-S1 decompression, interbody fusion. Left nerve was severely mangled, the worst he hes seen. Right one not as bad. My right side seems to be coming along. Left is quite bad as expected. With some numbness down left side of leg and pain in left foot. Dr said 3 mos on nerve healing. He doesn't think permanent, since there is good feeling and strength in the left foot and toes, especially the big toe. He is well rated and according to other people he works with and SIU nurses and techs, has never had a bad surgery. Hope I don't break the string.

    It is hard to sit too long, but if you exclude the left leg issue, the surgical site pain and right leg seem to be doing pretty good in such a short time.

    MY main problem and question concerns my stomach. in the hospital I had lots of pain, especially left side. Was given morphine, dilaudid, valium, and percoset. Have percoset, valium, and dilaudid at home. Do have instructions on when and to take them. My wife over sees that and me. Bless her. I was told to start back on my heart meds, also.

    I have nausea, gas pains, and a very overall sick feeling as it relates to my stomach. Had one suppository in hospital and it worked. That was Wed and none since. Will have wife get one today and try. I pass a little gas, not easily. But, no bowel movement. I had no diet restrictions day before surgery. Lots of burping and nausea, no vomiting. Is this all normal. I ask because years ago I had a stomach issue like this to erthomyiacin, and maybe because I took it the wrong way. With all those hospital meds going down, and some with no or little food, could that be the problem. How long do I wait to address it to the Dr.
    I have very little appetite.

    Stomach and left leg aside I am quite pleased.

    My biggest suggestion to others is if you have structural damage like me and leg and foot issues, don't wait. You only risk further damage and and a tougher recovery. One lady on one of these boards waited to long and is now in a wheelchair.

    I had a bad slip and bone on bone with svere nerve entrapment. He cleaned out a lot of spurs and bone to make room for the nerve and felt it better not to totally realign the vertebrae. That would have taken more scrapping and could have caused other recovery issues. This will work great and reduce further stress on upper vertebrae. I trust his explanation and wonder how many Drs would have forced the alignment and caused more problems down the line.

    Does on feel a medical would help, since we have two story. Haved not tried the steps yet.

  • So happy for you Ken that your surgery went well and that you are now home and resting comfortably. I'm not sure if you had an anterior fusion, posterior or both.

    I had both (with a 6-7 inch insion on the left abdominal wall)and I had quiet a bit of stomach and GI discomfort. It was as if the whole GI track was imflammed and angry from being moved around. I had some complications with pneumonia and blood transfusions, so not the typical hospital stay. I also didn't have an appetite for several week.

    Others on this forum had constipation issues and I was scared to death, so I used MiraLax as needed. It doesn't have a taste at all! You can mix it with anything and not taste it and there isn't any cramping. If it had been 2 days and nothing, then I would use it.

    Little by little, the GI problems got better.

    I also tried not to evaluate how I was progressing day by day~instead just getting through 4 hour blocks of time with meds, changing positions, walking, and resting/sleeping.

    So glad you are home and it sounds as if your wife is loving and supporitve! :) Good luck and let us know how you are doing! Shari
  • Thaks for the support and feedback. I didn't read much on the stomach issues the past year, so not prepared for the pain and burping as soon I eat or drink. My wife picked up some sennicot that they gave me in the hospital for me to try. If no luck will try the miralax.

    I am sure this will "pass" lol. I am just hoping my left leg nerve damage will improve in 3 mos like he said. He is a fellowshipped trained ortho well respected and I counting on that for an accuarate diagnosis.

    Thanks Again,

  • Sorry jayhawk

    It was posterior

  • It sounds like it is a good thing that you decided to go ahead with surgery, and that in the main, you are doing very well.

    The pains in your stomach could well be due to constipation. I had the same thing after my surgery and after several different medication, they gave me a couple of suppositories, which caused the opposite problem initially but then everything settled back to normal. I did start using prunes and lots of other fruit and vegetables in my diet too. I have also had severe stomach cramps due to Erythromycin and avoid taking it now. It is very common to have constipation after surgery due to the anaesthetic and pain meds and also not being very mobile. Try drinking lots of water too. I wouldn't leave it for too long before you ask for help because I think things may get worse and you will end up needing help, so get it sooner rather than later.

    Oh by the way, my surgeon left my slipped vertebra where it was, as it had been there for a very long time, and there would be a greater risk of nerve damage to move it
    Hopefully your leg problems are just due to swelling or irritation that will settle down.

    Wishing you a good recovery. Follow the rules and get plenty of rest and lots of short walks. I was able to go upstairs on the day I left hospital (They wouldn't let me go home until I could)

    keep us posted of how you progress :-)
  • I used (and still do) Miralax as well.I was prescribed this after my first fusion.You can get it OTC,and the store brands are even cheaper.Ken-do not let this go-I had to go back into the hospital after my first fusion because I had gone so long without pooping,I got to where I could not.Please make sure you don't let this happen to you!
  • Thank texascowgirl,

    We will get it tomorrow if no action today. I can feel things moving around and do pass gas. First shower today, went well.

  • Welcome home Ken!
    Sounds like the surgery went really well.
    Sorry about the stomache ache but I guess to be expected for the 1st 10 days post op. It seems that's how long it takes to get your bowels back to 'normal' with all the meds, etc.

    I used Colace, lots of water, and then realized I needed to do more walks. I didn't have a fusion so was able to be a bit more mobile the few days after. Oh, and definitely increase strawberries, apples, prunes, salad, spinach, etc. For breakfast, FiberOne (flakes) are quite tasty or Raisin Bran.

    I hope things keep progressing well for you!
  • I'm happy that your surgery went well and you're home and resting. You've been given some excellent advice for the constipation and I'm sure it'll work. I bet the shower felt good !!

    My surgeon left my slipped vertebra where it was and put a large cage in so that the nerve could sit more comfortably.

    When you're able to, do some small walks around the house and outside area and then rest. I found this helped the nerve to settle. I was given gentle stretching exercises as well.

    Keep letting us know how you're going.


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • Doesn't that first shower feel wonderful!
    I sometimes feel tempted to have one in the middle of the might, when I can't sleep and am uncomfortable.
  • Thanks everyone,

    The nerve pain is the WORST. If it were even a 7 I would be ecstatic. I know nerves can take forever and never to heal, but my doc is saying 3mos in my case. Trishdownunder, glad to hear of another similar operation. Yes the shower was great.

    Anyone have severe postop nerve pain like this with badly pinched nerves and start to get relief in a week or two and feel a lot better in 3 months. This level of pain at the moment will not be bearable for long.

    What stretches for the nerves Trish, and I am going to start on B6 B12 vitamins.

    Thanks to all,

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