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Help/Advise please

kyadog115kkyadog115 Posts: 266
edited 06/11/2012 - 8:43 AM in Back Surgery and Neck Surgery
Hi All..
I just left the Neuro's office. As u know, I had esi on L-5 S-1 about 2-3 weeks ago, Did not really help at all. I fell in Jan and MRI revealed herniation, S-1 impingement.
In looking at an MRI from Oct., before the fall, It shows some potrusion of disc material. I had a Micor'd in April 09...evidently he didnt get it all cleared out. Anyway, now he thinks the fall caused a stretching of that S-1 nerve...He's telling me my options are..another micro..TLIF... PLIF, or an implanted stimulator.I will not have an implanted machine. He said I'd have to sign 2 consent forms because he wouldnt know which proceedure (PLIF/TLIF) he'd have to do until he got inside.
I'm scared and dont know what to do. I cannot stand this pain anymore. He said only about 50-60% of people get some relief.The other percent do not. I'm not even very informed on these 2 proceedures. i know one is done with a rod and pedicule screws and I believe he said the other was an older method done with bone graft..is that right?
Also he mentioned my smoking. He wants me to look into chantix. I know smoking inhibits fusion but i know i cant quit.Can you guys advise me about these proceedures please?


  • What do you mean you can't quit? I guess you don't need a lecture on smoking at the moment, but I reserve the right to return to the topic with you!! ;)

    You might want to talk with DNice. She spent a lot of time determining whether to have another microD or a fusion. She did lots of research and "interviewed" a bunch of doctors before reaching her decision. She decided to go ahead with another microD, realizing she may need a fusion at some point in the future.

    I agree with you on the spinal cord stimulator. I was always told it was a solution of last resort, when you had exhausted all other options. In your case, you still have several choices.

    I would suggest you get an opinion from at least one more fellowship trained spinal surgeon. Since you have seen a neuro, you might want to look for an orthopedic spinal surgeon to see if they would recommend similar choices. (This is NOT a regular, general ortho, not a sports ortho, or one that does joint replacements...it is an ortho SPINE doctor!!)

    You need to determine how badly compressed that S1 nerve is, what the situation is with your discs, etc. Have you had a recent MRI and a flexion/extension X-ray? Whenever I see someone mention a problem in the the area of L4 to S1, I always think "spondylolisthesis." It was the source of my pain and was missed for almost a year in my case because I did not have this very simple X-Ray. You could also ask the spine specialist about it, whether it would show on the MRI, I suppose!

    Where is your pain located? Is it more localized in your back or leg?

    There is lots of information on fusion in general on this website, and it also talks about the different types of procedures.


    You can see video explanations too. They explain it better than I can....



    There is excellent information on this website. If you read through it, you will have a very good idea of all a fusion entails. But I'm not sure you're at that point yet. You may be able to get by with another discectomy...this is where another opinion from a spinal specialist comes in!

    More surgery is always a scary thought...but sometimes it is necessary to take care of the problem and restore better function to the spine.

    Try to approach this as a problem you need to solve. Gather information until you are comfortable reaching a decision. We're here to help.

  • I'm sorry to hear that your ESI didn't work for you. I'm curious - your signature shows that you have stenosis - was that in your cervical spine? Do you have stenosis in your lumbar spine?

    My symptoms were lower back pain, pain radiating into both hips and pain down the back of both of my legs to my knees. I had a disc bulge at L4/5, but the major cause of my problems was severe facet problems and stenosis. I wasn't given the choice of a micro-d, I assume because it wasn't the disc causing the major problems. But my doctor also said that I'd be having either a TLIF or PLIF, depending on what they saw when they got in there. Once inside, they also saw spondylolisthesis and that things were worse than they thought. My stenosis was worse than expected, thus they had to cut out more bone, and my spine was more unstable than they thought.

    So, my point is that I had a lot going on and a lot of pain when I discussed everything with my surgeon and decided to get the TLIF/PLIF. (Turned out to be a TLIF, btw.) I feel so much better now than I did before the surgery.

    I'm not saying you should have surgery, that's a very, very personal decision, but you have to decide what you can and can't live with. Will the Micro-d be enough to keep you out of pain for a significant amount of time? Can you live with the pain you have now? Is it worth having major surgery to have a good chance at getting better? I personally question the 50-60% chance of relief, I believe it's higher than that, but I might be wrong. Or the doc could be just talking worst case scenario to cover his rear. I've just seen a lot of people on this forum that got very good relief with a TLIF surgery. That's not to say pain-free, but less pain, many times much less pain.

    I know it's a difficult decision to make, but make sure you're confident with the one you make and that you're confident in you surgeon. Gwennie's suggestion of getting another opinion with an ortho spine surgeon is a good one if it helps you get comfortable with making a decision.

    Take care, Paul, and please keep us updated.

  • Hi
    Thaks for the reply. I had the stenosis in the cerviacl part....as u can see, i had a 3 level @ C3-6 w/hardware.
    But, we were reviewing the Oct 09 MRI, and it does show DDD & endplate changes. I'm 51 and i've gained a lotta weight in my gut. The doc said this doesnt help either.
  • Hi& Thanks,
    I know, i know , i know...about ill effects of smoking.But u know, i'm a long time 35 yrs or so,its not something e-z to quit...I'm very concerned about this poss. surgery. I cant live w/this pain,not being able to walk or stand for any lengths of time.
    My pain is all in my low back but when i had the micro D in april 09 it was cuz I had a lotta leg pain due to the L-5 herniation. The diskectomey rectified that. Since I fell in Jan and slammed my back hard on stairs, that MRI report of March 10 showed herniation..........hence, return of leg pain.However as I stated, the Surgeon thinks the nerve has been "Stretched"
  • also, I just wanna point this out in case anyone is familiar w/this. I've been writing down my "symptom"...cuz when I see the Dr, I usually cant remember all these sensations. Anyway, I gave him my list. I exp. numbness in the left outter thigh area,intermittently. He asked me if it is similar to a localized circle/oval..........i said yes, it in fact is. He called it a cretain name(medical term)..I foget now what he said it was..............does anyone know?
  • It wasn't bursitis that he said it was? I experience this as well and the docs think that may be what it is. Since my fusion almost 3wks ago, I don't feel it as much though so not sure now.
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