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SCS & Fusion Questions

AnneENorthAAnneENorth Posts: 15
edited 06/11/2012 - 8:45 AM in Spinal Cord Stimulation
In 2006, I had a L5-S1 Lumbar laminotomy & discectomy because of a very large herniation and disk fragmentation. Since then, an orthopedic surgeon looked at my MRI and diagnosed me as needing a fusion. But two PM's and a neurosurgeon from Cleveland Clinic have since diagnosed me with epidural fibrosis and the significant amount of scar tissue at L5-S1 was the reason for my pain and were both sure that a fusion would not help and recommended a SCS trial.

I recently did the SCS trial to mixed results. I believe that I got relief but I also don't think it was in the correct place. Unfortunately, I listened to the programmer who said to get it close and she would program it and do the rest. On a normal day I am in bed right now about 18 hours so I was unable to do much in the trial as I needed for fear of more damage.

I know that everyone said to stabilize the spine first but how do you know what dr to believe? They were all going according to Mri's, no other tests, and the fact that I have pain down my legs and feet and not back pain. The Dr. from Cleveland Clinic also said that if it was caused from nerve impingement at L5 I would have more back pain.

Can they put the spine stimulator in such a way that they would not have to relocate the stimulator if the fusion is needed at a later date? It just seems to me that if I had such a large herniation and had so much disk removed that even if I don't need it now that at some point in my future I would.

I am really scared to make the wrong decision. I am just so tired of being in pain and not knowing what to do and having to ask people to help me.


  • Hi Anne,

    I can't really answer how you decide which opinions to listen to...There is probably no way to know for sure, 100%.

    What I did want to say, though, is that once you have a SCS it is likely that surgeons will be hesitant to touch you. I would be very surprised if you did a permanent stimulator and could then later be considered for a fusion with the stimulator still in place. You might specifically ask your NS if he ever does fusions after people have stimulators placed. "C" brought this point up to me that the way you are approached by doctors will change if you go forward with the permanent SCS.
  • Why did the Ortho recommend a fusion? Did he see evidence of a new herniation? In this case, I would disregard the PM for the time being, the experts are the neuro and ortho. PM's manage pain. I would seek out a 3rd opinion. If you have any spinal instability, the SCS will most likely fail down the road. Did either of these Doctors perform your original surgery? Maybe you can get the ortho and neuro with you in the same room or on the phone to explain each others opinion to you and each other.


    P.S. Once you have an SCS implanted, you can never have another MRI.
  • The ortho was a couple years ago and he did not see any new herniation just going on the fact that I was having pain and my did disk space from my original surgery was small. He told me to hold off on the fusion as long as I could. The neuro from Cleveland Clinic was this year. I could not get them in the same room or on the phone. I guess I need a third opinion. Do I go with a neuro or ortho?

    Is any test to see where the pain is coming from for sure? The pm and neuro both said I did not need a fusion at all and that the space the dr cut out is large enough for the nerve.
  • Typically the leads for lumbar pain are placed in the thoracic area and most doctors enter 1-2 vertebral below the final lead site, so the stimulator would not have to be relocated in order to perform a lumbar fusion in the future.

    With that said, I would pursue the fusion first and get another opinion from a board certified neurosurgeon, outside of Cleveland Clinic. If you have structural instability in your spine and the results of your trial were mixed, then you're setting yourself up for a failure of the permanent implant and difficulty obtaining surgical treatment in the future.

    You can also have more testing, rather than basing the whole thing on an MRI. An EMG/NCV can help determine if nerves are impinged and give the doctor some idea of where the impingement is located. For those of us with multiple levels involved, a discogram can help determine if the pain is being generated by a disc, and nail down which disc is the culprit. If those tests don't yield any/enough useful results, there are other options for diagnostics available too.

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