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OMG need advice asap please

salty444ssalty444 Posts: 149
edited 06/11/2012 - 8:49 AM in Back Surgery and Neck Surgery
I am headed to my second surgery (revision, discectomy l5/s1) next tuesday. I had a MRI last week to make sure there are no changes and my Drs nurse calls me. Said that the written report shows no evidence of a herniation. He said the report shows type 1 endplate degenerative changes and there is moderate disc space narrowing. He said basically I could be in pain for the next 30 years until my back fuses itself together.

is this right? I feel like I am just lost for words. I want the pain in my back to go away, without taking pain meds.


  • dilaurodilauro ConnecticutPosts: 9,842
    Is the doctor that was going to do your surgery next week and the one that just reviewed your latest MRI the same doctor?

    I sure hope its not the same doctor. Its hard to imagine in one weeks time that there could be such a change in plans.

    Since this sounds a but confusing, I would think that perhaps a second opinion would be warranted. If two different two agree on the reading of MRI (or other diagnostic testing) and agree on the action plan, they you would be more comfortable.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I'm with Ron. If this is the same doctor who is doing your surgery next week I would ask why bother operating. I would also want to have a better action plan. It would seem that your doctor is saying your spine needs to fuse..but shouldnt he be able to do that with surgery?

    Sound like a lot of questions. Make sure you are comfortable before going ahead with surgery.
  • it is absolutely the same DR. However its the Nurse that gave me this info. I have had this revision scheduled for a couple months. I had a MRI last week because I noticed a new pain/rubbing feeling. The MRI guy said it looked as if I had a micro fracture and he pointed out a fragment that looked like a herniated disc. He said my vertebrae have been banging together.

    I am very upset by this. I asked about a fusion and they said that is a last resort procedure. Letting ones spine fuse by itself can cause issues can't it?
  • dilaurodilauro ConnecticutPosts: 9,842
    take only the word from the doctor, not from his Nurse or the MRI Technician. They all may be very capable, but you want to hear those words directly from your doctor not second hand
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • letting someone sit in pain for 30 years with bone rubbing together until it fuses on its own seems pretty primitive doesnt it?
  • the nurse actually told me that they use fusion as a last resort and only if the vertebrae is loose.

    i'm starting to think they just don't want me as a patient. Maybe I ask too many questions but thats too bad. anyone digging into my back I want to know whats going on
  • i'm with the others that say that a fusion is a last resort. i had severe disc narrowing when i was a young adult and was told by the surgeon the vertebrae would likely fuse on its own over time, which it did. after my second surgery on a different level 10 years later the surgeon did not fuse either because he said, again, words to the effect that fusion is the last resort and there is a strong chance that a fusion will not be needed. he said there are few surgeons who will do a fusion on someone who doesn't need it. of course 3 years later i needed the fusion because i developed spondylolisthesis. your spine can fuse on its own. it can also heal on its own over time so you may not experience 30 years of severe pain.

    just my 2 cents, but as others have said i think also that it is absolutely irresponsible for an MRI person to give you results of an MRI when it is supposed to be done by the requesting physician (that's the way it is here in canada anyway).

    i hope you get things sorted out and your pain can be brought under control by whatever means are best for you.
  • I am not happy, just talked to my primary and he is dumbfounded over that comment that was made to me today
  • Have you been able to talk to the surgeon directly?
  • I would think the nerves need more space in which to freely move around, not less. Letting the vertebrates collapse and fuse would make those spaces smaller, no?
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • You have some choices to make, and just like everyone here that has had a fusion, it may not be the one you want.

    When I couldn't stand the pain anymore, I took the pain killers. Didn't like it, as they make me dull, but it was better than surgery. I have a risky job, so in order to work, I had to quit taking pain killers. I wanted to work so bad that I opted for a discectomy, and it just reherniated. So then it was epidurals and pain pills to work and risk my life, or fusion. Tried to work that way for a year, but evidently I wasn't fooling anyone about how much pain I was in and how bad my back was. So I finally decided to try the fusion, in hopes of being without pain finally. Now I'm healing and praying that it works.

    Moral of the story, if a vicodin or 2 a day will get you by and you can still live your life, then don't be in a rush for such a risky surgery as fusion. You'll still be on pain meds for a long time after a fusion, and will be praying you're one of the 60% that fuse.

    We all wanted to avoid surgery, and not take pills, and win the lottery, etc., but the reality is you're hurt and the doctors will all have opinions as to what to do. One thing I can tell you, if you get enough opinions, you won't have a problem finding a surgeon to operate on you. It's all a surgeon knows, so any fix will involve it. If you can live with pain pills, you can find a doctor to do that for you too. Choosing not to do anything about it is always a choice too, but if you can't then those are pretty much your options.

    I personally wouldn't want the doctor to operate on me unless he knew he could fix it, and a discectomy without a definite herniation sounds risky at best, and negligent at worst. And a fusion is even riskier for DDD than it is for most other types of spine problems, as far as relieving any pain.

    You will be the one that has to live with your back the rest of your life, so the only opinion that matters is yours. Take your time, get many opinions and educate yourself on your choices, as spine problems are rarely life threatening, but surgery can be.

    Good luck and hope you find an answer you can live with.

  • Salty -

    It sounds to me like you need a second opinion from another surgeon. It's generally a good idea to get several opinions when contemplating a surgery like this, but if you're not 100% confident that you are doing the right thing with fusion surgery, do not have it right now. Take the time you need to think about it, take your MRIs to another doctor(s), and get to the point that you are feeling comfortable with your course of treatment.

    The other good thing about getting multiple opinions is that it helps you think through all of the issues. I disagree a bit with those who say that fusion surgery is an absolute last resort. I've had two fusion surgeries. One wasn't elective. One of the discs in my neck was severely herniated after trauma to the point that one bad fall and my spinal cord would be severed. The above adjacent level was badly herniated as well (all after trauma, not degenerative condition), so I had a emergent double fusion in my neck.

    The same incident blew out my disc at L5/S1, complete flat tire. I tried to deal with the pain for more than a year with drugs, physical therapy, shots in the spine, the whole deal. I probably could have gotten by for a few more years on the narcotics, anti-inflammatories, and shots, but I was only sleeping in two hour bursts, the drugs, pain, and exhaustion was interfering with my work, I had no social life because the idea of the pain of going out was more intolerable than staying home all the time, and it was depressing. I got multiple opinions, one surgeon saying absolutely no to surgery, one saying it was the only way I was going to get relief. The latter surgeon is the one who performed my neck fusion and I was really happy with the results and I just liked him better/had more faith in his counsel, which included his opinion that the pain was just going to get worse and worse and worse without the sugery, and my risk of nerve damage being permanent and more extreme was going to increase with time. So, I elected to have the surgery even though I probably could have gotten by for at least a couple years without it.

    Granted, I made that choice knowing that it meant that I will probably need additional surgery down the line at somepoint. My spine is now bookended in titanium. That inflexibility combined with the fact that I'm only 37 means that at some point, I'm probably going to have another problem. And the results of my lumbar surgery have not been as good as those with my neck (which also isn't perfect, but it pretty much as good as can be expected with 3 vertebrae fused together). But, I do feel significantly better than I did pre-op, I'm not living on drugs. I have flare ups that cause pain, sciatica, etc., and it scares me every time, thinking that it's something worse that's gone wrong. But I feel human again. So, as of right now, I'm glad that I didn't wait until the absolute last resort because outside the flare ups, I feel like I'm getting some semblance of my life back at a relatively young age when I really want to be able to be active.

    So, my personal opinion is that there really is no one universal wisdom on how to approach these things. I think it's something you need to talk through a lot with experts, not just in terms of your physical health, but also in terms of what want to do in your life and the role the surgery may play in that.

    I am with those who say it seems weird that an MRI tech or nurse is giving you a diagnosis after your scan. I've actually asked techs before, "how does it look?" and they've refused to tell me, saying I have to speak with my doctor.
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