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Considering L5/S1 MI TLIF on January 14

tmatasttmatas Posts: 1
edited 06/11/2012 - 8:49 AM in Back Surgery and Neck Surgery
My neurosurgeon has scheduled me for a minimally invasive TLIF on January 14 (one week from today) and I'm more than a little conflicted about it. My low back pain level is about a 3-4/10 on most days with a 5-7 if I do too much, especially toward the end of the day. My sleeping is virtually unaffected by any pain or discomfort most nights. Both of legs tingle all the way down into my feet, made worse by standing, much better by sitting and lying down. My heels are slightly numb, but not really much actual pain in my buttocks or legs like I hear a lot of people have. I'm able to manage the chronic low back pain and leg symptoms but have to somewhat modify my daily activities in order to do so. I'm still able to run errands and such (haven't worked since 2004 by choice, not because of physical problems) and, most importantly to me, I'm able to exercise by doing 30 minutes of moderate walking every day on my treadmill (without making my symptoms worse at all). I'm able to go out and have dinner with my family without much increase in my symptoms, but when they do increase, lying down almost always brings near complete relief within 5-15 minutes, and I'm able to get up and keep going. My low back pain and leg symptoms are daily but again, I'm coping fairly well most days. I'm never so bad that I must stay in bed or take any kind of pain medication, not even Tylenol (although I occasionally take it for migraines).

Some background:

I've had chronic low back back problems for about five years but have always healed from any flare-ups. I've been diagnosed with degenerative disc disease and diffuse disc herniation of L5/S1. My latest flare-up, which just will not heal, started one year ago (last January) after doing a very low-impact aerobic workout for 30 minutes. I put up with it until August and went to my primary care doctor, who referred me to physical therapy and gave me Motrin and Flexeril, neither of which helped. In fact, the physical therapy made it much worse (tried two different places with two different approaches to the therapy, both of which increased my low back pain and leg numbness and tingling. I tried a chiropractor, who made things even worse after two visits, including causing right leg symptoms almost identical to my left leg for the first time.

MRI lumbar spine (open, seated) showed diffuse disc bulges at L2-3 and L5-S1 levels with a posterior disc herniation and annular tear at L5-S1 level (moderate sized [6mm craniocaudal, 5mm anteroposterior and 8mm transverse] left paracentral disk herniation with caudal migration and annular tear, impinging upon the thecal sac and transversing left S1 nerve root, minimally compromising right and moderately compromising the left neural foramina and along with bilateral facet hypertrophy, causing minimal left lateral recess stenosis). Desiccation and severely reduced height of L5-S1 with preserved height and hydration of rest of the lumbar discs is noted Marginal vertebral osteophytes and Modic type end plate changes are noted at L2-3, L4-5 and L5-S1 levels. I also have moderate lumbar levoscoliosis.

CT lumbar spine showed lower lumbar degenerative disc disease with mild facet atrophy. Diffuse disc protrusion results in mild spinal stenosis at L5-S1. It was based on this scan, which the neurosurgeon ordered after seeing my MRI and stating that he didn't see much there (he said something like perhaps you should do more core strengthening exercises such as Pilates - to which I replied I'd love to but cannot due to an increase in all symptoms, and he seemed surprised), that caused him to order the fusion. He said my disc looked pretty bad, was calcified, and was pushing out onto both nerve roots (both legs). He has a very good reputation in my community. He feels I have a 80-90% chance of having a successful fusion and getting rid of most or all of my low back pain and leg symptoms and basically will be good as new and able to do whatever I want when the fusion is complete. My research into this is telling me otherwise (possibly). My main concern is that I'm going to go through all of the surgery and trauma that comes with it, including the recovery to fusion, but will not be any better or possibly be made worse than I am now. Or perhaps it will cause an adjacent level problem that would not have happened without the surgery.

I have seen a pain management specialist who is very good and I like him a lot, and after he performed an epidural steroid injection (to which I got only 5 days relief of all symptoms) he advised me not to do anything else. I'm thinking he meant surgery, and that he felt he could help me without it. He also had me on Neurontin but I didn't like the side effects (sleeplessness). I haven't gone back to him since the epidural wore off - I saw him hours before it did and told him how good I was feeling - sigh).

On the one hand I feel fortunate to have found a good neurosurgeon who is willing to try the fusion, but on the other hand, I'm not sure if having it is worth the risks, at least at this point, considering I'm coping with the daily low back pain and leg symptoms on my own, though they are definitely not fun and I don't look forward to having to do so for possibly years to come. My husband says if it were him, he'd have the surgery to take the chance at getting a lot better, but he's very supportive of me and says he will continue to do so whatever I decide as he knows it's up to me, although I do know that whatever I do decide affects my entire family.

I'm 46 years old and have no other health problems with the exception of migraines which are well controlled with some diet modification and supplements.

Your opinions, experience and advice (though I realize it's not medical advice) would be greatly appreciated.

Tina (sorry this ending up being so long!)


  • I just wanted to welcome you to spine health. I know surgery is a tough decision to make. We cannot give you advice on whether to have surgery or not, but everyone is very caring and informative to give you information on their own experiences and to also offer a sounding board to people weighing their decison. I am currently awaiting a fusion as well. It is a huge decision to make. For myself, I have made the decision to have it done, but there are many people on here who are dealing with it without surgery...ie. physio therapy, meds , heat cold etc.
    Whatever way you decide to go we are here for you to support your decision. All the best to you. Please keep us updated.
    >:D< Karen
    >:D< >:-D< : Karen
    L3-S1 herniation and bulges, stenosis, mod facet,ddd,impinged nerves,coccydinia
    discectomy/lami July 2011-unsuccessful
    adr L5-S1 Feb 2012
  • I also agree with Karen that no one can advise you as to what to do. In reading your post, you seem to have alot of doubts as to whether you are ready for this major surgery. I think you will know when you are ready for surgery. Have you had a 2nd opinion yet? And why the urgency of the surgery? I would ask your surgeon why he feels it is necessary to have it now, and what he feels waiting will do, good or bad. And get a 2nd or 3rd opinion until you feel confident that you are making the right decision. You seem to be dealing with it pretty well right now. I would ask him what the future holds if you wait, or what atvantage of now. Hope this helps. Good Luck and keep us posted.
  • Iam 63 years old.your situation is similiar to my past back issues.My goal was to avoid surgery for as long as possible.I did pt,steroid shots,lost weight,exercise etc.I was doing really pretty good til this summer and all of a sudden i could not walk more than a block or stand more than 5 mins.So it's a tough choice,but you will know when you need surgery.Your back will tell you.I had a couple of times where i almost fell over due to pressure on my nerves. I also developed drop foot.I had surgery on dec 7 2010.Iam doing really well.I know it will take 6mos to 1 yr to recover,but my back feels much better now.Good luck to you.By the way i had l4 l5 s1 fusion.
  • I can't make your decision for you, but this was my experience: My latest bout of back pain started in 2003. Due to misdiagnoses, from 2005 to August 2010 I tried several different types of PM injection, each with a disappointing outcome, plus PT, which would've stood a good chance of providing long-term success had I continued with the exercises. In November I finally had the decisive diagnostic procedure: an MRI, which showed, in addition to moderate levoscoliosis, mild herniations at L2-3 and 3-4 and a left-sided herniation encroaching on the L4 nerve root (readily explaining the sciatica radiating to my left foot plus tingling in the calf), plus Grade 1 spondylolisthesis. The doctor referred me to an orthopedic spine surgeon, who urged me to have a fusion. Two days later I fired him and decided on sole treatment with 6 weeks of PT, which ended today. At the beginning of that my pain level was, at best 8/10. Now it tops at 3/10 (hooray!), the tingling is gone, and sciatic pain has only reappeared, and just in my hip, when the therapist bent my leg a certain way. This time I'll keep doing the 2x/day exercises until I breathe my last, and the therapist's final words when I was about to leave the facility today were very encouraging, and he also said if I ever have worse pain all I'd need to do is give the facility a call to arrange for what I call a "refueling." Please keep us posted. HUGS, Essmoe
  • I also have an issue at the l5-s1 with a pain generator about 3 daily. I don't take medications but my lifestyle is limited. I have a degenerated disc with an annular tear. I have been recommended MIS tlif or alif. The orthopedic and neurosurgeons I have visited stated that my condition is not in any imminent danger but just a quality of life issue. For me, I am going to have the surgery in the summer because I am 30 and i would rather feel much better. One thing I have contemplated is quality of life. I would rather have the chance to be better and actually be active again or just get by living a sedentary lifestyle which i have been doing the last 10 years. hope this helps and keep me posted. Also, did you ever have any tests done like emg, discogram, and mylegram?
  • Your pain sounds much like mine although I know when I got injured. I had an ALIF minimally invasive on Aug 28, 2009 and another one 48 hours later because the doctor misplaced the L5 pedicle screw into the nerve. OOW! A year and a half of PT, a pain management doctor, a myelogram with a leak, and numorous scans of various types I went to another institution. They immediatelly saw the problem and I had a PLIF last months. I had no fusion because during the second surgery the surgeon believes she irrigated out the BMP and cadaver bone. I also have issues with my right leg because she put that screw in at the wrong angle too. Next year, once I have fusion, I need to have that screw removed and put in the right place.
    Please do yourself a favor and get multiple opinions. I did it out of my own pocket and found a great surgeon that has helped correct the mistakes of the first one.

    Ths may be against the rules on this forum but I will not mention names or institutions. Please don't go to a teaching university or anyplace where residents are doing most of the work. I dealt with untrained incompetant Doogy Housers for a year and a half. Get someone that has at least 10 years experience and does the surgeries full time. Not a professor that teaches 4 days a week and then oversees residents during surgery once a week. You want someone board certified too.
  • My two cents: I agree with the poster who wrote that you will know when surgery is necessary. Your body will tell you, you just better have a surgeon who will do it fast...or your suffering will feel like an eternity. I'm 3weeks postop right now and it sucks. I thought i would be recovering completely by week 6-8. Wrong, dont think (like i did) that a MIS TLIF is so advanced, or that you are in such good shape that you will recover quickly. Thats the truth. Recovery is terrible with lots of crying, praying, and depending on family for everything. With that said...when your condition worsens (and it will eventually) your quality of life will come to a halt, leaving you with no options. Oh scratch that... you can live a miserable, painful, zero quality life which will affect all your relationships. I can't stress how difficult the recovery is alone, not to mention, if you are lucky enough to have any of your symptoms relieved immediately following the surgery. Denying that your condition will only get worse with time could be a costly mistake. Rule of thumb (from my research) stated that recovery is dependent on how long you have lived with the trauma/symptoms. Ex: 7 months with pain, numbness, sciatica = 7 mths+ worth of recovery, due to the slow nature of neural regeneration, or from impingement.
    I wish you a pain free life, and i remember being at the point you are now. I thought since i run 3 miles a day, 5 days a week..not to mention freeweights 5 days a week i would could tough it out. I got worse and it came quick. At first, I couldn't sit for 2-3 hours, then 20-30 mins, then i couldnt sit for 3 minutes w/o pain. My Transforaminal Steroid Injection lasted 4 days. Trigger pt injections were useless. Listen to your body when it talks to you. Listen harder when it screams at you.
    I was going tovwait until my 6 wk mark in my recovery before sharing my thoughts, but when i read your post... it soooo reminded me of me at your stage. Good luck whatever you choose... and my God be with you every step of the way.
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