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).
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!)