Hi all (long post!) -
I'm new to the forum, but had lurked here before my original spinal fusion surgery to read stories and collect information. I'm 42 years old and in decent shape, but had increasing lower back pain over the last several years. After several rounds of physical therapy and epidural spine injections over the last three years, I finally had a L5-S1 posterior spinal fusion in July of 2010 due to intractable pain in my lower back and the beginning of right-side radicular pain. I was diagnosed through MRI, CT-scan and discogram as having a completely ruptured and degenerated L5-S1 disc impinging on my right-side L5 and S1 nerve roots. I also had right-side facet arthropathy causing foraminal stenosis!
It was a tough decision, but I finally did the surgery. I ended up using a neurosurgeon who had performed a micro-disketomy on a friend at work. I had the "gold-standard" posterior lumbar spinal fusion at L5-S1 with nerve decompression and removal of the right-side facet joint. The graft was a PEEK TLIF with Actifuse, some cadeavor bone and some of my bone they had removed. 4 pedicle screws and 2 rods were used to hold the single-level fusion in place. When I woke up in the recovery room I noticed that my right big-toe was completely numb and I was having worse radicular pain down my right leg than before the surgery. In addition, I had extreme pain in my right hip. Recovery was slow but I eventually returned to work (computer desk job) after 9 weeks of disability. I did 3 months of physical therapy, out of which 2 months was water therapy in a pool (highly recommend!) and 1 month with traditional land therapy. 5 months post-surgery (Dec. 2010) I seemed to be healing o.k. except for the pain in my right hip, which was not constant and only brought on by movement that engaged the hip. My NS (Neuro Surgeon) ordered a lumbar CT-scan to see if any of the pedicle screws might be touching any nerves. The CT came back negative for this, but showed that very little fusion had actually taken place. My NS did not seem worried at the time.
By March of 2011 I was on a project at work that required me to be sitting/standing through many long hours of meetings. At this point I begin to have new lower-back pain on my left side of L5-S1 in addition to the hip pain. I also felt a "tugging" feeling which I read could be the instrumentation hitting muscles. Also, I was waking up in the middle of the night with extreme muscle pain in my mid-back that would only go away if I got out of bed and walked around. My NS prescribed both Lyrica (100 mg bid) and an anti-inflammatory (Mobic). He also recommended going back to physical therapy and he also ordered another CT scan. I responded quite well to the Mobic and Lyrica and begin doing more active stretching at PT including some spinal rotation. The PT helped me get some hip mobility back, but it seemed that I was pushing myself too hard and ended up getting too sore even with the meds.
2 weeks ago (9 months post-op) I met with my neurgo-surgeon to go over the new CT scan results. He said that basically there was no difference in fusion from the December 2010 CT scan and declared that I had a "failed fusion". I reviewed the CT-scans with him and saw with my own eyes that there was very little if any fusion and basically no difference in bone growth over the Dec 2010 - April 2011 period. He had me stop physical therapy and has now recommended that I get a revision surgery since I am in worse pain now. My pain level does not require painkillers yet (Lyrica and Mobic seem to do o.k.), but seems to be getting worse. He said that the instrumentation will not last forever. Additionally, the CT-scan radiology report shows that I now have a 4mm "bulging" disc at L4-L5 and a 2mm "bulging" disc at L3-L4. Also, there appears to be scar tissue on the right side of L5-S1 (where the laminectomy was performed) persistently touching the L5 nerve. My NS is recommending that I get a 360 degree (anterior & posterior) revision spinal fusion. He wants to put a large graft with BMP material in from the anterior (front) side, redo the posterior instrumentation (thicker pedicle screws and new rods) and add new graft material in the posterior "gutter" region. He claims BMP is more aggressive in helping fusion than the Actifuse he used in the 1st surgery.
I met with an orthopaedic spine surgeon yesterday to get a 2nd opinion on my condition, and he concurred about my condition and basically recommended the same revision surgery as my NS. He reviewed the CT-scans too and thought he saw one of the pedicle screws slightly touching my L5 nerve and said maybe this was causing my right-hip pain (funny, my NS never saw this). Anyway, the ortho spine guy said he would be willing to do the revision surgery but also knew of my NS and said he was a good surgeon too. I asked if a bone-growth stimulator would help this late in the game and he said no.
So, here I am confused and scared about getting a 2nd surgery. I have 2 opinions that basically line up from 2 fairly highly regarded spine specialists in my area. My pain is getting worse and I can only sit at work now for 1/2 hour at a time. So, my questions for anyone out there that may have been through a similar process:
(1) Should I hold out and wait for 6 more months while in pain to see if I magically fuse over that period? Obviously avoiding a 2nd surgery would be great, but there was no delta in bone growth over the last 5 months at the fusion site. I don't smoke and kept my brace on for the first 3 months post surgery, so why didn't I fuse in the 1st place?
(2) Should I schedule the revision surgery ASAP and just go for it? Has anyone had similar 360 degree revision fusion surgery? Is the recovery period greater than what I had initially done? Are there greater risks with the anterior approach?
(3) I'm worried about permanent nerve damage to my L5 nerve (big-toe is still numb and when I stop the Lyrica I get some radicular sensations from right-hip on down). Will redoing the hardware maybe fix this or if it is scar tissue will I always have the nerve sensation?
(4) Should I seek a 3rd opinion? There is a "world reknowned" top 5% ranked ortho surgeron in my area (San Diego, CA) that my GP says is famous for fixing failed fusions. I called his office and he doesn't have an appointment for 2 more months! I put my name on a cancellation list to see if I can get bumped to an earlier appointment but have not gotten a call yet.
(5) Should I just live with the pain I have (while taking Lyrica/Mobic to maintain) and not get the revision surgery and hope that the hardware holds for a few years?
I have lots more questions and was hoping someone on this site who has been through a similar experience could share some insight. Sorry for such a long story but I thought I'd share where I'm at. I've also done a lot of research on the web and talking to friends of friends, etc., but have yet to talk to anyone who has had failed fusion. Please reply if you can shed some light on my situation through your own personal experience.