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Why another fusion?

nowwhat44nnowwhat44 Posts: 47
edited 06/11/2012 - 8:53 AM in Back Surgery and Neck Surgery
Long story short, I had a fusion at the l/5 s/1 level 4 years ago and have been doing good until few months ago when pain returned to my left foot. found out I have arthritis at the l/4/l5 level now and it's causing stenosis etc. No disk herniation though. Doc says my only surgical option is another fusion at that level? I don't understand, I read about all these other surgeries like:

Laminotomy: The lamina is a small, thin bony spinal structure located at the back of the spine (posterior) that covers access to the spinal canal and spinal cord. A small portion of the lamina may be removed to relieve pressure on the nerve roots.

Decompressive Laminectomy: This is the most common surgical procedure performed in the lumbar spine. The lamina is removed to decompress or relieve pressure on the nerves.
Foraminotomy: During this procedure, the neuroforamen are enlarged. Sometimes this procedure is combined with a laminotomy.

Medial Facetectomy: One of the causes of spinal stenosis is one or more enlarged joints. The spinal joints are named facet joints. During this procedure part of the facet joint is removed to increase space.

So why can't I have one of these surgeries, especially since the disc is not ruprured. If it was I could understand. I am only 36, I don't want more of this. I am messed up enough as it is. Thoughts?


  • After going through a "simple" procedure that was abdominal, I now have back injury due to complication's during the surgery...lost alot of blood, swelled and on and on..looking back, I wish I would of gotten a second opinion and really researched the M.D. that did my surgery! NOW when I'm asked who did the surgery, everyone say's "oh, he is bad"! I thought he was gonna be great and i'd be back to work in 4 weeks..I've suffered now for a year and three weeks, still trying to find out why I can't walk..sooo, I would say, before you go in, be sure! You appear like you are good at research judging by your posts...doc's make lot's of money off surgery's...just be sure to find your pro's and con's and be completely sure it will make life better...i'm opting out of any more surgery's...mine is spinal cord and nerve endings..I'm not doing anything until the pain gets really bad and pills no longer work...hope this helps a little..suzie
  • MetalneckMetalneck Island of Misfit toysPosts: 1,378
    This is copy past advice from an earlier thread regarding a cervical problem .... but all the thoughts are the same .....

    A couple of comments - ideas:

    You have mentioned "doc" is this an Orthopedic surgeon specializing in spinal surgery or a Neurologist that specializes in spine surgery? Have you gotten a second or third opinion(s)

    Have any of your healthcare providers discussed
    less intrusive treatments?

    Have you been through any PT, ESI's (Epidural steriod injections) massage, ultrasound, heat - ice?

    Absent a disk problem - have they considered a "simple" foramotomy??

    I went in for a "simple 2 level ACDF" with a "two week recovery - no big deal" .... it led to another 4 surgeries 1.5 years later and continued problems that have literally changed my life. (not for the better).

    I fully support the need for surgery when the pain is at the point where no meds can control it ... further damage could lead to paralysis - and ALL conservative modalities have been exhusted - and you have a consensus from a number of clinicians that this is the proper time and type of treatment.

    Please make sure you have done your due diligence (research and consultation with others) and that this is indeed the appropriate time, place, and treatment.

    I don't mean to scare you .... I am only providing the information I wish I had been given prior to my first surgery.

    I would consider getting a second opinion from a Board certified Orthopedic surgeon who specilises in spinal surgery ... If the other doctor doesn't agree with the first .... then get a third decision to "break the tie"

    Best wishes and keep us posted!!


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  • As soon as you do L5-S1 then L4-L5 will now take on extra load because L5-S1 is locked, ie, fused. It is a given for anyone doing back surgery. L5-S1 was at the bottom of the pile and now L4-L5 is. You went 4 years so far and the disc is still solid. Getting stenosis or DDD is typical. Depends on what shape your L4-L5 disc was in when L5-S1 was done.

    What I found is immediately after my surgery when I started PT. I made a commitment to exercise and build my core as best as I could. Change my diet and other habits more based on protecting my L4-L5. So far it is working well. I'm about 1.5 years out. At some point I'm sure I'll have more issues.

    I'd agree that until injections or pain meds don't work forget letting that guy cut you again. I've come to the conclusion that surgeons can be trusted most when they don't come near you with sharp objects... My only complaint is I wished he'd remove this outer hardware as it is is a pita some days.

    These new moveable and flexible discs are looking better all the time and moving through clinical trials. Pretty soon the insurance companies will have to approve them. If I need a 2nd level done I want that, not more rods and screws.
  • Hey, thanks for feedback. When i say doc I mean my ortho spine surgeon. He is young, only in practice like a year. I know these guys go through intense training/education and I don't discount that. But I am thinking I should seek a second opinion from a veteran doctor. Should I seek a nuero next or another spine ortho?

    My pain has not reached a surgery level yet, prob won't for a while and I control it with stretching and ibuprofen. I had injections but they could not get to my l/5 nerve root because there is to much bone, so it didn't help really since they injected the s/1 root. They will try l/4 next time. But I am thinking the pain comes from l/5 if there is all that bone there.

    I just don't understand why fusion is mt only surgical option. I will ask more when see him next week. I am getting depressed by all this. I am too young and have too much life left.
  • As I explore the forum I see people saying that you can have a fusion at L/5 S/1, like me, and still get artificial disk at the l4/l5 level. Heck, last I knew artificial disks were not even approved by the FDA those jerks. Yet my surgeon says fuse...is it only because HE can't do artificial disc I wonder? If that is the case he could at least give me the information. Doctors..I tell you.
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