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2nd microdiscectomy or fusion ? Looking for advice

Rapp0378RRapp0378 Posts: 56
edited 06/11/2012 - 8:57 AM in Back Surgery and Neck Surgery
Hello everyone i need some help in choosing between surgeries. microdiscectomy or fusion. Here is a brief summary of where im at

26y/o male. First herniation was dec 08, was due to work related accident.(firefighter)
Had microdiscectomy march of 09 with one of the best surgeon in florida
I was in great shape before the accident, so i recovered pretty quick. And was back to working full duty.
Not long after low back pain started. Nerve pain would come and go but low back pain always there.
Back pain got so bad that it would feel like the muscles were torn off my spine whenever i would have to do physically demanding training at work.
March of this year i had to leave the job i loved.Then Things seemed like they were getting better over the summer until a month or so ago.
I had to be taken to the hospital in severe pain, MRI shows re-herniation at same level. L5-s1
I am unable to stand straight, walk for more then a couple minutes or sit. I know that surgery is def needed.
My problem is deciding between fusion and another MicroD.
I have been told by half the Docs i have seen to avoid fusion at all costs and the other half says it could potentially bring me back to the level of fitness/shape i was before the original accident. If everything heals correctly. As we all know back pain/surgery is not black and white and this obviously leads to confusion. To make matters worse it is highly profitable and alot of people take advantage of that. Because of that i have noticed that so much of what i think is actually research studies online turn out to be paid and sponsored by certain companies. This is a shame because honest people who are looking for rational statistical information in their decision making process get dooped into the wrong procedure.

So my main problem is trying to decide which procedure will provide me with the best long term results without having additional surgeries. I would also like to chose the procedure that will allow me to return back to competitive sports/fitness. Fusion or a second MicroDiscectomy? At this point i am leaning towards having a MIS TLIF fusion. Some reasons are, my first MicroD left me with chronic low back pain, i could not be as active as before the surgery and it eventually re-herniated. Also, it seems to me that high level athletes seem to go the fusion route. (tito ortiz) (Nate quarry) these are UFC fighters but i have heard of some football players doing it. Is this because a fusion if healed correctly is better? Another reason is i really do not want to have another microD just to have a fusion down the road. I cannot afford the disruption in life of back pain and another surgery down the road. I lost my job and many other things because of the first. Now i have to start over so i feel like if i have to have surgery it better be the last time.

Some of the things i am worried about are.... The adjacent segments going bad after fusion. I have heard this is almost ALWAYS the case by some. Others have said L5-s1 isnt much of a motion segment to begin with so its not that big of a deal. Also, my first herniation was caused by an injury not genetics so wouldn't that be in my favor as well? And last but not least having a fusion and ending up worse off, i know its rare but still a concern.

I guess the moral of the story is would a fusion allow me to be more active then getting another Discectomy at an already damaged level. Im sorry for my disorganized rambling. It is tough putting together well structured thoughts under immense stress and pain meds. Oh did i mention i am trying to decide before thursday, that is when im set to have the MIS TLIF. lol
Thanks in advance for whoever responds. It would be a great deal of help to hear from people who are around my same age that have had fusions and continued with high level athletics, fitness or physically enduring profession's. Thanks again! - Ryan


  • Wow...I am sorry you are facing the same decision I faced back in 2010. I was 40 facing 2nd MD or Fusion. Very confusing and definitely a personal decision.

    Can I suggest something? I am not a physician and am only speaking from experience. I got the same recommendation 50% said fusion and the other 50% said revision MD. I kept asking why each one was suggesting what they did and why they thought the other were suggesting the opposite. It was interesting to hear there are just 2 schools of thought.

    School 1 - try for perceived best approach to 'remedy' (not resolve) the issue. The thought was, if I went revision, the fusion would eventually be something I needed so I was risking another surgery. The thought on fusion being 'best' was that by removing the potentially faulty disc, there was no chance of it herniating again.

    School 2 - try for the most conservative approach to remedy the situation while still leaving me options in the future if this didn't work. In addition, this school was of the mind set to keep the spine as close to 'in tact' as possible.

    Now, the advice? I got a remote e-consult from eCleveland clinic but I'm sure other speciality hospitals do this. The reason I suggest is is because they require you to be working with a local surgeon, they want to see your history (MRI's, XRays, post op reports, etc.) They want to take a survey of what your primary pain is, what you are using, etc. They give you an objective opinion (or at least this was my experience) because they are NOT the ones getting your 'business' as they will not be doing the surgery. Their money comes from the consult only.

    I was really pleased b/c it helped answer MY personal health situation and didn't soley rely on statistics.

    If that isn't helpful, here's some other food for thought.
    - are you willing to accept the risks, should they occur, with a fusion? Or will you be mad at yourself if things get worse?
    - how sure are you that you will be able to get back to your competitive self without causing risk to levels above and below the existin disc
    - how stable is your spine? What's the quality of the other discs (yes, they can tell to some extent if you have degeneration). I ask this because there can be a domino type effect since the discs above and below will have to carry additional load from a shock absorber perspective.
    - what is your primary pain? back or leg? or both?

    It's a big decision, do not rush it. Ask the doctor what happens if the fusion fails, then what? Ask the doctor what he would do if this were his wife? his son?
  • Thanks for the help. I have never heard of the e-consult. It sounds like a great idea and i will look into it. As for your other questions, my primary pain is back pain with the leg coming in a close second. The rest of my disc's are in perfect shape from what i have been told. That is one of the reasons i was leaning towards the fusion. Surgeries are hard and i do not want three of them and i see more of a risk of that by doing anothe Discectomy and having a fusion later, then doing a fusion now and having the next level go. (since they are all healthy) and since it was an accident that caused the first one. And its my l5-s1 and thats supposedly doesnt have much motion to begin with. You also asked if i think i could return back to my previous level of activity. I could not do that after the first discectomy because of chronic back pain, perhaps having the motion fused will take away the back pain and allow me to return to that level. Although like you said, if it does not work or gets worse i would definately be upset. But who wouldnt. It seems there really is no RIGHT answer. Just out of curiosity, what did you end up going with yourself?
  • If you keep your natural disc, you will have to protect it from then on. You will not be able to load it like you once could. The ruptured outer covering called the annulus,should close up with scar tissue. The scar tissue however, is not as strong as the annulus.

    L5-S1 may not have a lot of movement, but L4-L5 does. It will have to do twice the work if 5-1 is removed and fused.

    Clear as mud, right?! Sorry you're in this predicament.
    Are ADRs an option for you?
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • such a decision to make. It is a tough one, and as you can see from yours and previous posts there are reasons for and against both procedures.

    With your L5/S1, do you have other issues going on with it other than the herniation? Did they say anything about facet problems, disc collapse, stenosis, spondy etc? This can also help knowing these things when making a decsion. If you don't have other things going on with your disc and surrounding area(facets etc)some people go with a discectomy.

    If you have a bunch of things going on there, the discectomy may or may not help.

    I also had multiple ideas on what should be done for my discs for my first surgery. It is a very tough and personal decision.

    I wish you all the best. Please let us know what you decide, and we will be here for you as you go through surgery and recovery.

    >: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'm very sorry you are in so much pain and having to make this decision. I can't offer you advice, as in my case the surgical options were clear - I'm having a fusion.

    I was also very active and athletic before my back problems, but I'm resigned now to live healthy rather than hard, if you get my drift.

    I am looking forward to being active again after my fusion surgery (tomorrow), but I do not expect to return to my previous level of athleticism, knowing that I have to protect my back and body more than I did in the past.

    This is my personal take, and you have to come to your own conclusion, but after so many years of pain... It's a greiving process, realizing that you may never be as active as you were before... but being able to live without a disruptive level of pain has become my priority over being able to return to my former athletic glory.

  • Paul, i know exactly what you mean about loading the damaged disc. After my first microD i was extremely conservative with everything i did. Well as much as i could be while still working as a firefighter. Some movements were inevitable given my job but when out of work i made a point to change pretty much everything i was doing. I was still fairly active, going to the gym bike riding and swimming. No running, heavy lifting or anything to load the spine. One of the reasons i feel a fusion might be better is because i know that it took a great deal of stress to herniate the first disc(it wasnt genetic). So that would mean it would take another great deal of stress to have issues at the disc above, even if it is additionally loaded after the fusion. And with proper body mechanics i feel i could still stay fit better then post-microd. Unless the loading is way more substantial then what im being told. Like i said some doc's have literally said if i get it fused i will be back in a couple years to fuse above! And some have said its rather common and only 5% have issues at the level above. Crazy how its 2011 and doc's still have polar opposite thoughts on the subject. I have looked into ADR's but do not feel comfortable with them. The pro-disc L is basically a ball and socket joint so the loading of the spine would be dead center, a natural disc is much different. I believe that is why people have had facet issues with them. Also, the thought of migration and potential revision is scary. Plus they really dont have any data on how long they will last, being that im only 26 and potentially have many years left to wear it out.
  • Thank you for the kind words Karen,

    I do not have any issues with spondy, stenosis or facet. Slight disc space collapse. It is as dark as night on the MRI but still shows ok height. One of my questions to the doc's which i have gotten completely different answers on is this. The disc space is dark, which means it has lost the moisture and degenerated. So, does that mean that the disc space will continue to collapse eventually requiring a fusion? Some have said yes it will. One doctor actually said that there is no scientific evidence showing a degenerated disc causes pain. He said nerve imgingment causes pain, but there are many people with collapsed disc pain free, espescially in the elderly. I think the choice to have a fusion now would be an easy one if i new the space was eventually going to collapse and auto-fuse anyway.

    I am sorry to see that you had a unsuccessful discectomy. Seems we are in the same boat. If you do chose the fusion in the future i wish you the best of luck and speedy recovery Karen.
  • I understand your take in regards to returning to the previous level of athleticism. Perhaps i could have worded it different. I know that i will never be 100%, and even if i am i will never go back to doing everything i once did because of the change in my spine. I would just like to have the surgery that will bring me as close to that level as i can. That way i can have the ability to enjoy doing some of the things i used to, and with great modification and proper body mechanics, continue to stay in shape and exercise. It seems like i was more restricted after my microD then what i will be after a one level fusion? Maybe im crazy for thinking that. I asked the doctor if i could return to running and working out after the fusion and he said if it fused properly i would be able to do whatever i like.

    Good luck on your fusion tmrw!
  • That Prodisc is now old-school borderline obsolete.
    There is a newer design by another company that seems to be a better mousetrap.
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • Interesting, i never felt comfortable with the pro-disc design, although im no engineer so what do i know..

    Do you know the name of the newer designed disc? I have heard of one by spinal kenetics called the M6-L. It believe it is made in california but not FDA approved at the moment. Kind of Ironic that its made in the usa but you have to leave the country to use it.

    Paul, i was wondering... We may have spoken on here in the past, a couple years ago before i went in for my MicroD. I had a different user name at time so i cant go back and check. However i remember talking about jiu jitsu, anyway if thats you just wondering if you ever got back into training after surgery? I do not plan to myself, just curious as to how others are doing that are in similar situations. Thanks!
  • Yeah, it's the M6.

    That was me. I did not get back in to BJJ; I am too afraid of reherniating my discs. I miss it.
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • Ryan...you are thinking of all the right things on both sides of the decision. I would be curious if ADR (Artificial disc) is an option. I am going to guess most will say no. You sound like a good candidate from the fact that it's 1-level and your spine is in good shape but I think most will tell you that you are too young in the US. Still worth asking about.

    Now, what did I do?
    I went for the revision. I re-herniated right away so the belief was that the 2nd piece was already free or broke free when they flipped me back over. My spine is otherwise stable, I do have a little degeneration at L4/5. I was told I would be a good candidate for ADR BUT I'm too young (ha, at 40 was too young).

    I was told that ADR is not perfected yet (per US standards) and if it failed, they weren't sure on statistics on how to remove it or fuse around it. Also, ADR is a big surgery through the front. I hope if I ever need another surgery ADR advances to where I'm a candidate. For some reason, I felt ADR tries to keep the mechanics of the back in tact.

    I'm fairly happy with my decision. I did move running to the bottom of the list (I'll run if someone is chasing me) but can go to a highschool track to 'shuffle-run' and am back to hiking and other cardio exercises.

    Just remember, the decision is yours and it's very personal. The one thing I had in my favor was a surgeon who is with me for the long haul and a family member (husband) who was on board with both the decision and doctor I picked.
  • The M6 does look alot better. I miss it as well but not worth the potential risk. Tito ortiz has had a l4-s1 fused and a neck fusion and is back fighting. Crazy if you ask me.
  • Yes actually one of the doctors i saw wanted me to go the ADR route. While in the office i was really excited about, with everyting he was saying. It was a different story when i got home and did some research. It is hard to find actualy non-bias clinical information. One because they havent been FDA approved for that long and two because most of the so called research is paid and done by the maker of the Pro-disc. Im sure they have worked out great for some people. However you are right, revision surgery for an ADR is very danderous even life threatning due to the vessels around the area. I also agree the theory is much better then a fusion however i do not like the design of the pro-disc. And as you know thats the only one available in the us. So for now i have taken the ADR completely out of the equation. It is between revision surgery.

    I do have a fusion scheduled for next friday. However i am still unsure in my gut. Reading fusion horror stories doesnt help. Im trying to really weigh the pro's and con's. Some of what is making me lean towards the fusion isnt exactly medically motivated. I have insurance now and will soon be loosing my job as a firefighter. When that happens no more insurance. I also do not have any obligations right now so i could devote the time to healing. It really comes down to what i think will provide the least amount of future complications/surgery. Doing the revision seems to have more chances in my mind because i do like to stay active. Well did. And i think it would eventually herniate or continue to degenerate requiring a fusion anyway. Plus i did have continued low back pain after the first surgery, although no instability. But of course the fusion puts extra stress on the level above. Would that last longer then the time it would take to reherniate or get other complications with doing a revision? Who knows. I guess this is a delemia many have faced.

    Im glad you are feeling better and i dont blame you for putting running at the end of your list. I personally got a road bike and switched to long distant biking. Even though it required spandex shorts. lol
  • looks like you have done all your home work.
    i have seen 5 surgeons all but 2 are go with fusion 1 is go with revision and if or when that dose not work do fusion or maybe something new will come along(stimcell?) . the last one was a nero surg, he say i will prob have the back and leg pain at some level forever with or with out surgery. he say to do some more homework and see the real life out come of most fusion surgery's, not the story of most of the surgeons i have seen(they all say there percentage is way higher than the norm)sounds like a used car salesman.he say i will no when i am ready. and in my situation he would put it off as long as i can.
    but i do have some problems in the above disks.
    there are 4 people that i no that have had fusion done 1 is 8 years out he is 57 and at about 14 months after he was back to all most all the things he was before back problem days.
    1- 48- 4 years out say she is about at the after micro d days with pain level. but the over doing recovery is way faster. 1- 71 is waiting for next fusion L4-5 did not last long 3 years from 1st.
    and then there is the guy next door 45years old 2 out from fusion L4-5 L5-s1 he say he is better than pre spiney days but he is going in to have hardware removed its causing him back pain he thinks. they all say they would do it again.
    wow 26 and back problems.i feel for you. i wish i or someone had the black and white answer for you.wish you luck and keep in touch let us know how you are doing. sounds like you are on the right track.
  • John, Sorry to hear about your pain. Looks like we are in the same boat except for the difference in age. With 5 doctors reccomending and only 1 saying revision it sounds like things are a little more concrete in your situation. Thats good and hopefully sets your mind a little more at ease. I myself, have things split down the middle with some saying fusion and some revision. The tough part is both sides are very strongly for or agaisnt the two.

    I am in no way trying to give you advice or complicate things worse but i do know that if your level above has issues fusing below might speed up the process of the level above needing attention. But by then hopefully stem cells will have advanced allowing us to inject into the disc and repair it. Wishful thinking. On the other hand they might be telling you fusion because you have instability or loss of disc space at l5-s1. Im sure you have, but if you have not, try asking each doctor why they roccomend what they do, and why they would not reccomend the other. That might give new insight. Whatever you decide stay positive and i wish you the best of luck. And just my two cents after literally spending every night doing countless hours of research, i really believe that a huge factor is the surgeon and the specific procedure. Make sure you find the absolute best surgeon and try and have the minimally invasive technique. I have found numerous ways of finding information on surgeons so if youd like feel free to private message me and i can share. Also, you mentioned the 71 y/o needing a fusion above only three years after. I think when dealing with people of that age it is really difficult to distinguish between the fusion causing the problem or just natural degeneration.
  • Ryan, based on your response on ADR, you definitely are doing your homework which is awesome! Everything you wrote is why my surgeon wouldn't recommend me to his fellow Ortho that specializes in ADR. He said he just felt the risks outweighed the benefit at this time. He said, down the road, he may feel differently.

    If you are not sure in your gut on the fusion, push the surgery out. Let someone else take the OR and reschedule it.

    Of course, I don't mean to tell you what to do but someone gave me advice that has stuck. "If no one can talk you out of the fusion, it's probably the right decision".

    For me, I had a gut worry about fusion. I had a gut worry about not doing to fusion and picking MicroDiscectomy revision but when I thought worst case with each...I said to myself "if the fusion goes terribly wrong and I'm worse off, I will be ticked off at myself for not trying the revision". If the "revision goes terribly wrong...well, at least I have the option of fusion and it was less invasive".

    It is a big decision at any age and even more so at 26 but I'm very impressed at how seriously you are taking the decision and everything you are reviewing to make a decision that works for you personally.

    I just want to wish you well.
  • Thank your for the compliment and for your well wishes. I have always been one to research and inform myself as best i can. And because this injury has resulted in the lost of my job as a firefighter, something i truly loved, i have taking it very seriously. Im not saying that its less meaningful for anyone else on here. I truly feel everyone sharing their story and Like all of you i want my life back and i am determined to get there. Which is why i am going to go ahead with a fusion. The MIS TLIF to be specific. I contacted a fighter with the UFC who underwent a fusion about six years ago and spoke with him last night via email. He went on to fight 6 mores times and is still active. After hearing some things he had to say i am confident i am making the right decision. As some of you may know i was unsure about having a re-vision microdiscectomy because the first one left me with chronic low back pain only to re-herniate. So fusion was the next option, yet that was also a worry due to the possible effects at the level above. However, the person i spoke with got his life back, he is aware that potential problems may arise and is fine with that because the alternative is misery. I think part of my problem was that i researched to much and over analyzed everything just to become a indecisive ball of stress. Another part of my indecisiveness came from an unrealistic hope that a brand new, revolutionary scientific breakthrough was just around the corner. You know, swallow a pill containing medical bio-mechanical nano-bots that can eat away my ruptured disc and then inject some stem cell's that would start regrowing the old disc in time for christmas. Silly i know, perhaps that will be a luxury my kids will enjoy but in the mean time i need to stop holding my breath and do what i think is going to be the best option in present time. I already feel better just from stopping the eeny meeny mino mo and making my final choice. If anyone is interested i am going to make a video blog of the entire thing starting from going into surgery until i feel im back to normal. I will put it on youtube in hopes it might help anyone going threw this in the future. Thanks to everyone who replied, i hope we all find relief soon.
  • What about scar tissue? I've had two lumbar surgeries, the last of which was a Micro-D. Now I have such a mess of scar tissue that my original surgeon is afraid to do any more work on my lumbar.

    Although Micro-D is less invasive, it still adds to scar tissue, which can be a problem down the road. Just another thought to add to the process. As if you need any more to worry about!

    I know that I wish I had chosen the fusion over the Micro-
  • Hey Gary,

    Yes i do have a good amount of scar tissue from my first MicroD. That is also part of the reason i am going with the fusion this time. My surgeon said that part of why i am in so much pain and unable to stand or walk is because the scar tissue is not allowing the nerve to slide away from the herniation. Normally, when the disc herniates and pushes on the nerve, the nerve can and does move to one side or the other. In my case the scar tissue is rough in texture so the nerve is stuck being fully compressed and not moving to the side.
  • Ryan I'm a 38 year old male I had a microdiscectomy in 1996.Awful pain down my right leg worst pain i've ever had, I woke up from the surgery and felt 100% better.I did really good for about 13 years then started to have low back pain again thought it would get better but it didn't.In Jan 2010 L4 & L5 disk ruptured worst pain than in 1996 MRI showed huge rupture on the right side and bulging on the left.Could not walk from the bed to the bathroom only about 10 feet, well after about 1 month and losing 28 pounds I'm 6'5" 210 before losing the weight My same Surgeon scheduled a Revision microdiscectomy hoping I would have the same results.Surgery went good but about 2 months after surgery low back pain started to come back he sent me to Physical Therapy I had 6 months of Therapy and no improvement.So here I am now 3rd MRI this year and I have a 2 level fusion planned for next friday the 28th.He said I'm a great candidate for fusion I don't smoke,not over weight,young I'm hoping for good results.As with your situation I wish I would have done the fusion in Jan instead of the Revision microdiscectomy and would not have had a year of pain but you never no.But I think you are making the right choice. Good Luck Jason

  • Hey Jason, thanks for the reply. I am also having my fusion done next friday on the 28th. Sorry to hear about your situation. I can definately identify. This herniation is way more painful then my first and after about a month and a half of literally not being able to walk or stand i am ready to jump on the operating table with joy. If you dont mind me asking, did you do something or get injured to cause your recent disc rupture?

    Also, im sure it was a bummer to have a second operation only to need a fusion. That is what i was fearing would happen to me and a big part of the reason i am going with the fusion now. While i am really sorry to hear you had to go threw that, i also thank you for sharing your story because it does help me feel confident that im making the right choice. I hope you have a successful surgery and find relief.
  • Hey Ryan I have DDD so my back has always had issues.My rupture in 1996 and 2010,I don't know what caused them to rupture other than the DDD and wear and tear on them I never heard a pop like some people have said.My lower back just got really sore and it stayed that way for a couple of weeks then it would go down my leg to my foot.Once it was in my leg Surgery was the only thing that helped.I tried therapy and injections and only got a little relief.

    As far as my second microdiscectomy I wish I would have gone for the Fusion.This whole year has been a roller coaster up and down mostly down.Its a tough decision, who really knows you just make the best decision you can with the help of your surgeon and family.So I guess this Friday is the day for both of us I have to be at the hospital at 4am and surgery is at 7am.I'll keep you in my thoughts and I hope you do really good!!!Jason
  • Ryan,

    Best wishes. I am excited to hear about your successful recovery! Keep your chin up and know that in time, things will get better.

    You have made a good decision for yourself, based on your research, your doctor's insights, and your personal situation.

    Try to relax this week and do something 'fun' for yourself this week...good luck!
  • Hey jason, sorry to hear about the ups and downs after your second microdiscectomy. Thats exactly how i was after my first one.

    Looks like you are going in before me on friday so i will keep you in my thoughts as well. My surgery time isnt until 10:30 i believe. I will hopefully have my computer and internet while in the hospital. If we are both able to it would be cool to check in sometime after the surgery and compare. I will drop you a line over the weekend. Take care

    Also, i have spooken to a couple guys over the weekend. Both of which have had spinal fusions and are now in great shape and very athletic. It was very inspirational and set my mind at ease. Just thought id share it with you. Hopefully, that will be us after we are fixed up.
  • Dnice,

    Thank you very much for your kind words. Getting more nervous but i really think its the right thing to do. I will keep everyone posted.
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