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How much pain is required before considering Surgery?

trader4300ttrader4300 Posts: 14
edited 06/11/2012 - 8:58 AM in Chronic Pain
I really appreciate your opinions and thoughts. All I have had to go on until I found this forum is the doctor's opinions and some associates who have bad backs. So I hope I can get some good opinions from all of you that have had to deal with back pain.
My back pain has been going on for 4 years. I have been treating a bad disk at L5-S1 for all this time. One of the comments the Neurosurgeon told me was that "Your disk is completely worn out". Another comment in another session is "deal with the pain. You don't need this surgery" What! How bad does the pain need to be before one gets to have this taken care of? No, I didn't have an accident or a bad fall. My pain comes from a failing disk over time. I am now on Tramadol to deal with this pain. I tell you, I am in so much pain at night when this medication wears off that I can't wait to stumble into the bathroom to take 2 more tablets. Does my life need to continue this way? Why wont these surgeons effectively help All of us instead of just those that can barely walk anymore because of the criticality of their condition. If I let this go like the doctor recommends, it will be all arthritic in a few years and will then bother me for the rest of my life, surgery or not. I just dont understand. Any help for me on this?


  • You should get another opinion from a different surgeon.
    ACDF C4-5 June 23rd, 2011

    Another surgery in the near future. I am 26 years old.

    Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg
  • I would get more than one opinion and keep looking for a Orthopedic or Neurosurgeon to help you. Do you have any sciatica from the disc herniation?

    When I had a herniated disc with leg weakness and nerve pain my Dr. sent me for an EMG/nerve test to see if a nerve was being compressed by the disc.

    Is there a good Spine Center near you? Perhaps they will be able to help you? We're here to support you through this. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • a good bet ..if pain is keeping you from .living a normal life /sleeping/sex/working/and just normal things like food shopping ..then its time to get a few professional opinions ..please note that surgey is ..in many case ..not curative .say you need a laminectomy/or a discectomy .it may give you some pain relief but as sure as life goes on the max time a spinal repair normally lasts id about ten years then you will more than likely require revision surgey ,if you are at the point where you can't take any more {pain } then go see a specialist and have a good chat and talk about your options
    good luck
    tony {UK}
    1997 laminectomy
    2007 repeat laminectomy and discectomy L4/L5
    2011 ALIF {L4/L5/S1}
    2012 ? bowel problems .still under investigation
    2014 bladder operation may 19th 2014
  • I am about to seek my 3rd opinion from the Spine center in Buffalo. Would love to hear if anybody has any opinions about that place. I would love to get a good 10 years more of quality life. Why should I give up 10 good years, stay in discomfort all this time, then when I am too old to really do anything consider the surgery. That's what the doctors are urging me to do. WHY? Doesn't make any sense.
    Thank-you all for this help. I need this!
  • trader4300 said:
    Anyways, I am ready. My pain is high enough for me, my quality of life is in the tubes, my outlook is terrible, and I have become a real $%^^$##.
    ...and there you go. That's when you are ready. Not when someone here tells you.

    As for modern medicine. Don't get too excited about it. A lot of what they can do today is modern and very cool. Back surgery, not so much. Go look at what a fusion consists of. There is nothing there that doesn't make it 1 step above barbaric and crude.

  • I think "one step above barbaric and crude" is being generous!

    I guess for every person looking to have the surgery done, there's someone like me saying NO WAY! I'm wa too afraid to take the risk, but if that is the route you are looking to go, maybe you need to seek out a new doctor? I hope you find relief soon!
  • do you have a pain doctor? if my dr told me what he told you i would be at a new dr asap. why wait? see a pain dr get all the tests you can then have pain dr change your meds.have you had a disectomy or an mri or a nerve test or any other tests to show your dr you have something wrong with you. one question, if it is that bad, why have you waited so long? i would have seen someone new and a pain dr in a new york heartbeat.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • Surgery is not necessarily the answer. It's hard to answer your question without knowing what avenues you have already taken, as Jon has asked above. What treatments have you already had? What kind of doctors have you already seen? What tests have you already had? Have you done physiotherapy? Have you expended the entire list of conservative care treatments? Surgery should be the very last resort, after all else fails.

    You said you are taking Tramadol, which is a pretty lightweight med. Have you tried any other pain meds? What type of pain do you have? Is it mechanical or nerve related pain? Have you tried a combination of meds, both nerve pain and narcotic meds? Have you tried injections like facet joint injections, ESIs, trigger points, RFA, etc? Have you been referred to a pain management doctor or a physiatrist?

    If you've already had two surgeons tell you that you're not a surgical candidate, then it's probably safe to say that you're not. You could probably find one who is knife happy and would be more than happy to get you on the table, but be careful what you wish for, as you very well could end up worse than what you started out as. Your pain is obviously not being managed properly, so I would start with finding a proper pain management facility and reworking your pain meds. How much do you know of your condition? You said your ns told you your disc is worn out. Do you know anything else other than that? You need to educate yourself on your condition and how to change your lifestyle - exercise, stretches, diet, etc. There is a plethora of information on the main site here, if you browse through the tabs at the top of the page under Conditions, Treatment, Wellness, take a look.

    One final thought. You said that if you had surgery, you know that you will recover and get your life back, literally. Well, you don't know that, literally. With surgery, you are always taking a chance. There is no guarantee. It could help you. It could make you worse. I had surgery in June. I woke up with a paralyzed arm. Food for thought.
    APROUD CANADIANveteranButNOTa doctor, my thoughts are my own
  • Wow, from what some of you say, there seems to be perhaps more that could be done for me, but maybe not.
    Started seeing a chiropractor 3 years ago for back and leg pain. Some relief, but only temporary. Went to a well known acupuncture, got no relief. Been doing all the back exercises to no avail. Tried one of those back pulling machines that pulls on the disks gently to help open things up. That didn't help. Pain getting worse. Can't sit in a car for more than 2 hours without BAD pain in the butt. Decided to see a Neurosurgeon. Took an MRI. The radiologist says I have mild DDD and a protrusion at L5-S1. The NS said "Oh, thats not bad at all, it will probably get better by itself. Give it a year". he then sent me to a pain specialist. I tried all the mild stuff with no results. I had 3 epidural blocks with no results. They put me on tramadol, and this seems to get me through the day. But let me tell you, I had better not forget my meds or go somewhere without them cause once this medication wears off, I am really not nice to be around. A year and a half goes by and I go back to the same NS. He recommends a new MRI. Now the DDD is more advanced especially at L5-S1. Protrusion still there. Doctor recommends going in and removing the protrusion. Told me that probably wouldn't fix the back pain, just the leg pain. I could come back a few years later if the back pain still bothers me. I didn't like his mannerisms so I went to see another doctor. This NS comes highly recommended. He looks at the MRI and then gets me an X-ray. He explains that I am a good candidate for a fusion but only gives me 85% chance of being pain free. ( I didn't think that was very good odds). After some more discussion with this doctor, he told me to look around some more, deal with the pain, and basically refused the surgery. I now have an appointment with a doctor in a nearby spine center. Will be interested to hear what he has to say.
    I am 56 years old, in good general health. I have a lot of activities I want to do yet in this lifetime. I am not ready to roll over and just live with this. There has to be something that can be done. Thanks for your help folks. Please keep the comments and ideas flowing.
  • I am also failed back surgery. I thought i was in pain before surgery. I did not know what true pain was untill nerve was damaged during surgery and it never healed after 8 years now, There is always some good outcomes and also bad outcomes,

    Any surgery has risk. Spine just hapens to be a risk where if it fails it carries a much higher risk in pain and quality of life for a persons future, Good luck,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • Having back pains and some discomfort even when sitting or slightly bending over, are sometimes regarded as nothing serious. Often, some people even ignore stiff neck and regarding it as just muscle aches. However, it may be something much more serious than just stiff neck and body aches. Hence, we must not disregard them.


  • After listening intently to all your comments, I clearly am getting both sides to my concerns about surgery for my pain. I have to think that the people on this forum most likely are not the successful surgery patients, because their concerns are now gone and they would not have any reason to visit us. But the few that do return to tell their success story, we thank you.
    I have decided to wait on the surgery until it gets much worse. Now I worry about long term effects of the worn disk as well as the pain relievers I am taking. Isn't a worn out disk going to cause arthritis, where there is nothing anyone can do about? Aren't my organs going to suffer from having to deal with unnatural substances like Tramadol for the next 20 years? Will my liver go before my time? Should I be waiting for more advances in back surgery like I elected? I appreciate your answers and dialog.
  • Is a funny type of drug. Not funny ha ha, but just funny in that it's marketed as a non narcotic non addictive substance but it is indeed addictive. If you ever look it up, check out what people have to say about it. The worse thing about it is that the people that are addicted to it, there are no current programs or treatments specifically designed for that. One orthopedic tried to get me to take tramadol but he also told me that I was "too young to be experiencing the pain that I was feeling". Needless to say I went and saw a different Orthopedic and it turns out it could've harmed me because if you have a history of kidney disease of epilepsy in your family, which I have both strongly in my family, you ahouldn't be a candidate for that medication. But anyways, I've also heard from people on this site that have said they ahven't experienced any problems with the medication. Your NS gave you a slightly higher percentage than mine, he told me I had about a 60-80% chance of being pain free if I did the fusion. I was in so much pain that was enough for me. I had L3-L5 fused at age 24.
    About 6 months after the surgery the pain started getting worse. I tried physical therapy, nothing worked. Turns out one of my screws was broken. I was just re-fused in October. When they opened me up, my NS said that non of my bonegraft had actually taken and the pedicle screw on the right side was actually broken off into the bone. They literally had to dig it out. I'm still in a lot of pain. About 20 days ago I got a bone growth stimulator that thankfully my insurance covered completely. Too bad my doc didn't say that it may not help people with spondylitis(I read that in the handy dandy notebook that comes with the belt and I have spondylithesis, the more advanced form, yay!).
  • You are a 100% correct that most of the successful members have moved on, and out living life. The only thing I have to add is surgery is such a personal choice, that no one can make that choice for you. The surgeon giving you a percentage is something that is very realistic. When they say I can guarantee to fix you, then run. Surgery has risk no matter how you look at. I once had a surgeon say that to me, and said good we won't need to sign off on the "risk of surgery", of course that didn't sit well.

    There is the theory that some patients will have a better outcome the better shape they are in, but then many patients by the time they go for surgery have been weakened so bad from the pain, they are no in that good of shape.

    As someone else said you will know what is the right choice for you. Did you get the third opinion at the spine center? If so how did that turn out?
  • i pretty much agree word-for-word what numbskull was saying. i waited until life was REALLY unbearable until i finally told the surgeon " okay, i'm ready. please do the surgery." basically it got worse over the 9 years before i got to the point that i was bedbound and i had to have homecare come and wipe my butt. this is only my experience though, but i waited. my surgeon waited for me to give him the answer. he said he would do the surgery but the decision was mine alone. he told me the risks and benefits and said the decision was fully mine and that he was not going to make any decision for me.
  • After several discussions with the Spine Clinic, it turns out they don't accept any of the popular health care plans such as BCBS, MVP, etc... One has to wonder why a Spine Clinic would turn away patients who go out of their way to buy the better health care plans. My only guess is that this particular clinic wants to ensure their payments and only goes thru the government backed plans such as workers comp, etc...
    That really sucks and tells me something.
    So right now I am just waiting to see if the pain gets worse or better over time.
  • This is the same question I pondered this time last year. I posted the question on this forum and received answers identical to those that you have received.

    In my opinion, everything that everyone has told you is true, even though they may differ, because it has been their personal experience. Unfortunately, this does not make your decision-making process any easier, but it does make you a much more informed consumer.

    My surgeon (third opinion over a 15 year span of putting up with steadily increasing levels of pain) told me that with 90-95% confidence that he could relieve my pain. That sounded very good to my chronically pained ears (back). We did it in January 2011 and initially my outcome was an improvement. However, after a few months I began to feel a different, more persistent pain. Since then I have undergone physiotherapy, med's, MRI's, CT's, xrays, ESI and a trip to the physiatrist (pins and needles test). My pain pervails.

    I have lived a very active life (marathon runner, gardener, plane jumpper out of'er, etc.) and agreed to this surgery because the "stars were right." I turned 60 this year and figured that I had endured decades of chronic low back pain that was not going to improve (severe DDD, spurs, spondy grade 1, etc.) so I needed to "pull the trigger."

    You may be in a similar box.

    The decision is your's and will always be your's. I never understood why surgeons only gave diagnoses, but no recommendations. Now I know. Whatever happens becomes your reality and if it was your decision to submit to surgery then you can't blame the doctor (with the exception of malpractice). I understand this and I support this.

    One thing that no one mentioned in the decision making process is something that finally dawned on me. Evalute the opinions of your family members, friends and work associates. Not their opinions about the surgery, but their opinions (comment, both blunt and subtle) about you - how you look, your attitude, your stamina, your stature. They are a mirror that you should incorporated into your decision. Chronic pain increases in small amounts over a period of time. Your body allows you to gradually adapt to this pain, until finally a "threshold" is crossed and you say NO MORE.

    It's a tough decision. Good luck.
  • I am in no means a Dr. I am scheduled for a laminectomy L2-4 next month. I had a fusion L4-5 ab out 6 years ago. It took a good 6 months before I started to feel better. The surgeon inserted 2 titanium cages and bone graft material. The fusion is solid. I was doing great for a long time. I have DDD and Osteoarthritis and all that comes with it. Now the levels above the fusion are giving out. Been in severe pain and putting surgery off at least i year. Both L2-3 discs are herniated and ruptured They are impinging on the exiting nerve roots on both levels and sides. Been through the injections and ablation. Tried every medication. The surgeon also said I won't get much back pain relief. The nerve pain is driving me crazy and bedridden.

    I have worked in Healthcare for 30 years. I also worked in a Spine Center. The general rule of thumb the surgeons and Insurance co. looks for is Nerve Impingement. I think now the only time they do back surgery is impingement because left untreated will be devastating. I don't think I saw anything involving nerves. That's probably why the Dr. doesn't seem too concerned. It could be that it's not showing up on the Mri eventually, it will. L4-5 is the most mobile segment of the spine and is usually the first to go.

    There's going to be risks either way. Sounds like your quality of life has been pretty bad. My own personal opinion, if it were me, go for the fusion. It's a 1 level fusion and do it before there's more
    problems. The cages worked great for me. The worst part about back surgery is it does effect the adjacent levels over time. You will know when you can't take it anymore. You'll be ready to jump on the table.

    Hope you find the answers soon. You will probably have some pain after. Hopefully, you'll be able to lead a normal life for awhile too. Good luck.

  • I don't have any thing to add but do want to follow you, so I hope it is OK if I tag along for the ride ;)
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • this is a very good thread....

    I want to add my thoughts....

    Oxygen ring a bell?

    lack of oxygen anywhere in the body leads to pain,

    I have spondy grade 2....doctor said i needed surgery...

    I said no way!

    he also said that if i didn`t get it i would become incontinent....

    I asked for options...

    he said go swimming...

    I said cool!....i can do that!

    My pain is mostly in my hip area....

    used to be really bad in the morning....

    decided to do core strengthing exercises....

    with my own particular yogic breathing technique....

    it`s something i learned from my buddist meditation practice....

    what i do is press air into my lower abdomen and squeeze my lumbar spine out and down ( I lie flat and arch my lower back when i squeeze the oxygen into my lower abdomen) to decompress the spondy and oxygenate the tissues....it also aligns the vertebrae into place....your muscles do that when they are strengthened...that is their job....

    guess what in three days i am feeling a considerable improvement....pain levels gone down to a manageble degree....

    mind you i am not into pain meds....


    cause all meds damage stomach lining which in the end leads to more pain...

    I`m not against taking meds...

    if you need them...it`s your choice....

    but for me i refuse to go that route....

    until i have exhausted all other options....

    guess what?

    there are many options....

    you just have to weed them out...search and ye shall find!

    I`m also on a prolotherapy program...

    my first one was not done correct (not enough injections) so i switched to another doctor with more experience....

    will be going for my third in a couple of weeks...

    the thing with prolo is that it is a long process...not a quick fix...

    but the risks ar nothing compared to surgery...

    get my drift?

    so what may work for you...has to be investigated by you and tried out....

    my doctor told me there are people who have controlled their spondy with swimming....

    I said to myself....

    I can do that....

    I alos take a good glucosmaine complex....

    drink lots of water....

    drink vitamin c with b complex....magnesium citrate works great as a muscle relaxer (pain goes down)

    all these things are natural and safe if done correctly, studied,

    the spine is the central frame...

    there are options....

    never give up,

    search, search, search.

    I forgot to add...i also use an inversion table....


    Live to Pray
  • Been a while since I checked in with you good folks. Thought I would give an update and address some of your suggestions.
    My pain levels have increased. The Tramadol is now just barely getting me by. I wake up in early morning hours and sometimes take medication at that time. I try not to take too much. I really dont want to be on this stuff. No more than 6 a day. My last dose is at 5:00 at night. But by 7:00 am I am in a lot of pain and can't wait to get up and take the meds. It takes me at least 2 hours in the morning to "get going". This means letting the meds do their thing. After that I am pretty good. If I miss a 4 hour med session, my back tells me.
    I know it is getting worse. often when I get up in the morning, if I am not careful how I walk, I get a twinge in my back where it feels like a bone segment presses directly on the nerve. If/when that occurs permanently, I will be hospitalized because that level of pain is unbearable. Luckily the spasm only lasts a second.
    I have heard that "this DDD condition will go away". They say that after a while it all calsifys and sort of hardens up. Men in their older years dont suffer from lower back pain as much as men in their 50's. Wondering if there is any truth to this. Will this DDD condition get better on it's own?
    Apparently, my disk is completely worn out by now. The exercises and swimming and vitamins will not help it at this stage, as I understand. I already went that route. It is not like the disk is herniated and just needs to get repaired. It is beyond repair.
    I also heard about a routine where the disk is replaced with a man-made gell compound and people have had good luck with this. Anybody know anything about this or what this procedure might be called?
    I tried calling my local spine center in Buffalo but they wouldn't accept my health insurance. I get the impression they have enough work from the workers comp cases they get.
    I have been pondering another session with a different acupuncturist. Some people have miraculous results. Also considering seeing another back surgeon for yet another opinion. Sure wish I could get my quality of life back but I am dealing with it OK. Haven't had sex in 2 years or participated in any sports or anything like that but I guess this is the drawback of this disease.
    Any thoughts or suggestions you may have are really helpful. Please keep them coming. You guys are great!
  • this may be an option for DDD,

    read the article.

    Live to Pray
  • sorry double post
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • brainferry - links are not permitted posted :) If you have a helpful link send it through a message to the person.
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • sorry bout that,

    anyways the link says ozone injections to the spinal disc have proven effective for ddd,

    you can put it in your search engine and you`ll find lots of info on ozone,

    Live to Pray
  • This has been a great thread! I have gone through the exact same thought process this spring, when deciding if I could and should "take it" anymore.

    My nerve damage (left arm numbness and weakness) just got worse, the flare ups were more severe and lasted longer. I took stronger narcotics more often and spent less time with family, more time in bed waiting for the pain to get under control.
    More sick days, less exercising, gardening and hanging out with friends. No more driving, dropping things and lack of sleep.

    Well into a 3 month long flare up from hell, it dawned on me this spring that my quality of life is severly impacted by my spinal stuff and I decided to take a chance on surgery. The surgeon gave me 80-85% on a 2 level ACDF. I wanted to hear 100%, but my husband said: if someone tells you that you have an 80% chance of winning the lottery, wouldnt you buy a ticket? I would.

    Im going in for my 2 level ACDF this Monday, and I am ready for whatever will be.
    If I stay the same, at least I gave it a chance and Im not new to pain management. Ive lived like this for the last 5 years, and my world has gotten smaller and smaller.
    Im only 39 and I deserve the chance of getting better. If I get worse, I am ok with that as well, surgery is the last thing we have not tried. I will deal with whatever will be.

    I agree with everyone that says it will be your choice ultimately. With the specific symptoms you have pointing at one level, most likely you are looking at a one level fusion. Absolutely, wait until you cannot anymore, but also praise yourself enough to want better for yourself.

    All the best,
    Cause: car accident & genetics
    Effect: herniations C4-7, stenosis, osteoarthritis, myelopathy, neuropathy
    Non-invasive Treatment: everything under the sun
    Invasive Treatment: 2 level ACDF, C5 & C6, May 2012
    Moving Forward: SCS
  • Good for you! You have had enough and are moving forward with your elected procedure. Please keep all of us up to date on how this works out for you.
  • a good indicator of should i have surgery or not ..i know thats sounds like BS but i have had years of pain 16 to be exact and i recently had ALIF fusion i thought it was to relive the pain ..i was wrong the consultant told me that its being done to prevent any more damage to my spine .any pain relief would be a bonus ..sadly i am in MORE pain now that i was before the surgery ..my advice would be to leave surgery alone fro as long as you can its not a guarantee that you will be pain free .in fact many find that they are worse off .i have had 3 operations and i have congenital defects too i am 46 soon and male .if you can work/walk /shop/drive/have some social life and a sex life and sleep the leave surgery alone ..i spend most of my life on my recliner and i hate it as i was a very active person not that many years ago ..good luck
    tony {UK}
    1997 laminectomy
    2007 repeat laminectomy and discectomy L4/L5
    2011 ALIF {L4/L5/S1}
    2012 ? bowel problems .still under investigation
    2014 bladder operation may 19th 2014
  • I think you all may be right. As long as I can still function somewhat on the pain meds, perhaps I should put off the surgery until either I can't stand it anymore or until a new technology comes out.
    Does anybody know if new research is actually being done on lower back pain, fusions, disk replacement, DDD, etc? I would like to think that someone is working on this somewhere to help us out.
  • theraphy, and also disc replacements will get refined and more advanced.

    I agree with fellow posters who say that you should wait until YOU cannot take it anymore, but my surgeon also said something that suck with me.
    Sometimes people wait too long and when there's time for surgery, permanent damage is done (to nerves) and there's so much wear and tear, and scar tissue from repeated inflammations, that the outcome will not be as good as if you jumped on it when nerves etc had a chance to heal from de-compression, rather then being beyond repair.

    I could perhaps have waited and suffered more and gotten evenmore steroid injections that would create more scar tissue. I could wait for the myelopathy to spread even more and have my left arm permanently paralyzed.
    But why? To be heroic and toughen out the pain? What was I waiting for? Certainly not improvement since I kept on getting worse and my word grew smaller each day.

    Surgery is not the easy solution to everything, but it might be worth it if your condition has great impact on your life. As long as you know the risks, why wait until it might be too late for great recovery?

    I might be back here in a few months, posting about how I regret surgery and that it destroyed my life, who knows. But if I feel that it greatly improved things and got me my arm back, I promise to post about that too!

    Let us know how everything goes for you!

    Cause: car accident & genetics
    Effect: herniations C4-7, stenosis, osteoarthritis, myelopathy, neuropathy
    Non-invasive Treatment: everything under the sun
    Invasive Treatment: 2 level ACDF, C5 & C6, May 2012
    Moving Forward: SCS
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