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Need some advise on how to proceed

DaltonDDalton Posts: 2
edited 06/11/2012 - 7:59 AM in Back Surgery and Neck Surgery
Hello everyone,

I am a 25 y/o Marine stationed in Southern California. Im looking for advise, opinion, experience, anything really to help me make my decision in how I should proceed with treatment. From what i've seen on this site there seems to be a wealth of knowledge and everyone seems very helpful. I look forward to hearing some of your responses.

Heres my problem...

I have degenerative disc disease with 2 severe disc herniations at L4-L5 and L5-S1 along with sciatica. The sciatica has subsided temporarily due to a couple of injections however the back pain is still very much present. I have tried non-surgical methods to reduce the pain but have had no success i.e. physical therapy, acupuncture and chiropractors. I had a discogram a few months ago to determine which level was causing my back pain and was positive at L5-S1.

I have been seeing the neurosurgery clinic at Balboa Naval Hospital in San Diego. I have had several appointments with a Neurosurgeon and yesterday had a second opinion with the Neurosurgery Dept. head. Both have recommended a hybrid surgery; Fusion at L5-S1 and a disc replacement at L4-L5. At the second opinion the doc told me the fusion is not really meant to treat back pain and it would limit my mobility in the future, but it was the only option; they could go in and do a disc replacement on L5-S1 (the level that is causing my back pain) but if I were to have problems in the future with L4-L5 then the only thing they could do would be a fusion over top of the replacement (which even I know would not be best thing). I am aware that the FDA has not approved a multi-level disc replacement in the U.S., however, I've read on this site and many others that people are getting them.

My main concerns are: maintaining my mobility, recovery time, and future complications. For these reasons I am thinking the best thing would be to get both levels replaced, I don't know how to go about getting this done or even if it is in fact the best thing. The doctor at the second opinion seemed to elude to me that it was. Traveling to Europe to get the procedure is not an option as I don't think the military will cover that.



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Comments

  • HI,
    Gee, only 25 and disc issues...sorry to hear that...however, in my opinion, I would go for the fusion. Friends with lumbar fusions have done well, though it does limit some mobility.. If you lost mobility, would you still be able to stay in the service? Or isn't that your plan..? Recovery time takes awhile, as it is your spine you know, that supports your whole body. I don't know if you would have future complications - it all depends on the degree of the DDD and it's progression.
    I doubt if you could go to Europe with the military paying the bill...and if you did, what if there were problems - could be a real problem trying to get back to the dr's there...
    Good luck to you, and I hope whatever you decide, it works out for you!
    Frannie
  • Hi. I had my artificial disc replacement on my l4l5 in 2004 as it was done as clinical trial, My concern was also to keep mobility so i can go back to construction work,

    I had hope that i can go back to playing golf and everything else i done before the back issue,

    In my case the surgery to replace the disc and use the artificial disc was a bad one because nerve damage during the surgery just to get the artificial disc in place is much worse then any back pain i ever had before my surgery,

    2 years later another dr who realy dont believe the use of artificial disc on the lumbar because he simply sees too many complications with them sugested we fuse the l4l5 leaving the adr in to stop movement so nerve thats damaged wont continue to be agrivated,

    Now i am fused and i have artificial disc at same level, But of course nerve damage is forever sometimes so it realy did not help me at all,

    The last 8 years i had many dr,s say rhe arrificial disc realy works mostly in the neck because less pressure is on it when its on the uper part of the body such as the cervical,

    So in my case i wish i would of worried less about mobility before going in for surgery and i should of just had the fusion from the start before all the nerve damage form such surgery,


    If you had a discogram is your disc leaking? Or did it just show positive for being the pain generator? Mine was leaking is why it had to be removed,

    If you dont have a leak and disc could be saved just by removing a part that might be pressing on a nerve then i would do everything to save the disc if posible,

    The less invasive the surgery the beter, There are some people that did ok i guess with artificial disc at 1 level and fusion at another, I am just not 1 that is in love with the idea of artificial disc when even some drs dont all agree how well it works especialy for the lumbar,

    Bigest problem also with this artificial discs is once its put in, and if there is complications, Nobody wants to take it out because it was done from the front and they refuse to go back in because of the danger of death on the table because of the scar tissue after the surgery,

    Its always a hard decision to make because any surgery can change a persons life either for the beter or the worse,

    I thought pain was bad before my surgery, That was nothing to what i have now and this is as good as it gets,

    So all i can say is make sure the disc cant be saved and use up all other options before going in to major surgery, Spine is so complicated no dr can give any sure answer on how good the turn out will be,

    Best of luck and keep us informed,


    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • Hi there,

    Sorry to hear of such issues at the young age of 25.
    But sounds like you want some advice and while none of us can tell you what to do, we can give you experiences to think about the questions to ask yourself and your professional surgeon.

    You are young. Your issues are in the lower back which happens to carry the majority of the body's load. This being the case, the lumbar is tougher to treat in some cases than the cervical (neck) area. ADR is 'relatively' new and while it's authorized in some countries, the US is a little stricter on it. You might want to ask why.

    Ok, so some thoughts.
    1 - surgery is a personal decision. Back surgery is optional and therefore you need to be confident in your decision b/c as the prior poster said, things can go wrong.
    2 - If the shots are working to some extent, it might be worth continuing with them.
    3 - surgery, typically, will help the leg pain but the back pain will be present to some extent so do not let anyone fool you into thinking surgery will put you back to 'good as new'. You will get 'better' but you will never be 100%. Your decision should be made on whether or not your quality of life will improve
    4 - life goals - what are they? do you want to continue in the military? Do you want to have a family in the future and just want to be sure you can play with your children and work on home improvements? etc.
    5 - ADR scares me for someone your age. Reason? The same as the person posted above. IT is a MAJOR surgery and while mechanically I love the concept, I think the technology needs a few more years to mature. I am actually a good candidate for it, yet my doctor told me he would not recommend it for someone so young (ha...I was 41 when he told me this). He said they last about 20-25 years and if people have complications, there is no definitive proof that removing or fusing around it is safe. IN addition, the surgery is gone through the front at this point so it is huge b/c you need a vascular surgeon to move organs around, etc.
    6 - I am conservative but also wanted to get my life back. My surgeon helped me make a decision that was good for me. But it took speaking to several surgeons to find one that was looking to treat me for life and not just a 'surgery success'. He told me what he would do if the option I chose failed, what he thought were indicators of a surgery failing,e tc.
    7 - My surgeon told me a good plan (which luckily agreed with me) was try least invasive (or most conservative option) b/c then I'd always have the opportunity to have more treatment/options ahead of me.
    His goal was to 'buy me time' so I would have more options over fusion and/or so many ADR would be a safer option.
    8 - I had a microdiscectomy - this is also like a laminectomy/discecomty. They shave some of the bone, then remove the herniated portion of the disc sitting on the nerve. For me, I ruptured the disc and lost 2 very huge pieces.
    9 - ask the surgeon what he'd recommend if you did not want either surgery or just one. If he bawks, maybe he is not the right surgeon. A doctor should always have some options. Of course, one doctor I spoke to said he'd treat me more conservatively but was convinced it wouldn't work. So I found another surgeon. The surgeon I chose, spent a lot of time with me and made it clear that it was my choice and that he didn't want me to make a decision that day. He actually sent me away to think about it which I greatly appreciated.

    10 - My issues is L5-S1 which was clear on MRI. I have no stability issues, just cruddy disc. My L4-L5 is under load and showing signs of DDD but holding steady.

    You are thinking about things right - but in backs, doing everything 'now' may be too much. IF the source level is L5-S1 that's the level to focus on.

    Fusions are tricky at the lumbar level - I know people who have had great success in reducing pain but others who have seen no difference. The fusion will not limit your motion so much that you can't do stuff but you do need to consider the additional load a fusion puts on the near by levels.

    Anyhow, take your time. Research, read these boards.
    - When no one can talk you out of surgery - you are probably close to ready.
    - When your world is closing in on your (e.g. you won't go further than your mailbox), maybe it's time to consider surgery.
    - When the risks of surgery are something you are willing to accept (meaning if the worst case happens and you don't think you'd regret your decision) vs. the pain you are in, then maybe it is time. For me, I knew there were some risks that were not worth taking on the fusion so I opted for a revision Microdiscectomy. (same surgery again).

    So far, things are better than they were but still hoping I have options to get even better.
  • to SH, and sorry that your are having so much trouble with your back at such a young age.

    I injured my back a few years ago, and after many opinions from fusion to discectomy, I had a discectomy/lami last July. Although I did not receive any relief from it, I really don't regret going with the least invasive option first.

    Unfortunately I did not improve, and actually got worse. After another MRI and injections, I am now scheduled to have an ADR at the L5/S1 level.I don't know for sure about how it is in the United States, but think that they are still only doing one level.I am from Canada, and my surgeon does do two levels. Many people from the U.S. seem to be going over to England, Spain, and Germany for disc replacement ( as I have read on another ADR forum)

    Has anyone recommended a discectomy to you as a first try?

    Wishing you all the best, it is such a huge decision that only you can make, and you will know when it gets to the point that you can't go on the way you are.

    >: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
  • The only thing I want to know is how much mobility you have in your back right now? After my surgery I actually gained mobility, I couldn't do much before the surgery, so to me I was thrilled. Doctor said I lost a certain % of mobility, but I told him I couldn't move at all before so it didn't matter to me. He said it was permanent change, where my pre surgery loss was considered temp. In my view it wasn't temporary, if I hadn't had surgery I was never going to get that mobility back.
  • I know there is a surgeon in Brazil that does ADRs and goes to San Diego once a month for consults. Supposedly a really skilled, world renown ADR surgeon that people from all over the world go see. But, I dunno. I'm sure if you google words like ADR, luiz, Brazil, surgeon, you will find him.
    Are your discs such that a microdiscectomy won't help or buy you some time? I'm sorry you are having to deal with back problems.
    -----------------------------
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • Thank you all for taking the time to give me advice and for sharing your experiences.

    The doc told me the discectomy was only for the leg pain and would have no effect on my back pain (is he blowin' smoke?). If I could go for the less invasive option I would be all about it. Currently the sciatica is not an issue, (due to the injections) the pain is all in my back, however, it's very difficult to discern where the back pain ends and the leg pain begins. I guess the best way to describe my pain; if I were to lay on my back and attempt to straight lift my left leg (or right, though not as severe) I will get severe sharp pain on the left side of my butt and throughout my lumbar.

    I am a very active person (to an extreme degree at times) and expect to be throughout my life, I wouldn’t want anything to jeopardize that unless it has to be done. I've done two tours in Iraq and one in Afghanistan and hope to do one more in Afghanistan before I get out in the summer of 2013.

    Right now my mobility is hindered but I am in no way incapacitated. I can still do alot of things with the exception of lifting heavy weights and bending over in certain ways. I can’t really run or hike (I probably could, but it would be very painful).

    DNice, you've hit the nail on the head; I don’t feel as if "the walls are closing in on me" and honestly feel very hesitant about getting this surgery. However, there are extenuating circumstance, I need to do something by April, any later then that and I will be processed out of the military.
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