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Trying to Decide

tandk1116ttandk1116 Posts: 1
edited 06/11/2012 - 9:03 AM in Back Surgery and Neck Surgery
I have damage in my L4/L5 area. My most recent MRI shows my discs are pretty much disappearing. One is almost completely gone & the one above it is starting to show damage. Pretty much from the middle of my back down to my ankles hurts constantly. I also have pain in my arms. The neurosurgeon has suggested 3 rounds of injections & then surgery. He hasnt specified which surgery at this point (he says we will discuss that when the time comes) but I know it will be a fusion of some sort. I am very nervous about this.

I started having problems in Nov 2009. I have had 3 steroid injections & finally refused to have any more because they didnt work more than a few days & I gained about 30lbs. I went through 3 rounds of PT with the tens & pully system. Finally my doctors decided they would just focus on making me comfortable with medications. Nothing worked to alleviate my pain. Finally they found a pain med & muscle relaxer combo that makes my pain bearable. I was told at the time I was not a canidate for surgery due to my weight, which is 287lbs. My primary doc, pain management doc & the ortho surgeon told me the risks were too high for a person of my size. This was in Houston TX.

We moved to KY last year & I started seeing a neurosurgeon. He took some xrays & decided that surgery was not an option at this time. I went to another neurosurgeon for a second opinion & he says do surgery now.

Here are my concerns. I know from research that my weight does play a part rather the doc wants to tell me that or not. He is also telling me that this will possibly be the only surgery I will have to have. My docs in TX told me that once I had the surgery it would be one of many due to many factors. I am also concerned if no other surgeon would touch me than why is he so willing to do the surgery? If I have the surgery & the time comes for another I might be stuck if he is not practicing or we are back in TX at the time.

I guess what I am wondering is if anyone regrets not waiting? I know there is no turning back once I make the leap. I am only 34 & do not want to spend the rest of my life regreting the decision. I have had many people tell me that they regret having surgery & if I can manage my pain with meds then wait as long as possible. I am limited in what I can do as far as walking sitting & standing for any length of time. I do suck it up alot & tough through it though.

Have any other obese patients had the surgery with success? If so did you find that recovery was longer or harder? Were there complications?

I would like to lose more weight before surgery because I think it will increase my success & help recovery time if I do have the surgery. Also the ortho told me he felt losing the weight would help alot with the pain. Has anyone else found that to be true?

Thank you for taking the time to read & hopefully respond :)))



  • I thought the years that I was told I was not a "surgical candidate" were tough, but having had two spinal operations in a year and facing possible future surgery is tough. I gained 30 pounds in the year that I've had the surgeries. Now I have got to the point that I need to get it under control. Before my first surgery - ACDF- I had two opinions the same and one very different (that's the one I went with). It was the doctor I felt most comfortable with and he came with high recommendations. He did my second surgery as well (I knew before my cervical surgery that I needed the lumbar).

    Although I know eventually more will be needed in the lumbar area, right now I want to try shots again, lose weight, try PT (again).

    Do what you think is best, but make sure you understand everything you need to about the surgery and about recovery.

    4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.
  • Surgery on your back is optional and therefore is a very personal decision.

    No one can tell you have the surgery or don't.
    They will only tell you what they would do if they were in your shoes (which they are not and therefore have no risk in giving you advice.

    I thought my lumbar surgery was an emergency/urgent decision b/c of how bad the symptoms were when I ruptured the disc. I feared I would lose bladder/bowel control. Even with that pending worry, I was able to take 2 weeks to make an informed decision. I had a micro-discectomy and my only regret? Not researching/asking enough questions to understand the risks, recovery, and success.

    That aside, when that surgery failed, I was told the only option was to operate again. My surgeon told me revision micro discectomy but supported me on getting a 2nd opinion. When I did that, it opened a ton of questions because I got conflicting opinions. The 2nd opinion told me fusion. That confused me. On one hand it made sense b/c why not stablize the issue but on the other hand, it was a very final decision. I got several more opinions and did a ton of research.

    I found my final surgeon (neurosurgeon) who told me I really had 3 options - wait/do nothing, revision MD, or fusion. He gave me pros/cons to each. I asked him what he would do. And, he laid out a plan for me...not just for surgery to fix current issue but we ran through a series of what ifs. He assured me my questions/concerns were all valid. He explained why some doctors go more aggressive and others more conservative. But he told me the decision was mine but he could only recommend what he preferred and said I should select a doctor that was willing to work with me through ups/downs. He was that doctor.

    I opted for revision. Fusion was final. Why? He said that with advancements, the revision should resolve my issue and even if it only bought me 2-5 years, I may have other options. He told me of the complications with fusions on lower back but also told me of successes. I knew that multiple surgeries always risks infection and scar tissue but I knew if I did the fusion and something went wrong, I'd kick myself for not trying to revision microdiscectomy.

    I spent a ton of time on the decision.

    I think you need to know
    - what are the risks with fusion
    - what is best/worst case for recovery
    - are there certain people who are better than others for this surgery (turns out yes, some people are better candidates for certain surgery).
    - are there things to be aware of for recovery and success
    - what's recovery like
    - how will s/he know what success looks like? What failure looks like? What if things don't go well, what are the check points and if they go wrong, what options are left?
    - is there an option to visit a physiatrist (muscular/skeletal doctor) who will work with you, your GP, and your neuro to try alternate approach before resorting to surgery.

    I think there are many here that will regret not waiting b/c most folks that don't fair well are still here looking for answers.

    There are several that fair well and only visit from time to time.

    That being said, from my experience the people I know that have had either cervical or lumbar fusion, it seems the cervical folks have far fewer complaints than the lumber fusion folks. The folks I know who have had lumbar fusions say it is a very slippery slope. The lumbar (lower back)supports a good portion of the body weight.

    Not saying do/do not have surgery but ask a ton of questions. Worth a few consults if needed.

    When no one can talk you out of a fusion, you are probably ready. But really understand the risks and ask yourself "if this happened, will I regret the decision?" Don't assume the worst won't happen...I knew the risks but I knew the risks of doing nothing.

    I opted against fusion b/c I wasn't willing to accept the risks knowing I had an alternate option to try before fusion.

    Good luck.
  • Ask the doctor

    1 - what would he recommend if this were his daughter/wife/son, etc?
    2 - ask what he would recommend if you wanted to try one less aggressive approach and/or one more aggressive approach.

    It helped me understand 3 viable options.
  • This could be a very difficult decision but your doctor will help you every step of the way. You must be well-informed about the pros and cons of the surgical options you have so that you can have something to base your decisions from.
  • bookcatbbookcat United States Posts: 66
    I am sorry you are having to go through this decision-making. For me, that was the hardest part of my lumbar fusion process. One of the considerations for me was how much risk I could tolerate given the uncertain outcome. I discovered that I am not risk-adverse and, in deciding to go ahead with a fusion at L4-5, was willing to accept the potential for future fusion surgeries.

    I now have 3 lumbar fusions (L2-L5). While I still have pain, the success of being able to walk far outweighs pain tolerance. I would make the same choices again. I have decided that life has risks, and as long as I am willing to deal with the post-surgical outcome, whatever it may be, I will not regret making a choice.

    I encourage you to think about how risk-adverse you are and how that plays into your decision.

    PLIF L1-3 6/13
    ACDF (C5-7) 8/12
    PLIF (L2-5) 2003/05/08
  • I have the same sort of problems as you do.

    The way I look at it is
    1. Exercise will strengthen muscles, send the blood wizzing round the system cleaning away toxins & help build spinal stability
    2. Loosing weight means that there is less pressure on the spine. This has got to be good.

    It is difficult to change the way you live your life.
    I have to be on my case every day LOL. On the days when it seems almost beyond me I break the exercises up into smaller chunks & just do a few at a time.

    It is important to have support when trying to make major changes & I have found hypnotherapy tapes are great for keeping up one's determination to succeed.

    You are not going to let someone twice your age beat you are you? Go for it.
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