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Facing the possibility of surgery

Here is my story:
I hurt my back on the job in June of 2008. Classic symptoms - Lower back pain radiating across the back and down the left leg to my toes; Burning / aching pain constantly; Leg weakness. Went through the standard Worker's Comp mess of seeing doctors who where in the insurance company's back pocket. Was told that I had a herniated disk at L5-S1. Took almost a year to even get into physical therapy. Due to my pain level, PT discharged me stating that I had made little to no progress, despite putting forth effort to complete all exercises (their words in their written report). Doctor reported to the insurance company that I was at MMI (maximum medical improvement) at that time. After months of being in pain, thinking I would get no better, I went back to him to get a referral to a pain management dr. He told me he WAS pain management and said "I guess I didn't do so good of a job huh?"

At that point I retained an attorney, and petitioned the Industrial Commission to see another doctor (and won). I started seeing a Physiatrist that specializes in pain management for back issues. After numerous ESI's that did nothing but make me hungry, pain meds (to up to and including Morphine 120mg per day which was useless) and PT for 10 weeks, I was referred to a surgeon to see if I was a candidate for a SCS. Now, understand that this surgeon has a reputation of fixing patients and getting them back to work ASAP. The surgeon explained to me that I was experiencing two different issues. The mechanical issue of my back - L3-L4 and L4-L5 severely degenerated and L5-S1 herniated and affecting the Sciatic Nerve Root on my left side. The Neuropathic issue in my left leg and foot resulting from several years of the nerve root being compressed (which has most likely led to some extent of permanent damage). He told me that the fix for my back's mechanical issue was a three level fusion (L3-S1), and that it alleviate my back pain but would likely not change my leg pain. Since my pain is worse in my leg than my back, he suggested that I try the SCS for pain relief. I had the psychological eval and evidently passed as my trial was scheduled. I loved it...I had an immediate pain decrease of about 70%. So, six weeks later I had the permanent SCS implanted and was at a 70-80% pain reduction for almost a year and a half.

Several months ago, the pain in my leg started becoming stronger than the stimulation sensation. I had Vicodin for break-through pain, but it never really did much. My original pain management doc had moved out of state, so I went to the same clinic but saw his replacement. Nice guy, but I feel like I am starting over, as he gave me a Z-pac and said he wanted to try injections again. Then maybe a CT scan to see if things in my back have changed. So, I go back next week to let him know I am NOT taking any more shots since the other four I have had did nothing, so we need to move on to the CT scan.

Ok...enough back story - now to my question. I am already under restrictions of sedentary work only, no lifting over 20 pounds, and no repeated flexion or extension of lower back. I can not sit or stand for any length of time, and if I walk more than about 45 minutes, I am so nauseous I can't stand it. I am wondering if anyone out there has had a three level fusion like the surgeon described, and, if so, how has it limited your mobility and ability to perform the daily functions of living? I already have to have my wife do anything that involves any point below my knees as I can't bend to get there (shoes & socks, showering, etc.) Also, what medicines are commonly used in a pain pump, and how do they effect your cognition?

Sorry this was long, and thanks in advance for your input.


  • I have had 4 fusions, not all at once. it started with the l-5 and the last one was l-3. each person has different things with pre and post surgery, i can only speak from my own experience. the first one was the best. still had pain but i had no mobility issues at all. after 2 years they removed the hardware but did not help the pain. the first fusion blew out the disc above it and they tried a lamanectomy but did not work so they went in and did a fusion. the 3rd one was the one i had the problems with. major mobility issues and pain issues. i could not walk more thatn 50 ft without stopping due to pain. the disc above it eventually broke and had last fusion, though the side not the back this time. it helped with the walking pain but still have sever pain. i can walk without pain but have to stop because i feel out of shape. but still pain in rt leg which has gotten worse over the months. my left leg is now numb from the groin to the knee due to last surgery. it has not gotten better eventhough drs say it should. so basically it is a crap shoot with back surgery. don't let this scare you off. i would not get multiple ones if you can help it. the more the worse.
    good luck
    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.
  • Thanks for the input Jon. The surgeon said if it comes to surgery, he would rather do all three at once to prevent just that issue (which he said would be the case if he only did the L5-S1 level). My only two reservations are 1) what further mobility / occupational limitations a three level fusion will introduce, and 2) will it be worth the effort knowing that it may very well not do anything for my leg / foot pain. Not being able to do the things I know how to for the past four and a half years has caused depression issues, and I really don't want to make things worse.
  • edited 02/28/2013 - 4:49 AM
    Well...I had the lumbar CT done in December and it showed some degenerative changes, along with 2 disc changes. Had one more ESI and it did nothing (as I expected)...the pain doc did finally find a medicine that actually works; Nucynta. Only problem is that I fall asleep within an hour of taking it, and I am so groggy for the next 12-14 hours that I am effectively useless for anything.

    I finally got in to see the surgeon and he told me what I needed to hear (not what I wanted to hear) - surgery will fix my back but may not do anything for my leg pain, and it may make things worse. Like I need "worse" at this point. So, I elected to stay away from surgery. My lawyer said that my only choice may be long term pain management. Not sure what that means since it has not been managed for the past almost 5 years. So...waiting for the lawyer and my rehab guy to sit down next week and chat about my options...should be interesting.
  • after my first fusion, i was on limited action for a year, no lifting over 5 lbs, no bending etc, you know the drill. i have been on pain meds for 11 years and all under the care of a pain management dr. I have a nuerosurgeon that i see occasionaly. i see pain dr every 2 months and have had a few injections that never help. i have said this a few times so forgive me if i repeat myself but 1/3 surgeries are successful, 1/3 stay the same and 1/3 get better but i hate to be the bearer of bad news but don't expect to get back to 100%. i actually have gotten worse with the more surgeries i had. if you have metal, they will give you 2 years and then you can get it removed to see if it helps pain issues. good luck
    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.
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