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Newbie.. needs advice on the fusion decision

Anterior lumbar interbody fusion with posterior l4/l5, l5/s1, fusion, foraminotmies
Sounds like a monster of an operation and decision. Here is my story. Let me know if my facts / wha tthe doc told me, are way too optimistic

I had my apt with a Neuro Surgeon today.
He looked through my MRI’s then went back and re-checked them.
Here is what he told me:

My discs are screwed, I prob have some bone on bone grinding. It is degenerative. I can quit squatting / working out, but it isn’t going to get better. At best I can slow down the degeneration, but my disc looks herniated, and shot. It will go through times it is less or more of a problem, but in time will just keep getting worse. My back can go out walking, sitting, or driving a car. Which is pretty much my experience in the past. He recommends an Anterior lumbar interbody fusion with posterior l4/l5, l5/s1, fusion, foraminotmies. Basically they use metal pins to hold 3 vertebrae in place, opening up the spaces the nerves come out of. This replaced the 2 bad discs. This is done on the back of the spine, and on the front. The front involves thoracic surgery, where they go in through my stomach area, I guess.

• This is a permanent solution. That are will never give me problems again.
• 1% chance of something bad happening, like infection, blood clot, etc…
• He thinks I’ll eventually need it, whether I do it now, or wait.
• The surgery is serious, done under general anesthesia, and would have me in the hospital for 3 or so days. Full recovery can take up to 6 weeks. I’d prob lose a week of work.

I like the guy, but wish I had more time with him. As always you think of questions after the fact. The big question is,

** if I wait to do the surgery, and my vertebrae around those discs keep getting damaged, and my sciatic keeps getting damaged, am I taking a big risk? ***

The other doctor told me I risk permanent nerve damage, weakness in my left leg.
So they are booking an apt for me for end of march. I’ll give them a yes or no by mid march. My plan is to start working out, and see what happens with my back. Then either keep apt and get surgery then, or cancel and wait until it gets as bad as it was a few months ago.

I know if I was still in the state I was in Aug / September, before the injections (3 + 2), this would be a no brainer.
I equate this to a car problem. The car has something wrong with XXXXX. It is rattling, but you can keep driving it. Eventually you will have to pay $$$ to fix it. But you are holding out as it is still drivable. Will this waiting make repair worse in future? Can you live with it, or will it break down? Or is the $$$ the same in a year as it is now, and you just delay payment at the cost of driving a broken car for a year?
Reasons to do surgery:

- I’ll prob lose a week of more of work do to back problems over the next year. (this one balances out with not to do reason)
- I currently have good health insurance, and the future… who knows I could get layed off, or ??
- Work right now is really easy. This is an ideal time as far as work.
- Eventually I will need it. The cumalitive pain, and problems caused by my back will eventually outweigh the pain and recovery time of surgery.

Reasons not to:
- 1% chance of complications
- Lose a week of more of work. (this one balances out with todo: reason)
- Metal in my body stops me from getting MRI’s, Alarms can go off at the airport?, etc…
- Pain, and recovery time.

As I stated before, these estimates and figures may be crazy optomistic given what I've read on here. I'm 40 years old. A hardcore bodybuilder. Reading peoples stories, I feel my symptoms are so minor. Or maybe I just do a good job of ignoring pain and working through it. I dunno. I haven't used anaethesia in years for dental work. And I go into work at time when I can't even straighten my back, and barely walk.
Gymnastics, Martial arts, then 24 years of bodybuilding catch up... 1 ruptured disc, one bulging.


  • I just had almost the same surgery (L4/L5-L5/S1 fusion) on December 5th, I am 30 years old. And like you have had problems with my back on and off for years, but it would typically go away. November 2011 it went out, but never got better (as it normal would), it got worse, way worse and at that time I had NO insurance. I did the chiropractor thing and the physical therapy exercises that I had learned years prior. Long story short being in agony and having no way to relief it other than pain killers, my motto was "The world doesn't stop because my back hurts", I never missed a day of work and I honestly think it's a mind over matter. When I finally got insurance and an MRI and saw the severity of the damage, it really freaked me out. Then they started talking about all the potential things that could happen if this was not treated. I did have to do the shots (just to show the insurance I tried everything prior to opting for surgery) but I did post on here almost the same thing you are, am I just delaying the inevitable? All I can tell you is I am glad I had the surgery, the pain I had was gone immediatley (I do have to say prior to surgery I was feeling better and wasn't nearly in as much pain as I was months prior, very odd but again I chalk that up to mind over matter, even my surgeon said he didn't know how I was walking as severe as it was. I guess I won the herniated disc award for the year, as he said!). Having surgery is not only a big decision not only because, it's surgery and no one wants to have surgery. But I totally understand everthing else your weighing out. I have a 2 year old and my husband works 2nd shift and my 12 needs to get to and from school everyday and I only get a very small amount with my short term disability. It just not the surgery you have to think of, but on the other hand you have to think, there is no ideal time to have surgery. I'm overly organized and the last thing I would have wanted is to have put it off and ended up in an emergency situation. So I would suggest making a pro's and con's list, but in my opinion (and this is only my opinion, I'm not an expert by any means). Get a second even third opinion if they say eventually your going to need this, and you have good insurance, I would lean more towards doing it now. It's not nearly as bad as I thought it would be, I feel better than I have in years.
    I hope all goes well, please keep me posted as to what you decide and feel free to ask me any questions, I'd be more than happy to try and help.
  • DaveFusionDDaveFusion Posts: 476
    edited 01/10/2013 - 7:41 PM
    Onetomanysquats: Megmac has made lots of good points. A 360 degree (front and back) fusion is bigger than just the back. (Obviously) and the timeframes quoted by the surgeon seems optimistic in the extreme. But your very fit which does go in your favour. If you said 6 weeks of work, I'd say its possible, maybe. Some here have after 4 weeks, but it's rare. And certainly not if there is any complications. Ones that have any hiccups seem to take a lot longer.

    The 1% risk figure you were quoted seems unrealistic. It's generally, 1 for this and x for that and y for something else. And no guarantee that the pain will be all gone. Check out http://www.spine-health.com/blog/top-ten-reasons-you-should-run-your-surgeon

    Take care.
  • OneTooManySquatsOOneTooManySquats Posts: 14
    edited 01/10/2013 - 8:49 PM
    I'm thinking the best decision so far was coming on board here. Thanks to both of you. i'm used to working behind my desk in pain though. How bad is the post opp pain, for lets say.. just sitting at a desk? I was working "crunch" time in august, at the height of sciatica. I was popping just enough vicodin to make me loopy, was still in a lot of pain but kept working. Walking... that was just painful. Is it a wait 6+ weeks so you don't injure yourself, or is it just too painful to work? Again i'm talking purely deskjob programming. Oh, and something I swear by, that has kept me from losing my job at a few places... get a memory foam pillow to put behind you on the chair. Works amazing.
    Gymnastics, Martial arts, then 24 years of bodybuilding catch up... 1 ruptured disc, one bulging.
  • I found him based on his ratings online and reviews online. However DaveFusion, I took to reading those articles. HE falls into these:

    "5.If they propose doing a multilevel fusion in the lumbar spine for degenerative disc disease. The spine is meant to move and although fusing one or possibly two levels for a badly degenerated disc is reasonable, fusing multiple levels rarely is necessary or advisable.
    6.If the surgeon does not offer a patient any non-surgical treatment options they may be operating under the old "I have a hammer so everything I treat is a nail" adage.
    7.If they get perturbed by the patient asking questions. A well qualified informed physician does not mind a patient asking questions. A marginal physician is more likely to be put out by an inquisitive patient

    Things were pretty rushed, and he insisted i'd have better mobility after the fusions.
    Gymnastics, Martial arts, then 24 years of bodybuilding catch up... 1 ruptured disc, one bulging.
  • I would say only missing one week of work is impossible,you will be lucky if you don't need a walker in that time frame.
    This type of surgery is rough on anyone,not to mention the cocktail of drugs you will be on. Regarding full recovery at six
    weeks post op that is just no true you will just start to fuse if all things go well at six weeks. Most people say 12 to 24 months before they feel normal again.
    I would suggest that you do more research on here reading other posts as well as reading post op must haves.

  • 360 (from the front and the back) at L5/S1 October 29, 2012. I was out of work for 5 weeks and like you I have a desk job. Only missing 1 week of work is extremely optimistic as I was in the hospital for 3 days and wasn't comfortable driving more than to the grocery store for about 4 weeks. I still struggle daily with sitting for 10 hours at work. I have to get up and walk every 45 minutes or so and I lay down while I am on my lunch break. However, I would not change my decision to have the surgery if I had to do it over again. I won't say the symptoms I had before the surgery are completely gone because that would be lying. However they are way better. Right now I am about 11 weeks out from my surgery and I still have an open incision because the fluid keeps building up and getting infected.

    What I did to make sure I got all my questions answered is typed up a list and at my appointment I handed my surgeon the list and he went through it until we covered it all. If your surgeon won't do this find a new one. If you haven't already get at least one more opinion. From what you have said it sounds like surgery is in your future no matter what but it is best to have more than one person say it.

    Single level L5/S1 360 fusion with 6 screws and a rod (10/29/12)
    Diagnosis: Grade 1-2 spondylolithesis, Pars Defect, L5/S1 disc tear anterior and posterior, DDD, spinal stenosis
  • backache99backache99 Posts: 1,338
    edited 01/12/2013 - 2:56 PM
    it was a multi level operation and there are many posts from me about it so i wont repeat myself .all to say yes its a monster operation i was in hospital 6 days then spent 6 weeks zombied on my recliner then roll on 12 months i am still in pain and having problems and on a massive amount of pain killers ..i read of some recovering with 6 weeks and i am in disbelief as my consultant to;d me me that it would take 2/3 years ..yes years !!! good luck
    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
  • OneTooManySquatsOOneTooManySquats Posts: 14
    edited 01/12/2013 - 3:49 PM
    I checked the bodybuilder forums, for peeps with the same operation. I think they seem to heal alot faster. Also, I have to factor in, the ones that heal without a hiccup are less likely to be on here posting. I worry about the financial risk of being out of work that long. What would you guys say is the limiting factors stopping you from working? Is it

    1) The drugs, and not being able to focus? Is it like being drunk?
    2) The pain of sitting? I'm used to going through those episodes. I work on my knees for while, stand for a while, etc...
    3) The pain of driving there. ( I've been there , where every bump makes your grunt at least ) I'm 7 miles from work.

    Or is it just so freaken painful you can't even concentrate? And I have to say a huge thank you to you people. Your posts here are priceless for me at this point.
    Gymnastics, Martial arts, then 24 years of bodybuilding catch up... 1 ruptured disc, one bulging.
  • i am 46 male and married .i was also very fit .i used to swim a lot .the reason i am now disabled is PAIN then lack of sleep for the last ten years i have only slept for 3 hours max at one time .i am woken every night due to horrific pain .i need massive amounts of oxycontin and oxynorm .and my life have been destroyed by pain .i have had 3 spinal operations and i will never work again .nor will i have sex as all the nerves in that area are permanently damaged {another risk of surgery} with all respect that happened on the second operation .if you new me 17 years ago and then now you would not believe i was the same guy .i was slim fit .good looking {according to most!} never had time off work and i was well off financially .now i am over weight not fit not rich lost my looks and suffer 24/7 in PAIN and that's pure evil .being fit doest mean you will necessary recover better i was very fit on my first operation .the last one almost killed me .i was in so much pain immediately after the ALIF words have not yet been written to describe that pain ..i asked the medics to kill me and AT THAT TIME I MEANT EVERY WORD it took over 24 hours for the pain to be managed i was in hell because i already take massive amounts of painkillers so the normal post op PCA was not enough needed more than anyone else had needed in 40 years of the hospital being open ! .the anesthetist was staggered .i was on diamorphine 4ml per 5 mins and ketamine and they were pushing bags of other pain killers and muscle relaxers through for 48 hours then i went back to a even higher amount of oral oxycontin .they had me on 5 x80 mg oxycontin and 10 x 20mg oxynorm {just whilst in hospital} the rule book went out of the window} i am now on 3x 80mg of oxycontin and 6 x 20 mg oxynorm a day that's still a lot and i have to take more on most days ..its 4am here in the uk and i have had just 90 minutes sleep tonight pain woke me ..again good luck
    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 had a good recovery and my fusions do not cause me any pain. I will admit that going back to work in a week is a little unreal. It will just be to hard to sit for long periods of time. I was going to return to work in three weeks, but I caught a staph infection that almost killed me. That's another story for a different day. Keep in mind I had two PLIFs. I have had 5 back surgeries in total. I am having number 6 sometime next month. Your surgery is meant to stabilize the spine, there is not a guarantee that you will be pain free. I contribute my being pain free, to being active after my fusions. I walked tons. The doctor just said you can't bend lift or twist. He will not tell you to hibernate in a recliner or lay in bed all day. There are people on this site that have returned to work 3 or 4 weeks after their surgeries and have been successful. Just remember to do your homework on your surgery and if u are having problems with your surgeon seek another opinion. There is a lot informative posts on this website, but there is also a lot of negativity toward being active after surgery.
    Discectomies 05/08 and 04/11, fusions L4-5 Feb 9,2012 and L3-L4 June 28,2012, Staph infection washout 3/2/2012, Bulged L5-S1. SCS trial on January 17th, 2014, which was a success! Permanent SCS on February 20th.

  • This is the same question I pondered two years ago. 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, discogram and a trip to the physiatrist (pins and needles test). My pain pervails and I can best be described as having a failed fusion.

    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 that 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."

    Of interest is the fact that my surgeon said that I may have waited too long to have surgical intervention. And as a result, my spine had attempted to compensate for the abnormality with bony growth (spurs), etc. So you can wait too long, just like your automobile analogy suggested.

    Personal state of health, insurance coverage, financial posture, family responsibilities all impact your decision. It appears that you have taken those into account. However, I am a bit doubtful about the "return to work in one week" statement. That does not sound reasonable. Recalculate the impact of the surgery against your situation and factor in a work absence of 4 weeks and another calculation at 8 weeks absence. I truly believe those tenures of work restriction are much more common, reasonable, and better guarantee a successful fusion.

    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 (comments, both blunt and subtle) about you - how you look, your attitude, your stamina, your stature. They are a mirror that you should incorporate 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.

  • One Too Many Squats, I realize your trying to understand what recovery will be like, it's just hard to explain as all of us don't experience same problems. One thing is for sure it's nothing like having your appendix removed or having knee surgery or some other minor surgery where you feel like crap for a few weeks and then life is good again.

    With a little luck you might be able to return to work after a few weeks off who knows, but that doesn't mean that you wil be healed,that takes much longer.

    None of us here are trying to scare you nor are we all a bunch of wusses, were just trying to tell you this is not a simple operation, better to go into this with your eyes wide open and fully informed.

    Regarding your questions of why we can't work ? I think most of us here wil tell you that the medication doesn't effect us that way as to feel drunk or stoned.

    As for sitting, I cant sit in a regular chair for more than a few minutes,the only type of chair I can sit in is a recliner. Standing still is also a problem for me,the same goes for walking any moderate distance without the assistance of a cane or shopping cart if I'm in a store, and then you can pretty much set a watch to how long I can go before I have to sit due to the building pain/spasms, and if I try to ignore the pain I will end up paying for it for the next day or two with unrelenting back pain and spasms.
    Regarding driving, in order for me to drive I have to have my seat adjusted back to the point I look like some inner city thug going down the road, hows that for a picture?

    Having said all this I think I should tell you that I have had two fusion surgeries,the second being a revision surgery due to the fact that I never fused the first time. I personally believe I didn't fuse the first time because I tried to go back to work too soon at seven weeks post op, but my work was manual labor construction,not a desk job so there is a difference.

    If your going to have fusion surgery you have to ask yourself is it worth going back to work too soon and possibly suffering the same fate? I was afraid of loosing my job and went back way to soon and what did it get me? I still lost my job due to the fact I coundn't come off light duty and I ended up having a second surgery and permanent nerve damage.

    Many people have this type of surgery with great outcomes,others don't, just do your research and get a second or even third opinion,there is no going back once you had this surgery.

    I wish you the best on whatever you decide.
  • I hear so many horror stories and people are crazy pain meds that I don't even know how they function... I just had the surgery last week.. I had degenerative disk disease at l4-5 l5-s1... I am in no way ready to go back to work but I am up.. Walking around, showering, and have decreased my oxycodone from 6 -10 mg tabs a day to 2 tabs a day. It's your own personal preference but it's all in the surgeon. If you have a good surgeon you'll be fine. I am go glad my surgery is over and go glad I had it done. I still have a long recovery but I didn't expect to be babk to work in a week
  • I serious thank you to all of you for you posts. I skipped out on surgery. And then, even after 2 epidurals, I hit rock bottom in enough pain that I couldn't drive 6 miles to work without dropping f-bombs and having to occasionally pull over. I couldn't sit at my desk for more then a minute without excruciating pain. My epidural kicked in by the end of the week, and I could function again, but still in pain. I'm good with pain. I haven't used anesthesia for dental work in 10 years, and at least that many fillings. I went in to see a surgeon, as I didn't want to risk not being able to work anymore. He noticed I had drop foot. I couldn't walk on my heals anymore. And I didn't even notice the times I'd trip over my own foot. That scared the crap out of me. Pain is one thing, but disability is another. So I scheduled and am now counting the days till Oct 15th when I'm getting a single level. microdisectomy. This doc recommended the opposite extreme from the other.. New MRI, disc completely ruptured. The other disc is bulging, but seems asymptomatic. I think I am someone who can work through pain easily. But that can be a good thing, or bad thing, when you push your body and risk permanent damage. I am floored by the difference in opinions and am wondering if the first doc was trying to sell me a used car as opposed to looking out for my best interests. OR maybe he saw something the second didn't.
    Gymnastics, Martial arts, then 24 years of bodybuilding catch up... 1 ruptured disc, one bulging.
  • SpineyKD23SSpineyKD23 IllinoisPosts: 89

    It is amazing how many different opinions you can get. It sounds to me like a micro d is the least invasive choice. Some surgeons like to try every smaller procedure before doing a big one and others like to avoid them because the feel the bigger surgery is inevitable and doing it now would prevent complications from multiple surgeries. Neither are wrong and it depends on the case. I am likely to get a fusion later, but because of my age, condition of my discs, success with previous surgeries, etc. I just had my third micro d (second at L4-L5) even though my surgeon said it we could have done a fusion now. He felt considering my circumstances another smaller surgery was worth potentially cutting me open 4 times ( a fusion later on would be #4).

    Based on reading your posts it sounds like a micro d would work better for you- you sound like you are willing to risk needing 2 operations (micro d and fusion later if needed) than jump straight to the fusion. The micro d may help you significantly, but it does sound like it will just be postponing the fusion. Kind of like my case. It is all up to you- I have been in the pain you are describing and after being in varying levels of pain for the majority of 5 years and trying to get through college I opted for 3 surgeries in 3 years. If you are willing to put up with the pain you can choose to. I do agree with the comment about waiting too long though. You have to find that balance. A micro d is as minor procedure as you will get. A fusion- not so much. Do take your time deciding on a surgeon. I travel 2.5 hours to see my neurosurgeon. He works at a brain and spine institute that is among top 10 in the country, he is head of neurosurgery and though his bedside manner isn't perfect I am so glad I chose him. Find somebody you like. If you have to travel that's a small price to pay, assuming insurance doesn't restrict you.
    25 years old: Herniated L4-L5, L5-S1 December 2008. L4-L5 microdiscectomy Sept 2010. L5-S1 microdiscectomy March 2012. Redo L4-L5 microdiscectomy Sept 2013. Redo microdiscectomy Oct 2015.
  • OneTooManySquatsOOneTooManySquats Posts: 14
    edited 10/19/2013 - 12:37 PM
    Here is my condensed diary. I went with the discectomy on both sides of l4-l5. On day of surgery the thing was a ruptured mess.
    Previous: Ruptured disc on MRI. Weeks varied between not being able to sit for more than a minute on meds, to walking (limping) without pain meds. Slight drop foot on right side. Cannot walk on heals on right side. Numbness, tingling.
    Day 1: Tuesday – AM surgery. Afterwards, walking, little pain. All sitting / standing /lying down was a process done with upmost care not to rotate, bend, back. Not doing so would cause pain. Unlike before, pain also occurred in glutes and upper halmstrings. Didn’t take pain meds. Took Nyquil to help me sleep. Slight fever 99f.
    Day 2: Wed - can’t stand without shaking all over. Feel cold. Went into shock when I got out of bed in afternoon. Laying back down stopped the shock. Happened again an hour later. Stayed on knees till it passed. Getting out of bed, standing up was an adventure in itself, with muscle weakness all over. Took a flexaril pill. In tears from the pain while trying to stand. Fever up to 100.5f.
    Day 3: Thur – Went in for re-check and was sent to ER due to tremors. All tests came back healthy (chemical, chest x-ray, Cat scan of brain). Extreme muscle weakness, and still having tremors. After getting home around 4 pm, I switched pain meds from hydrocodone 10 mg to Oxycodone 5 mg.
    I’m being very careful and using backbrace 100% of time. Also taking pain meds regularly instead of waiting for pain. Added 800 mg / day advil. By end of day shakes were gone. Weakness gone. Drugs masked all pain.
    Day 4: Friday -drugged + pain free
    Day 5: Saturday - As of 3:30 pm, I have taken no pain meds other than advil. I still feel mildly drugged. I am walking around completely pain free. I can walk on my heals with a very small difference on the right side.
    Gymnastics, Martial arts, then 24 years of bodybuilding catch up... 1 ruptured disc, one bulging.
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