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Questions about surgery and MRI and backs etc.

Hello everyone-

I am a 45 year old female with back issues. I had ACDF surgery on March 11 to much success. The pain that was in my shoulder and arm has gone away and I was very happy with the doctor, a neurosurgeon.

While my neck and arm had become a big problem over the past year or so, my main pain issue has always been with my lower back. For the past 15 years or so I have had pain in my lower back gradually increasing to the point where I can't really do anything without aggravating it. I can't sit in a regular chair- because my butt bone (for lack of a better word) hurts so much. If I garden (light weeding or raking) for 15 minutes I feel very bad pain and have to get in the recliner. Occasionally I have that very sharp pain in the center of my butt that goes down into my leg. Once or twice a year my back "goes out" where I can't stand upright at all for a about a week.

I had my neurosurgeon look at the MRI from my lower back during my last visit and he said he could do the same thing to it that he did to my neck: fusion. He immediately picked out the problems area L5-S1 and explained what was going on.

I was a little bit taken aback as when I originally got the MRI two years ago, my doctor at the time, an orthopedic, said just to keep an eye on it and acted like it was no big deal. My neurosurgeon suggested that he take x-rays during my next appointment to see if there is any change from the past MRI. He wanted to schedule another MRI, but I want to cut down on costs.

At first I was thinking, "no way, no how." But after his news sunk in, I started doing research and the possibility that I can be pain and narcotic free within a few months is very appealing.

I have been taking narcotics, off and on, for about seven years now for lower back pain and am tired of being on them. I have had PT and saw a chiropractor with no relief. Soma and Norco is all that provides some relief. I've tried to stop taking them all together but the pain is just too bad. I can't tolerate steroids so have never gotten the shots.

Right now I am in a *good* situation to have additional surgery (deductibles have been met and I have already gone through all the requirements for short term disability). I am a high school teacher, and I've been thinking, heck, go ahead and do it. I can return back to work second semester (start of January) and will be pain and pill free.

BUT I know it's all not that simple. I know there are no guarantees but from what I have read, if the surgeon can accurately pinpoint the causes of pain, there is a much better chance of a successful outcome. I do trust my surgeon, but of course they are making a ton of money on every procedure.

What are your ideas? Recommendations?
My MRI shows bulging, dessication, degeneration, and bone spurs at L5-S1 with a small amount of stenosis. What is your opinion? I value anything you have to share- I have gotten so much useful information from this site and am grateful for your insight.

I'm sorry for rambling- I used to be quite active but every single year I find myself doing less and less and less due to lower back pain. A return to *normal* life would be amazing.
3/11/13 successful ACDF
7/13 inconclusive discogram
Currently in PT for lumbar pain
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Comments

  • KyleFranklinKKyleFranklin Posts: 3
    edited 07/24/2013 - 8:05 PM
    Sounds like you have been through a lot and I am really glad that you are aware of your narcotic use. Those things can really creep up on a person and destroy the life they were intending to help.

    I have no personal with lumbar surgery or any back surgery because I have been able to find stretches that relieve my pain.



    You have to keep going and fight hard. There is light at the end of the tunnel and definitely don't settle. If you have to take some pills to be pain free - then I think it is worth it. Hopefully your doctor can find a solution though. Will be thinking of you!


    Link removed, solicitation not permitted.Please read the Forum rules
    Post Edited by The Spine-Health Moderator Team
    Kyle
  • Born2RunBBorn2Run Posts: 32
    edited 07/25/2013 - 7:56 AM
    Thanks Kyle!
    All the negative attention that pills get in the news makes me feel like a loser at times. Like I'm guilty of something. I know that there are many people who relate to this feeling.

    Does anyone think that surgeons "push" fusion/spine surgeries? My father said something like, "Of course he wants to put you under the knife again. He gets $50,000 for a half day's work..

    I am very conflicted.
    3/11/13 successful ACDF
    7/13 inconclusive discogram
    Currently in PT for lumbar pain
  • I believe my 20 hour (2 day) surgeries requiring more than one surgeon and their surgical office was paid less than 15k. through insurance.... but when you consider 2 surgeons 2 days, plus cost of office space, plus the cost to furnish the office (those tables are very expensive), plus office staff (surgical nurse, receptionist, insurance person, clean up, etc.) malpractice insurance... I could go on and on.... Yes, lots of specialists to live a comfortable life, but most aren't millionaires as you'd expect.... not to mention they almost always fall under the highest tax bracket.... so the 50k for 4 hours is so not true.... Honestly I have found most quality spine specialist try to do lots of things BEFORE jumping to surgery. Yes, some are "hoops" for insurance companies, but I have tons of friends who have seen orthopedic surgeons and neurosurgeons who did not have surgery, nor was surgery suggested... I'll get off that rant now... Best of luck to you. I hope you find a treatment plan soon that you can see some improvements.
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • Born2RunBBorn2Run Posts: 32
    edited 07/25/2013 - 10:35 AM
    Thanks for responding AllMetal-
    You bring up great points and I agree with you. You know how it is, you surf the internet for advice and find all kinds of naysayers. And then a family member has to throw his own negative two cents in.

    The thing that has be a little concerned is, why did the orthopedic surgeon shrug off the MRI two years ago but my neurosurgeon now is saying surgery (same MRI)?

    I remember the orthopedic's words. This is paraphrased, of course, but his casualness made me feel like a wimp for even seeing him: "one day that disk will burst and you'll feel it in your leg. At that point we will give you some shots. It's all part of getting older."

    I didn't care for this guy for several reasons. I like my NS very much though.

    Do you have any advice? I know it's my decision, and I am more than just leaning towards having it, at this point. I have an appointment with my NS on 7/6 to consult and let him know what I want to do.

    Thanks!
    3/11/13 successful ACDF
    7/13 inconclusive discogram
    Currently in PT for lumbar pain
  • AllMetalAAllMetal Posts: 1,189
    edited 07/25/2013 - 4:05 PM
    I personally wouldn't plan surgery on a two year old MRI.... I just wouldn't... what if there is now more wrong that you need fixed? Either you will then have to go through two surgeries, or just a much more extensive one then you had planned. My advice before considering surgery would be to request an updated MRI... Of course, that's my opinion and my opinion only.
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • Born2RunBBorn2Run Posts: 32
    edited 07/26/2013 - 5:18 AM
    My NS does want to do another MRI. Due to cost I am going to do x-ray first to see if it it is worse. If it is, then updated NOT and surgery, I guess.
    3/11/13 successful ACDF
    7/13 inconclusive discogram
    Currently in PT for lumbar pain
  • davrunnerddavrunner Posts: 478
    edited 07/26/2013 - 6:10 AM
    You really do need a new MRI before making a decision on surgery. On my lower back I've had mri's about every 2 years to check the degenerative changes and help determine when the recommendation for a 3 level surgery goes from elective to medically necessary. On my neck I get an annual MRI with the same recommendation for a 3 level fusion.
    Additionally I would recommend at least one more opinion, but you are the only one who can say it is time to go under the knife.
    Over the last 12 years I have seen 4 different surgeons, 2 nuero and 2 ortho. I have been told by both nuero and ortho surgeon that I wasn't a candidate for surgery and went through the whole gambit of blocks and injections to include botox.
    I had a nuero surgeon who did a cervical laminectomy which stopped strength loss but didn't help the pain.
    I am now seeing an ortho who is very honest about what he can and can't do for me and what to expect when I finally make the decision for surgery. He says I will be happy with the 3 level cervical fusion and it should fix most of my pain issues in upper back and arms but no so optomistic with the lumbar fusion. Because of the extent of the surgeries he recommends holding off as long as possible due to very strong possiblity of further deterioration and need for surgery adjacent to fusions.

    You should not feel like a loser because you need meds. Don't let other peoples issues become yours, hold your head high and don't let them intimidate you. I like to look them in the eye and kinda dare them to say anything...
    laminectomy c4/c5 2008, ACDF c4-c7 Jan 20 2014 sched
  • MRIs can be had for under $300 cash.

    I'm sending you a pm with a link to helpful info since we're not allowed here to post it publicly.
    -----------------------------
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • Shari514SShari514 Posts: 120
    edited 07/26/2013 - 11:58 AM
    I had a lumbar fusion 13 weeks ago and I cannot emphasize enough how awesome it feels to no longer have Norco in my handbag! I haven't felt this good for 4 years and I'm regaining my life. I can walk on my treadmill everyday for 45 minutes, run errands, clean my house, cook dinner and NOT be in pain!!! I would definitely go ahead and get the additional studies you need done, but as you said; you're in a good place. Maybe get a second opinion. I was shocked at how little my neurosurgeon made for my surgery.....somewhere around $20k. My husband and I realized how far down I was in January; on the way to our son's wedding I had to take a Norco. I was able to smile, to socialize and to dance, but I was in pain. I worried and wondered if I was going to become addicted to the meds. I had already seen a surgeon who told me I needed a fusion, but my husband insisted I do some research and begin moving forward. My dad nearly had a stroke when I told him I was having surgery and a close family friend tried to talk me out of it. I know not everyone is the same, we all have different problems, but I took a chance and 3 months later I have my life back! Don't let other people have too much influence on your decision, you know what you're going through and you know if it's something you should look at further. Good luck and I hope if you have surgery you'll have the same outstanding results I've had.
    Shari
    Lumbar laminectomy L-4/L-5, 2006
    XLIF with posterior pedicle screws L-4/L-5, 4-23-2013
  • Thanks for all of your advice and responses!

    Well, I had a new MRI on August 3 and saw my neurosurgeon this morning with more xrays.

    The good news id the ACDF surgery looks good and has fused wonderfully.

    The new MRI and x-rays show more DDD since the old one. The disc is basically gone at L5-S1. My surgeon told me that my particular insurance will not approve surgery based on that alone so he has me scheduled for a discogram. How will this test influence the insurance company? Is lumbar fusion done for just DDD? I've read all of the posts about discograms, so I know what to expect.

    Is it normal to add another test to satisfy insurance requirements?

    Once again, any input will be appreciated! Thanks in advance!!
    3/11/13 successful ACDF
    7/13 inconclusive discogram
    Currently in PT for lumbar pain
  • Born2RunBBorn2Run Posts: 32
    edited 08/06/2013 - 9:03 AM
    Another question that slipped my mind-
    The place where I am having my discogram done doesn't use any sedation/pain relief. Will it be bad? I guess I have the CAT scan right after the injections- it's hard to imagine having this done (lying still) while in pain from the discogram. Any comments?
    3/11/13 successful ACDF
    7/13 inconclusive discogram
    Currently in PT for lumbar pain
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