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L5/S1 ALIF+PLIF, foraminal stenosis+DDD - need opinions

Hello everyone,

Posting on behalf of my father. He is 48 years old and developed severe back pain and leg pain from Feb this year. We've been to a spine surgeon specialist and have been getting some advice. We have been given a nerve root block (steroid injection) and we tried conservative treatment (swimming + physiotheraphy) for 6-7 weeks but the condition has not improved. It is looking like we need to take surgical action as I can't image what type of pain he goes through every day. He is currently off work and on Lyrica 25mg + panadeine fort (basically tylenol+ a bit of codeine).

Here are the MRI findings for his lumbar back summarised:

* L2/3 - mild broadbased disc buldge, minimal impingement on thecal sac.

* L3/4 - mild broadbased disc buldge, minimal impingement on thecal sac. Mild narrowing of neural exit foramina on the left.

* L4/5 - broadbased disc buldge, right para foraminal bilateral annular tear. Bilateral facet joint hyperthropy noted. Mild narrowing of the neural exit foramina bilaterally with potential irritation on exiting L4 nerve root weight bearing.

* L5/S1 - broadbased disc buldge with facet joint hyperthropy causing mild impingement on the thecal sac. Narrowing neural exit foramina on left with potential impingement on left L5 nerve root. Mild narrowing on the right with potential impingement of exiting L5 nerve root weight bearing.

The surgeon has told us that it is basically bilateral foraminal stenosis on L5/S1 due to the disc degenration on the L5/S1 level that is causing the back pain and the leg+knee pain. He wishes to fuse L5/S1 anterior and posterior. There will be instrumentation (rods, screws, wedge). I was wondering if there was anyone out there with similar problems who elected for surgery. If so, how did it go and how much of the pain went away.

Also concerned if the 1 level fusion is actually sufficient upon reading some posts on this forum and the internet. I'm quite scared at this stage and my father even more so. However, the pain is really getting to him and I understand that we are left with no choice. My main concern is the multi level disc degeneration the MRI report points out. Is the surgeon not telling us something regarding the effectiveness of the surgery?

Thanks all, I am happy to provide more info if needed.


  • sciaticjennssciaticjenn Posts: 36
    edited 04/22/2014 - 10:11 AM
    Hi! First, I'm sorry your father is in pain. Everyone on this site has suffered and we all wish each other pain free days ahead so that goes out to your father too!

    In addition to the MRI has your father had X-rays where he was made to flex his spine in several different directions? Those can tell a lot about wether the spine slips during movement. I had to have it done before I could get my decompression surgery.

    I too had severe bilateral foraminal stenosis but I had three surgical options and two thought the decompression surgery would work and was the best course of action. I also had a disc herniation at L3/4. One said fusion which the others disagreed with completely.

    My advice is before you settle on a surgery you should get at least one other opinion. Seek out the best in your area or make a drive to the best DR known for not only success but one who approaches the surgery with the latest advancements in available. And stay away from places that advertise on the internet or tv! A good spine surgeon is a busy without needing to pay for ads!!

    All the best to your father. I hope he finds success in whatever treatment he decides on!
  • Thanks for the reply sciaticjenn. Dad has gotten xrays but I don't know if they were of different positions or not.

    As for the second opinion, how would I approach this if I've already given the green light for the surgery? He did say it would take 3+ weeks and Dad has to see a vascular surgeon soon. I guess we could do this in the background.

    We did go to a neurosurgeon a month ago and he didn't suggest any surgery at all which panicked us, because the pain he is in can't be permanent.

    Anyway, I'll keep you updated.
  • sciaticjennssciaticjenn Posts: 36
    edited 04/23/2014 - 2:36 AM
    You always have the option to delay surgery! Getting a second opinion is very important in any type of surgery and with spine surgery it's a must! While it might delay surgery a bit but the piece of mind in knowing you made a sound decision is worth it. I can truly sympathize with your fathers pain, we all can here, but this is going to affect the rest of his life!

    All the best to your dad!!!!!!!!
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