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Facing possible Anterior and Posterior Lumbar Fusion Surgery

I’m 50 years of age and in December I was diagnosed December with degenerative disc disease at L4-L5 and L5-S1 and am experiencing moderate to severe pain in my lower mid-back, but mostly, the pain is at the S1 joint. My S1 joint is misaligned and the vertebrae above L5 is also misaligned. I also have mild scoliosis and narrowing of the nerve canal. I think it's called spinal stenosis. Most days, the pain level is between 3 and 5, but depending on my activity level, the pain can get as bad as an 8 or 9. At that point, I have to stop what I’m doing and ice my back or apply this topical cream my doctor prescribed. It’s absolutely heaven (I call it my ‘back crack’); however, it’s really just a Band-Aid and wears off within about 30 minutes to an hour. I have a desk job and sit on my bum all day. I get up about every hour or so for short walks to help alleviate the pressure on my spine. I mostly encounter pain at L5/S1 when standing or walking. The pain usually starts after about standing or walking for 10 minutes or so.

I began a regimen of physical therapy twice a week for six weeks and learned all kinds of stretching exercises. For a while, I believe it was helping. But in the last few weeks, I’ve been experiencing twitching or muscle spasms in my left leg and moderate to severe ankle and arch pain in my left foot. This only happens at night. My ortho doc doesn’t seem to think the leg and ankle pain is nerve related. Sometimes further stretches will help, but overall, my sleep is being impacted. I had pain injections in February. I was relatively pain free for about two months. Now that the pain is back, I’ve scheduled another round for later this month.

I have visited two orthopedic surgeons and one neurosurgeon. One of the ortho surgeons and the neurosurgeon recommend Anterior and Posterior Lumbar Fusion Surgery. The other ortho surgeon recommended disc replacement. There are days when I want to jump on the operating table and say ‘let’s do this! I’m sick of this pain!’ Then there are days when I’m scared to death of this surgery. I know that it’s more for stabilization and that there are no guarantees that it will relieve my pain, but the surgeon I have chosen to stick with also said that he believed in this surgery and that he wouldn’t do it if he didn’t think it would help his patients.

In the seven months I’ve been dealing with this, I’m beginning to feel overwhelmed. I personally know two people who have had this surgery, with good to semi-good results. One co-worker told me her back pain is now gone, but she’s having leg nerve issues and is practically learning to walk again. But, with physical therapy, she said the leg pain is subsiding somewhat, but she knows there is no guarantee that the nerve will ever get better. However, she said the surgery was still worth it because her back pain is gone. Another friend has had amazing results. She said she has absolutely no more back pain and wishes she would have had the surgery sooner. She does, however, have ‘foot drop,’ but has not experienced a lot of pain from that. A third friend avoided surgery altogether through decompression therapy. I looked into it, but the treatment lasts 12 weeks for a total cost of $5K, which is not covered by insurance.

I haven’t read a lot of good news stories on this forum and that makes me not want to have any surgery, but I don’t want to take pain meds the rest of my life either. My physical therapist firmly believes that with enough muscle strengthening, I can regain stabilization and relieve the pain. At first I believed and over the course of the last seven months I’ve worked really hard. But I’m beginning to wonder if I can honestly put in the necessary work-out time to achieve enough muscle strength to make a difference.

I don’t talk about this much with my family and friends, because it’s just so overwhelming. I’m glad I found this forum and I hope that it helps me make a decision about whether surgery is right for me.
Thanks,
Madelyn
DDD, Lumbar Spinal Stenosis, SI Joint dysfunction, Grade 1 Spondylolisthesis at L4-L5
Facing possible Anterior and Posterior Lumbar Fusion Surgery at L4/L5 and L5/S1
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Comments

  • madkgmmadkg Posts: 17
    edited 07/05/2014 - 1:05 AM
    That was a pretty long rant. I have so many questions and ask that anyone who is facing the possibility of surgery or anyone who has already had this surgery to please share their experiences too. The surgery I've been told I need is Anterior and Posterior Lumbar Fusion Surgery at L4/L5 and L5/S1. I know that everyone's experiences vary, but I need input from others going through the same thing.
    Thanks,
    Madelyn
    DDD, Lumbar Spinal Stenosis, SI Joint dysfunction, Grade 1 Spondylolisthesis at L4-L5
    Facing possible Anterior and Posterior Lumbar Fusion Surgery at L4/L5 and L5/S1
  • Have you tried SI joint injections yet? Fusions are a major surgery with a long recovery time and really should be the last option. The choice is ultimately up to you and your Surgeon. I know how scary it is to think about because my surgeon is also recommending I have a fusion ( PLIF most likely). I just had surgery in January and I had a really rough recovery (not a fusion) so I have decided to hold out as long as I possibly can. Are you experiencing any nerve pain? Are the medications helping to control your pain? It's really important to ask a lot of questions before making a decision. There is a good link on this site that gives examples of some common questions to ask. If you go into it with realistic expectations that will help also. There is always a chance that it may not help with the pain. But like you, I also know of a few people that have had a positive outcome. You should talk with your family about it because you will need help and support post operatively. I know I probably haven't been much help but I do understand what you're going through. Before my most recent surgery I just asked myself if I can live with this type of pain? and the answer was no. That's why I opted to have it done. I was also at risk for further nerve damage so that made my decision easier. If it's not serious enough to have it done immediately then take your time to fully think it through.

    I wish you the best!
    LC
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • The decision to have surgery or not is a huge one, but ultimately, it must be made by you, in consult with a surgeon that you feel has your best interests at heart.
    As far as adr goes, I am not a huge proponent of it in the lumbar area for many reasons but I will include the resources we have on our website to give you the information to make your own decision.
    This forum in particular is mostly for patients who are either getting ready to undergo or considering undergoing surgery, and like most spine forums, once a patient has surgery and it turns out well, they go back to living their very busy lives and we don't hear from them as often as we do those who are still trying to figure out what to do about their conditions. There are many, many successful spine surgeries out there, far more than you would think by reading various forums.
    Fusion surgery is a big decision, but undergoing any spine surgery is. I will also include some links regarding fusion surgery for you to read.
    http://www.spine-health.com/treatment/artificial-disc-replacement
    http://www.spine-health.com/treatment/artificial-disc-replacement/lumbar-artificial-disc-surgery-chronic-back-pain
    http://www.spine-health.com/video/total-disc-replacement-back-surgery-video
    http://www.spine-health.com/treatment/artificial-disc-replacement/artificial-disc-replacement-surgery
    http://www.spine-health.com/treatment/artificial-disc-replacement/evaluating-potential-risks-and-consequences-artifical-discl,,,,,,,,k9yt
    http://www.spine-health.com/treatment/artificial-disc-replacement/issues-consider-having-artificial-disc-surgery

    Fusion Surgery
    http://www.spine-health.com/treatment/spinal-fusion/spine-fusion-risks-and-complications
    http://www.spine-health.com/treatment/spinal-fusion/spine-fusion-post-operative-care
    http://www.spine-health.com/treatment/spinal-fusion/anterior-and-posterior-lumbar-fusion-surgery
    http://www.spine-health.com/treatment/spinal-fusion/types-spinal-fusion
    http://www.spine-health.com/treatment/spinal-fusion/spinal-fusion-surgery-recovery-one-three-months-post-operation
    http://www.spine-health.com/treatment/spinal-fusion/spinal-fusion-surgery-recovery-three-months-and-after

  • madkgmmadkg Posts: 17
    edited 07/06/2014 - 2:52 AM
    Thank you both so much. You've both been a lot of help! I had a round of pain shots (SI joint and lower back) in February and will have another in a couple of weeks. I'm still exploring the website and am learning a lot, thanks! I was really hoping that exercise and stretches (shown to me by my PT) would have helped by now, but I'm still in quite a bit of pain most days. I have a feeling surgery may be inevitable, but until then, I'm making it my job to get my muscles and core as strong as possible. I've been prescribed Tramadol and Gabapentin and I think they've helped a little. I have a feeling that I may have restless leg syndrome and the meds seem to calm down the twitching. Thanks again for reading and responding to my long rant. God Bless you both!
    Thanks,
    Madelyn
    DDD, Lumbar Spinal Stenosis, SI Joint dysfunction, Grade 1 Spondylolisthesis at L4-L5
    Facing possible Anterior and Posterior Lumbar Fusion Surgery at L4/L5 and L5/S1
  • LC84LLC84 Posts: 599
    edited 07/06/2014 - 3:59 AM
    I hope the meds continue to help as well as the upcoming injections.

    You're welcome and god bless you too!
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • I had this type of surgery done in 2007. It worked in the sense that my spine is stable. I have no restrictions as far as lifting, bending, or twisting. However, I still live with a great deal of pain. Would I do it again if given the choice, yes. The pain is pretty well managed by meds.
    The procedure you are looking at is a massive operation. If its all done in one day, the surgery can take anywhere from 6 to 10 hours. The recovery time is very long because remember now, you had two major surgeries. My recovery took 18 months but hopefully yours won't be as long. Good luck.

    Dick
    Emergency surgery in March of 2006 for spinal infection of L 2 and L 3. During surgery, discovered I had Cauda Equina Syndrome. Spine became unstable after surgery and had 360 fusion with 10 pedicle screws, plates and rods in April of 2007.
  • Thanks for the post. When you say you're still in pain, is it the same kind of pain as before your surgery. Does PT help at all?
    Thanks,
    Madelyn
    DDD, Lumbar Spinal Stenosis, SI Joint dysfunction, Grade 1 Spondylolisthesis at L4-L5
    Facing possible Anterior and Posterior Lumbar Fusion Surgery at L4/L5 and L5/S1
  • PeggyMcPPeggyMc Glendora, CaPosts: 17
    edited 07/15/2014 - 7:21 PM
    Hi Madkg,
    I am scheduled for this surgery, July 24th and 25th. I had an L4 L5 fusion in 2011. I'm really scared about this one. The pain I have now is so bad. I have had to resign from my job because sitting was killing me! The one hour commute to work made it worse. The pain in my back is bad but the pain in my hip, leg and foot are really bad. I have numbness and tingling in my foot, plus I get these crazy cramps in my calf. I have had many injections which didn't do a thing, I've had P. T. , mostly stretching which I do anyway, nothing works. I love my heating pad alternating with ice packs. So, it's surgery time!
    I would love to hear what you will do. I hope and pray that you get relief somehow. This completely stinks!

    DDD
    And two prior surgeries
  • Hi,
    I had an anterior fusion in the L5/S1 last Sept and 10 mos. later I am still in a lot of pain, actually it is no different than before the ALIF. While writing this, I am currently sitting on an ice pack! My surgeon sent me to a spine specialist, and I too have had 3 more injections since Jan, the last one just being this past Tues. They have injected the SI joint twice and this one was to go into the L4/L5 region, no pain relief as of today.
    I am at the point of having to quit my sitting dental job because the pain in my lower back is so severe. I now have a very unusual sensation that runs down my left leg and into my foot and I get leg and foot cramps regularly. I will be going to my primary care dr to have another MRI ordered to see if it will show anything new, the spine dr wants to do a discotomy, but an MRI has not been done since 5 months prior to my surgery.
    I know 2 other people who have had the ALIF fusion and are still in pain, but I guess some people must get relief. My dr (who is a neurosurgeon) pretty much assured me that it would solve the pain, but he basically has no clue why I still have pain. He is the one who has sent me to the spine specialist.
    The surgery itself was difficult and I know now that I went back to work way too soon. If you do have it done, please follow the doctor's orders exactly. I thought I couldn't take off 6 weeks from work and went back at 2, biggest mistake ever.
    I have been through 4 months of aqua therapy, mixed with regular pt, also with no relief.
    I am anxious for the MRI to see if anything new has happened.
    I am guessing that some people do get relief, and I hope you will make the right decision and can get out of pain soon.
    Please feel free to pm me if you have any questions about the actual surgery or recovery. Take Care.
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