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Undecided on TLIF Procedure **** Advice please

pam.robbinsppam.robbins Posts: 2
edited 12/15/2014 - 9:50 PM in Back Surgery and Neck Surgery
I have had low back pain for most of my adult life (46 years old), but not constant and about 6 months ago I noticed the pain started radiating down my right buttock down the back of my right leg and down the side to my foot. Then about a month ago the same pain moved to be on the left as well. I have seen my PCP several times who kept telling me I had bursitis in my hips and would give shots into the bursa. Those obviously didn't help. He prescribed several different anti-inflammatory medications that didn't help as well. I finally gave up on him and made an appointment with an orthopedic. He first did a pelvic x-ray and said the same thing about the hip giving me another shot into the bursa and follow up in 2 weeks. I followed up in 2 weeks and he did a l-spine x-ray and said I had sciatica and ordered an MRI. Here are the results: Procedure: MRI Lumbar Spine W/O Contrast - Clinical Information: Sciatica - Technique: Sagittal T1 and T2 imaging is performed. T2 axial imaging is performed - Comparison: None - Findings: Vertebral heights, alignment and marrow signal are normal. There is reactive endplate marrow change at L5-S1 and benign fatty marrow in L4. Conus position signal is normal. - L5-S1: Mild broad-based left foraminal disc bulging moderately narrows the left neural foramen but does not result in neural impingement. - L4-L5: T There is minimal diffuse dorsal and lateral disc bulging without focal herniation or stenosis. There is no neural impingement. - L3-L4: No abnormality - The upper levels of the lumbar spine and lower thoracid spine with sagittal sequences are unremarkable and demonstrated retroperitoneum is unremarkable - Impression: Broad-based left formainal disc bulging at L5-S1 with moderate left foraminal stenosis but no neural impingement.

I was referred to a neurosurgeon and had that appointment today. He spent minimal time with me to tell me that my disc was shot and the vertebra had significant DDD and arthritis (may be the same thing) and that I needed surgery and had it scheduled for December 30th before my head could spin. I had a couple seconds to ask what surgery and he said Lumbar TLIF (I had no idea what that meant until I got back to work) and I asked would I be pain free and he said not 100% and it might be required on other discs later down the road 1 to 10 years. I asked what he was going to do and it was explained to me that he would cut an 3 inch incision and insert a plate and screws and that was all I was told. I went in telling myself that I would not have my back cut on at any cost.

My question is, what other non-invasive options are there? I haven't tried Physical Therapy or Chiropractic. Would either of those help? I'm a walker, but what exercises could I do to strengthen my back without having to have surgery. The pain is excruciating. I know I don't have to tell anyone here that, but I take muscle relaxers and pain pills and they aren't easing the pain enough to tolerate the nausea that comes along with them. I'm looking for any suggestions or advice anyone can give. I only have 2 weeks until surgery to change my mind or try something different. The pain has changed my life! I used to walk up to 5 miles a day and I can barely walk 1, I can't sit or stand or drive for long periods of time. I'm miserable to the point of tears.


  • If that was me, I would definitely get a second and third opinion! In my opinion, no surgery should ever be performed until all other avenues have been pursued! That is standard procedure. Sounds like he is knife-happy. Your results don't sound too bad to me, although I am not an expert, but my mri was 2 pages long and I still had to try everything else first.
  • pam.robbinsppam.robbins Posts: 2
    edited 12/16/2014 - 2:27 AM
    Horselady did you try decompression therapy with a Chiropractor and if so, did it help at all? I'm thinking of getting a Chiropractor to look at my MRI to see if he thinks it would help. I am getting a Neurosurgeon in another city to take a look at my MRI (with the help of a friend that is a nurse) before I schedule an appointment with him since he is so far away to see if he thinks surgery is necessary at this point. He is viewed as a very reputable surgeon and wouldn't operate if not necessary.
  • I did not. I already had my surgeries, fusion 2 yrs ago. I went to a chiro years ago and it helped but that was way before my real problems started! And a good friend went to a chiro and ended up in emergency back surgery.

    Good luck with your situation!
  • Coltsfan78CColtsfan78 Posts: 182
    edited 12/17/2014 - 8:27 AM
    Hmmm...I agree with horselady that I would probably not try the chiro. I say this as someone who tried that first when my only symptoms were tingling (no pain) and within two weeks of treatment-I was still going to the chiro at this point- I was in excruciating pain from that point on until surgery. I also agree that compared to my (multiple) Mri reports, yours doesn't sound awful either, but I will say upfront that I absolutely am not a doctor or have anything other than my own experiences to compare this to.

    As for the TLIF, I had that done in late Sept. of this year. I had no other alternative because I had already tried every other conservative therapy there was and nothing at all helped....everything made the pain worse. I first did two microdiscectomies, both of which were outpatient and fixed the problem, but only for a period of a few weeks each time, which is why I most definitely needed the fusion. I truly had no other alternative.

    I have two titanium rods, 4 screws and a spacer filled with bone material and "miracle grow" where the disc used to be between L5/S1. It wasn't a fun surgery, and I probably had a slightly worse time since it was my third surgery in the same area in less than 4 months, but I survived. The recovery for me has been interesting, but I'm also not the typical case as I had some issues with the function of my foot following the surgery that still have not resolved. In fact, I am likely facing a fourth surgery to remove one of the screws and a piece of bone that might be causing a problem (didn't show up until after the TLIF.)

    I think I'd definitely follow through with the second opinions and make sure you're as informed as you can be about this procedure because it isn't something to be taken lightly (not that you are).
    Left leg radiculopathy/sciatic pain
    L5/S1 microdiscectomy - May 30, 2014
    L5/S1 microdiscectomy - Aug 14, 2014
    L5/S1 TLIF - Sept. 24, 2014
    Left-side screws/rod removed along with bone fragment Dec. 29, 2014
  • I'm 59 and am battling with the decision myself of whether or not to have a TILF. I have had two discectomies first lasted about a year the second time the disc at L4 -5 collapsed within the first two weeks. I was in a lot of pain for about a month and when the OS got me back in to see him he said it was time for TLIF. Since then the pain has been tolerable. But was told at some point it would get bad again, of course no one knows when, could be tomorrow, could be years down the road. I am very active for my age, motorcycle, jet ski, construction superintendent, been married to the same lady 41 years, and still have a active sex life ,so its a tough choice when I'm not in that much pain right now,compared to before. The detox from pain meds is tough for me each time, last surgery was November 23 ,I detoxed slowly but still got very down when getting off the oxycodone , and am mean as a snake when on them,( or so says my wife, and she is always right!) Have read so many horror stories about recovery, but have also seen a lot of people saying they were glad they did it.... Its a tough decision. My surgery is scheduled for January 22nd so I have some time. I hope we both are able to get comfortable with whatever decision we make, stay in touch....you're not alone , and these people here from what I've seen pull no punches, and the moderators have to be the salt of the earth to hang in there and provide the best path they can out of some pretty deep holes......
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