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TLIF on L5-S1 proposed by my surgeon after a year of back pain only -- not sure what to do

JLF1966JJLF1966 Posts: 36
edited 02/12/2015 - 9:08 AM in Back Surgery and Neck Surgery
I've included notes below in block if you had any questions/ideas on what happened or what is wrong. You can skip that section if you'd like.
Injury - woke up in February of 2014 in pain. Had a broken hand at the time so wasn't doing much physical activity other than machine lifting (mostly leg work). Not sure if relevant but quit taking Paxil (generic) at this time for anxiety.

Weight - Was 225 in summer of 2013, was at 170 at time of injury. Currently 155 at around 6'2" as a male.

Pain got progressively worse. Did PT for a few months and saw a chiro -- no help. MRI in June 2014 shows herniation, mostly severe at L5-S1 area. Schedule surgery for August 2014. I'm now 6 months post op from a left side L5-S1 laminectomy and have been in increasing pain ever since. Two post op MRIs show the surgery to be a success but the pain is still getting worse -- I haven't worked since I've had the surgery and a lot of days I find it very difficult to leave my bed. I've also had several CT scans done, a DEXA scan (bone density was off the charts high), a discogram to test L5-S1 and L4-L5 levels (both came out ok/negative for problems), blood work (showed I was not positive for arthritis indicators but did have low white blood cell count), EMG (which showed minor problems, nothing that would be causing current issues). I've tried injections (had 4), post-op PT for 15 weeks, chiros, massages, water therapy, painkillers/muscle relaxers, TENS machines, heat/ice, etc. and nothing has stopped my pain from continuing to get worse each day.

Seen Patel at Northwestern (said fusion would be 50/50 to help), Dr RX (Sports/Spine doctor who said I should get fused), several doctors at rrr (recommended same PT that I've done), several pain management doctors, and RX at fff is my surgeon.

Things that help -- heat, TENS (short relief), working out, sometimes ice and massage, sleep but pain comes back immediately after all of these

Questions - Medical Marijuana? Anabolics? Kidney stones in past relevant? Standing MRI? Stem cells? Will pain ever go away? Cervical or thoracic MRIs?

Medicines I've Tried - Oral Steroids, Lyrica, Gabapentin, NSAIDs, Muscle Relaxers, Norco ("Works" but makes me feel really out of it)

MRI pre-surgery: http://i.imgur.com/529nwV7b.jpg
MRI post-surgery: http://imgur.com/a/dW0pe, http://imgur.com/a/VDhM8
After seeing Dr.RX at xxtoday (who came highly recommended and has quite the resume), he said that "in his heart of hearts", he would guess all the pain is coming from the L5-S1 level and would have it taken care of except that the results of the discogram make it much iffier to do the operation. He said waiting is probably not going to help but unfortunately there isn't much that they can do to figure this out.

Dr. RXX (my surgeon) changed his mind -- before, he was very against fusing my spine. He said he has been thinking about me constantly and thinks that my back is figuratively up against the wall and that the odds point to fusion being the best option. It's not a guarantee or anything but he said if he was in my shoes, he would do it. He wants to do TLIF and remove the left facet joint which seems to be one of my issues. My other option would be to wait for something new to come along (but realistically that would be several years out at the bare minimum) or the absolute last resort would be to have a spinal stimulator installed (heard that is not fun nor does it always work but apparently we have one of the best guys for it here in Chicago).

This is an incredibly tough decision. The pain is getting worse and worse all the time and is becoming disabling. I can't work or concentrate for very long -- I feel like I'm not as sharp as I was before because all I can think about is the pain. I understand that this area will likely have to be fused eventually any way but having it done now is going to cause more stress on other levels earlier than I probably want especially since I am only 28. It's also not as likely to work since we haven't identified the pain generator. That said, doctors have said my spine is much more of a mess at that level and the rest looks generally fine (although small herniations all over). It's also about the best level to have fused and it would only be one level which is a positive but I don't have all the 'success' signals for fusion (for example, my disk is still relatively tall despite being slipped/dehydrated and pain being my primary complaint over weakness/numbness). I don't know what to do but I've pretty much exhausted all options and even though this is far from a guarantee, I'm still considering it because my pain is so miserable right now.

Note Please read Forum Rules: It is a forum violation to name specific doctors or medical institutes - Ron DiLauro, Spine-Health System Moderator 02/12/15


  • Jillybean079Jillybean079 Posts: 266
    edited 02/12/2015 - 4:06 PM
    It seems you have been trying conservative treatments for awhile. Have you tried injections? I understand your fear of fusion surgery...I did a lot of thinking before I chose to schedule mine. My surgeon gave me the same odds 50/50 because I have so many injuries at different levels. He also said this could make me worse. So I know this is not a cure, but I'm hoping it might help with some of the pain. It came down to this for me, I can stay the same and do what Ive been doing (PT, injections, meds), which aren't helping all that much, or I can try surgery to see if it helps. Is it a gamble? Yes...most back surgeries are. At least your surgeon is being honest with you...
    Spine-Health Moderator 
    Ankylosing Spondylitis
    Bulging discs T12-L3
    Annular Tears with Disc Extrusion L4-S1
    Moderate Central Canal Stenosis
    Moderate Foraminal Stenosis
    Enlarged Facet Joints/Ligaments
    Spinal enthesopathy
    L4-L/5 PLIF with cages, rods, screws 2/15 

  • I've had 4 different injections unfortunately and none of them have worked.
  • I was so concerned that I joined just to respond to you. What type of injections did you have and where were they physically located? Were you 'conscientiously sedated? Have they "buned off" your nerves from the L45-S1? How far apart (timeframe) were each of the injections? I have exactly the same diagnosis by the way. I truly feel for you especially since you are so young....
  • I've had 4 injections, tried each facet joint and level. I took sedation for the last 3 since I blacked out for the first one. They were each about 2 months apart.

    I haven't had the nerves burned yet since they don't really know the exact pain generator.
  • Okay, I understand... I am assuming the injections were steroids. My doctor did the steroids with pain medication that numbed me for the next 16 hours. The steroids helped a little but not much. I did get pain relief for the hours that the pain med worked. We then did the nerve burn which lasts me a year. I have to have both sides done a month apart. I hope they can figure it out for you. It sounds just terrible. Good luck and I mean that.
  • PS... I would DEFINITELY try to get an MRI! Can''t believe they have not done that yet...
  • I've had 3 MRIs. I'll ask about the nerve burning, thank you.
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