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which surgery to have first!! what a choice

shazzasshazza Posts: 66
edited 06/11/2012 - 7:27 AM in Back Surgery and Neck Surgery
Have two problems with my back...

First is a severely degenerate disk L5 - S1, where it has now totally collapsed, and with an annular tear and herniation. Surgery for this on 5 March - TLIF fusion surgery with pedicle screws and rods

Secondly, after fracturing L1 vertebrae and crushing disk almost 2 years ago, the bone has disintegrated and the disk is now pushed into the bone. Option of having this surgery first which is going in from the side, removing a rib, then removing the L1 vertebrae (corpectomy) and the L1 - T12 disk, replacing with bone and hardware to support.

I knew about the first option, but wasnt told about the second one til today...needless to say was a bit shocked and overwhelmed by it all. Surgeon asked which part the pain is worse, but they are both as bad as each other. We both dedided that the first one is going to be done first.

Im in shock because I neively thought that we would be talking about addressing the both at the same time, meaning healing eventually and being done with it...

Now I actually feel as if the surgery im having is going to be a walk in the park compared to what i have to look forward to when we address the second surgery...anyone had a vertebrae and rib removed? Apparently they have to go in through the side and remove a rib for access, because the spinal cord runs down this section still, so a posterior approach is not possible.

Any comments or experiences welcome, am now less scared about my TLIF anyway!!


  • I think you need a second opinion. Maybe find a NeuroSurgeon or Ortho who can do both at once or other options. Take care and good luck. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • between the two surgeries? Are they talking about a year or just a month? I had two surgeries within four days, which I wouldn't wish on my worst enemy (actually, I don't think I have enemies). Anyway, it may be that there is too much involved to do both at the same time. I have just spent three months of hell after my two surgeries. I am finally beginning to feel better. If they are only going to wait about a month or two, to allow you to become stable before attempting the second surgery, I'd say that's reasonable. But to make you wait say a year and go through two tough recoveries would not be bearable in my book. Discuss this with your doc and see what he has to say.


    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
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  • The surgeon wants to do the fusion first, and wait long enough to see if that is improvement enough, before deciding to do the second, so my guess is they want to wait a long time before doing it, in the hope that they wond bother i think. The trouble is they offered me the choice of which to do first, stressing they want to do the fusion, but if my other pain was worse they would do thatfirst instead. They are both as bad as the other, but at the bottom the space is decreasing to nothing rapidly, and if i leave that the space will be gone completely, and i will start fusing on my own.

    I think the lower part of my spine will be able to hold me up if i have the upper one done first though.

    I just didnt want to go through recovery to have an even bigger surgery after it

    Im shaking all over thinking about it

    Thanks for replying
  • dilaurodilauro ConnecticutPosts: 11,347
    I would get a second opinion as Charry stated. Especially regarding the L1-T12 situation. I dont wont to over simplify surgeries, but the L5/S1 is becoming like a walk on a beach now. Besides L4/L5, the L5/S1 surgery are the most common in terms of lumbar surgery.
    Any time you hear about surgery involving a Thoracic disc, you know its going to be more complicated, not all surgeons are willing/capable to handle it and many times there are no guarantees that the problem you had before had will be fixed.
    Definitely get a second opinion, so you know everything about the surgeries, including the what ifs?

    If you have only the L5/S1, will that cause a problem for L1/T12?

    If I have both surgeries at the same time, what are the risks and what is the expected recovery time?

    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • with the others. This is bigger than usual so seek a second opinion. In the very least it may throw up questions you have missed with surgeon number one.

    Is the L1 stable?

    What is their reason for going for fusion first? They have one otherwise they wouldn't have offered you the opinion.

    And finally, my problems are spondy L4-S1 but i do have pain issues around my flank areas and pain can radiate up into my chest. By stabilising the lower spine they may be hoping to significantly reduce your pain. Just a thought.

    Good Luck

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