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Looking for advice from anyone with a Two-Level PLIF....

AnonymousUserAAnonymousUser Posts: 49,321
edited 06/11/2012 - 8:28 AM in Back Surgery and Neck Surgery
For the past 4 years I have had mild lower back pain, numbness in the back of my legs if I stood the wrong way, and numbness in my left foot when exercising. I never really thought too much about it, I honestly thought that I was just getting old and fat. However, this past November 2008 my lower back started really bothering me and it just got progressively worse. I saw my PCP and an Ortho Doc, tried various pain meds, anti-inflammatories, and muscle relaxers, nothing worked. I couldn't stand up straight and had severe pain down the back of my left leg and finally ended up in the ER on December 22nd. My holidays were a blur. I got an MRI, started PT, and got an epidural injection on January 12th. The epidural helped significantly. The pain in my leg never went away, but I was at least able to function again.

After a month of PT, I was not improving. The pain in my leg remained no matter what we did and my leg began to get weak and muscles began to atrophy. My Physical Therapist suggested that I see a neurosurgeon. When scheduling my second epidural, the Pain Mgt Doc also suggested that I see a neurosurgeon because of the way my MRI looked and that I was still having pain and a very limited range of motion.

I went to see a neurosurgeon and he told me that on a scale of 1 to 10, my problem is a 9! Long story short, I have DDD with herniations at L4-L5 and L5-S1, and spondylolisthesis. He told me that I need a Two-Level PLIF. I freaked. He told me that the longer I wait, the more nerve damage I will be doing and that a 2nd epidural is just a temporary fix.I may not have as much pain as I did in December, but the back of my leg and my heel are numb. My leg is weak, my calf muscle cramps up, my leg feels tingly, burning, achy, and I even fell once because I got up and walked too quickly.

My question is this: Have I suffered enough to warrant jumping into this very serious operation?? Is the numbness/weakness I'm having as concerning as all of the pain that I have been reading about? I have been reading this site for weeks now, and I see so many of you have been dealing with severe pain for years and years before getting this surgery.

This is all just happening so fast, I was just so shocked to find out that I have been walking around for all of these years with just mild symptoms, and now I need a fusion? I really do like my Doc, he was great at explaining everything and spent a lot of time with me and my husband. He said that I have an excellent chance of a full recovery due to my age (39) and the fact that I don't have any other underlying health issues. I did get a 2nd opinion and unfortunately that doctor suggested the same procedure.

Help! Any advice and/or similar experiences that you have would be greatly appreciated. My surgery is scheduled for March 9th and it is approaching fast!



  • Hi Shannon,
    Welcome to the site, glad you have been reading and doing some research on your back issues. I had a two level PLIF L4 to S1 on Dec 2nd so about two and a half months ago. I am 27 and was diagnosed with DDD and stenosis as well as foot drop, numbness of my left leg knee to toe, weakness of left leg and general pain from a pinched nerve. I knew there was an injury and kind of wanted to bury my head in the sand about it hoping that PT and what not would work but it came at me a little like you, like a sandstorm.
    The way my doctor described it to me was that my discs were dying due to the one that was injured, it had collapsed onto the L5 creating problems in that disc and the more disc material that kept coming out I would eventually have no disc and mother nature was going to attempt her own fusion. With that said from my doctor, I decided for myself that this was going to be the best course of treatment for me in the long run.
    Since the surgery I have regained the use of my left leg and no longer have the same type of back pain. I now have recovery pain and no longer those horrible hitches and spasms. It has been so far a succes for me. I am in PT now three times a week and have been since the third week post op.
    For your question all I can offer is my own history and experience on why I made my decision. You have two doctors who agree that this is the best course of action, and it comes down to if you trust them that they are doing what is best for your situation, pain, and body. With your age and otherwise very good health I pray the procedure goes well for you, it has for me and many others. We all know the risks before doing this surgery, for me it came down to faith and trust.
    Keep in touch and let us know how you are doing. Best wishes
  • I can totally empathize with your shock at suddenly discovering you need surgery. I, too, had had mild pain (no numbness) on and off for years but with a couple of injections and Pilates it did not bother me very much. However, in June 2008 I made some kind of goofy move getting out of a recliner and OUCH! Instead of settling down it got worse over the next 24 hours and my husband took me to the ER in the middle of the night where they did an MRI. The next thing I knew my PM doctor was sending me to an Orthopedic Surgeon and both said I needed surgery soon if I did not want to risk being paralyzed, etc. (Spondylolisthesis and a piece of disc broken off in my spinal canal). I was stunned - had no idea my back was such a mess. So - July 21 and 23 I had ALIF/PLIF for L4/5.

    If you have been reading the posts on this site you know that the recovery is long and SLOW! But - I must say the recovery was not horribly painful for me. I took pain meds for about 2 weeks - hated the way they made me feel and decided I could do without them. I have used ice and heat for the achiness and it has been OK.

    There have been times I have wondered if I could have waited longer to have surgery. Then I realize that I would have just constantly worried that I would do something to make my back worse and that I did not want to keep taking the Valium I took for the month I was waiting for surgery. So, for me at least, I think it was the right decision.

    If you have not done so, read the Post-Op Must-haves on this site - the list is excellent - to get yourself, your house and your family prepared for your recovery. You will need lots of help for the first couple of weeks - and the "no bending, twisting or lifting" restrictions significantly limit what you are able to do.

    Good luck with your surgery if you go ahead with it!

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  • If you've got nerve and muscle atrophy, you've got to do something. However, it doesn't seem like you're at a point to accept it. I always advocate another opinion, but you like your doc and have another opinion. If both of your opinions have been from neurosurgeons, you might consider getting an opinion from an ortho spine surgeon only because he might have a different idea of what type of procedure would be best.

    You have to be at peace with your decision, but unfortunately, it doesn't sound like you have a lot of time to accept whatever needs to be done. Read up on this site so you are prepared. There are so many stories and articles here. Keep in mind that on the message boards, people usually only post when they have problems, those with no complications often don't hang around. That makes the message boards look like everyone has problems.

    I think you were smart to get another opinion. Anyone who takes fusion lightly isn't really thinking at all. You are thinking and asking questions and researching-you are doing all of the right things. Your case sounds like you have some serious symptoms and I'm glad that your doctors are taking you seriously and have a treatment plan.

    I had a two level lumbar fusion. From the stories I've read, lots of people say the first three weeks are the worst. Educate your family on what you will need. You have two daughters-have them help out. Even if they are young, they can help you out.

    Keep reading articles, the more you know the better you'll do. Don't forget to update us so we know how things are going!
  • I highly recommend a Discogram -

    I know, if you know anything, it is scary. But, it's what convinced me that my problems really were back-related and it pinpointed exactly what pains were coming from where.

    Before going through a fusion (MAJOR surgery) you really should go in with your eyes open - KNOWING that all your other options have been looked at and considered and even tried.

    My EMG was negative a year prior to the Discogram, so I'm not sure if an EMG would have helped or not.

    The discogram was very definitive and it really reassured me.

    I, for one, am very glad that I am 'on the other side' now and am healing up. It's a long road, but compared to before - wow, there is no comparison.
  • If I am not mistaken I had a 3 level PLIF (L2-L5), with L4-L5 being my main issue, spinal stenosis, disc was a blob pushing against my nerve. Had severe right leg sciatica since November.

    Started in November, had a steroid injection it helped, went away after a few weeks, did another in Dec, short relief, had a MRI done at the end of Dec which showed spinal stenosis and massive disc herniation/explosion as I call it at L4-L5 which was causing my issues.

    It also showed multiple chronic buldges along my lumbar spine, so we did a PLIF L2-L5 where the Doc did a lamenectomy to open the spinal canal, discectomy on L4-L5 which resolved my sciatica instantly, spacer placed there and my doc used the bone from the lamenectomy to make a paste to put at L4-l5 for fusion.

    3 weeks and a few days now, pain free, walking a mile+ a day, doing therapy 3 days a week and feel great.

    Only complaint/issue is I can not lye flat, I get very stiff. My doc/therapist said it will go away with time and therapy regaining my lower back muscles back to normal.

    So I sleep in a couch chair which sucks but a worthwhile tradeoff for being pain free.
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  • I had a 2 level TLIF L4-S1 with titanium rods, screws, cage because of the reherniation and retrolisthesis of L4-5 and nerve compression at L5-S1. I too have severe DDD in both levels, facet joint athritis, and chronic degenerative endplate changes.

    This was a major event and no amount of preparation is ever enough to get you ready for this. It will be very painful once you wake up in recovery. Make sure your surgeon will have orders for a PCA machine while you're in the hospital. It's better to push a button to give you meds than waiting for a nurse to come in and give you a pain medicine shot.

    The recovery will take a long time and it can be difficult. A lot of us go through feeling depressed because of pain, frustration, and boredom. You have to be fully committed in the recovery and keep up all the appts and go to physical therapy.

    I hope this is some of the advice you were looking for. There is just so much involved and there are many great experiences posted at SH and they should be beneficial to you. Take care and I hope your surgery goes well.
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