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Should I get surgery?

AnonymousUserAAnonymousUser Posts: 49,322
edited 06/11/2012 - 8:29 AM in Back Surgery and Neck Surgery
I have been dealing with back pain for a year and 4 months now. I am 29 years old. It came on suddenly just before Christmas of 07. While I always had backaches after walking around for long periods or doing certain exercises this was the first time I couldn’t even do anything. I had to call in sick to work and my husband had to help me get changed. After about 3 or 4 months I went to see a chiropractor. He sent me for x-rays and the report did not note anything significant. The chiropractic care seemed to help, made it a little more manageable.

Fast forward to August of 08, pain came back and it was worse then it was in the beginning of the year – when rising from sitting I would have to hold onto something before I could start walking. I went to see my MD who sent me for an MRI. It came back with Grade I spondylolisthesis of L5 on S1, degenerative spondylosis, bilateral pars defects (which 2 dr’s have told me they don’t think is healed), mild central canal stenosis and a bulging disc that contacts my S1 nerve. He sent me to a neurosurgeon. The neuro said he would like to try some conservative treatments first but that he thinks my condition is only going to get worse and that eventually I will have sciatica down my left leg as well as the right. I tried PT for 2.5 months, it helped some and at times I was almost pain free but just before Christmas 08 the pain started coming back. The PT said towards the end of therapy that I should not go in reverse. I went back to my neuro and we scheduled a steroid injection. That helped for about 24 hours and then the pain was even worse then it was before the shot. The sciatica now goes down to my ankle rather than just to my knee. So last week I went to an orthopedic surgeon for a second opinion. They took new x-rays and came in and said the news is not good and that I can make the decision to live with the pain, depending on how much it affects my quality of life or decide to get surgery.

My back pops or shifts almost every time I stand up, it popped while I was in the ortho’s office and they heard it, which is why they think the pars is not healed. I am having trouble rising from standing again, one of the ladies in my office calls me elderly. When I first start walking my gait is noticeably different and people in the office comment on it. Usually the sciatica pain is stabbing but recently it has turning into a burning sensation in my thigh area. I can’t walk long distances, I can clean the house but after an hour or two I have to take pretty much the rest of the day off. I have trouble turning around to back out of the driveway. I can’t hike anymore and I love hiking. I recently went anyway cause I had family in town – I paid for it with almost 2 days of back pain, had to take 3 ibuprofens to help.

But then since I am good at ignoring the pain (I refuse to let it stop me from doing things) and I am not on pain meds, I don’t have tingling or weakness in my legs and I am only a Grade 1 it makes me feel that I shouldn’t be a candidate for surgery. But I know I can’t live on ibuprofen forever. I want to have kids. I go back to my neuro next Friday to talk about surgery. I have about 2 pages worth of questions to ask him. So I guess I just want your opinions. The ortho, the neuro and a friend that is a surgeon have all said surgery. A family member said I should go back to the chiro – but that kind of scares me, to have him adjusting my back when the pars are broken, what are your thoughts on this?



  • I just posted a similar comment. Will be curious as to what I get back and what you get back. I had my neck fused for much the same reason last summer and it is great. The best doctoring I have done. I am leaning the same way for my lower back as I will need to have four discs removed and fused. I know for me after having the neck done I have no qualms about going forward just curious as to what others think. Good luck!
  • I am not a doctor, but, Christine it sounds like you should get several opinions from the medical community also. Then you will want to decide. Learning as much as you can about what they are asking you to consent to, good and bad.

    Honestly, if their opinions all match up and you are feeling your back shift I would consider allowing the surgery if it will stabilize things before further nerve damage can occur. However you really need know full what is going to be done.

    You mention being able to ignore most pain and press on. That is a double edged sword as with most surgeries of the back you may have some pretty severe restrictions placed on you that you need to follow to heal well. The double edge is that you may well be able to withstand the pain and do very well afterwards!

    Lots, of things to consider before surgery takes place.
    You can get a lot of good info here.
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  • I do know that it will be a fusion of L5-S1, my neuro would take the minimally invasive route and he would also remove the disc inbetween L5S1. I have been doing LOTS of research and it seems for sponsylolisthesis surgery outcomes are more favorable then conservative methods. Its just that small chance of possibly having more pain after surgery that makes me nervous.
  • There are no guarantees in life, and even fewer with spinal surgery. I had an almost identical situation to yours, except it was at L4-5. I waited three years before proceeding with a fusion because I kept thinking there ought to be a more modern way of handling the situation. There wasn't and I was also told that there were no fabulous new procedures on the research horizon either!!

    Like you, I really did my homework. I consulted with eight different spinal specialists: a physiatrist, five orthos and two neuros. When it got to the point that I was driving to the mailbox to get the mail and couldn't stand for more than about a minute, I agreed to surgery.

    I had a one level PLIF with a cage, rods, pedicle screws and BMP. My surgery went well. I fused. I am better but I still have some sciatic pain.

    You are right that of the patients who have fusion, those with spondy have the most successful outcomes statistically.
    Spondy almost always gets more severe as time goes by. It will not heal on its own. The bones may fuse on their own, but it won't be in the optimal position. Chances of nerve compression are great and it will not go away on its own.

    Since you have seen several specialists and there isn't any question as to your diagnosis, I think you would be smart to proceed with the surgery and not lose any more time. Your odds of a successful outcome will not increase by continuing to wait!! Are you guaranteed a perfect outcome? Of course not. But you can do everything possible to maximize your chances of a good outcome...and then hope for the best.

    I'm happy to answer any questions you might have.

    xx Gwennie

  • I agree with your Gwennie and your doctors about going ahead with surgery. However, the decision is ultimately yours. When you have to miss work, see no friends, a significant diminished quality of life, and exhausted all conservative treatments, sometimes surgery might be the only option.

    I tried everything. What made me go ahead with surgery were my pain meds were not working anymore, got the maximum number of injections and have nerve damage. I just couldn't stand the pain anymore.

    Good luck!
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  • I have also read that the longer you wait the less likely you are to have a favorable outcome. The thought of surgery scares me, so of course I feel like I am looking for any excuse not to do it. I know I am the only one that can make the decision to do it, and a big part of me wants to - I am so frustrated with this pain. When it is at or near its worst I have to hold back tears, part is the pain and the other is the frustration of. I want to be able to run around int he yard with my dog, and to cough or sneeze without fear of pain. I am curious to ask my Dr. on Friday if it looks like the slip has gotten worse when I show him the new x-rays. I think that will be a major factor in deciding. I have tried yoga the past week and it seemed to help a bit. My Dr.s have said exercise is OK, just no high impact stuff, so every time I go to the gym I think to myself - gotta condition myself, the better condition I am in, the easier recovery will be if I get surgery.

    And Gwennie - 8 spine specialists! I admire your determination. How long ago was your surgery? When I was at the ortho's office and they walked in with the new x-rays "it's not good news" was the first thing they said. And my friend that is a surgeon always reccomends against surgery but upon hearing my condition said surgery will most likely be the way to go.

    Gwennie - did you try chiropractic care? Like I said in my first post - I am kind of tempted to go back but it really makes me nervous thinking the the vertebrae is fractured and they are going to be adjusting my back. I use to crack my back all the time and I don't anymore. Plus my neuro said no chiropractic care.

    I have been trying to research risks of chiropractic care with spondylolisthesis but have not been able to find anything yet.
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