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Surgery or not...how do you decide?

notprettynnotpretty Posts: 5
edited 08/10/2014 - 1:19 PM in Lower Back Pain
Hello...my low back issues have a long history so forgive this book that follows.

47, Male, Laminectomy 1989, 1990 L5-S1, L4-L5. L3-L4 known to be bulging at time of first two surgeries, chose not to do anything to it...blew it about 8-9 years later per discography or disco-gram...forget correct name. One major injury in 1986 and another in 1988 is likely the cause of most of the damage to my discs. Played and started 6 years tackle football at linebacker undersized and sacrificed my body to over-come the lack of weight. I believe football contributed to my first major injury in 1986, one year after I stopped playing the game. I was a Ronnie Lott type of player...hard hitting weak side linebacker/Strong safety...not something I'm proud of at all now. DON'T PLAY TACKLE FOOTBALL...especially in a position where you are undersized.

Surgery helped initially, but as time past I kept having episodes of spasms/pain. These symptom did go away with rest/recovery time. From 2000 to 2006 things progressively go worse, particularly after the third disc blew. The episodes of spasms/pain and even sciatica became more frequent, 2-3 major episode a year...lasted 4-5 minimum...and others that were less. And, I began to have what I call baseline pain...pain that averaged a 3 on the 1-10 scale, but did vary from 1-5. Then pain meds started....the Norco (Vocodin 10MG) led to Oxy and I was able to manage the pain but not my control of the meds. Over 4-5 years I got to Oxycontin 40 MGs, 6 a day and knew I was out of control. Got off oxy's and went to suboxone...3-4 years later I was a human blob, hated myself and life and finally detox'd 1 year ago today. FYI...imo...do not take suboxone for long term...use it to get off short acting meds and then get the heck off it. It takes much longer to detox from due to its long acting nature. Two months later and I was still a mess...Heck I'm still see changes. So, now/today, its a year later...and I am thinking clearly and want to live...but, the back is still there and messed up as ever.

2012 MRI shows no real nerve impingement...and this fits my symptoms...not much nerve pain. The structure of the bones look very wrong. The L4 Vertebra is literally tilted down say 25-30 degrees from its normal position. Its very noticeably on the scam relative to the L3 and above vertebra. The normal gap where the discs sit on my L2 is about 1/2"...the gap between L5-S1 is about 2 millimeters and the gab between L4-L5 is maybe zero...touching bone on bone I think, but it may have 1 millimeter still separating them. Personally I think the bones are touching and are beginning to fuse and that is why my recent issue is taking so long. I am waiting on a doctor's response to this thought. Now...having said all that...This tilt is due to the laminectomy/removal of the L4-L5 and L5-S1 discs and due to the discs drying and shrinking over time. I don't know if that is normal or not...presents a issue or not, but if they are touching I can't see how it wouldn't. It sure doesn't look normal. L5 is also tilted down, but less, and is compounded by the fact its transverse process on the right is fused to the hip/ilium bone...something that is not totally abnormal, it happens, but does make my situation a bit more complex.

My pain history is mostly NOT neural or nerve pain/sciatica related. I get an injury...something tweaks in my low back doing something very simple...and pain and spasms kick in immediately...usually peak in 24-36 hours and then improves in 4-5 days, sometimes 7-8 if its bad. That is my pattern. I usually don't get nerve pain...I do get shooting pain at the peak of spasms now and then, but the shooting pain is not constant and adjusting body position usually gets it to calm. In my life I have probably experience 65-75 of these 4-5 day "Episodes" and maybe that many again to a lesser degree. I can't sit now for much more than 20 minutes, but before I could. But when I did, my butt would go numb as would my feet...mostly the right foot, but sometime both.

ON July 14th, I mowed the lawn (Small patch of lawn...The only physical task I do beyond buying groceries) and while doing that something went...arrrgh...and I knew it wasn't good. Its been over a month with complete bed rest and its just not going away. Transitioning to standing from laying down is extremely painful, but after I get standing I can stand about 10 minutes before pain ramps up again. 20 minutes on my feet and I'm toast. With complete bed rest, I can get the spasms almost gone. But, on the right side they just won't stop completely and as soon as I try to stand and walk for 20 minutes, the spasms return grow rapidly and with vengeance. It leaves me basically unable to walk, sit or stand for even a short time.

Previously, I have seen Neuro's and Ortho's and the Neuro's say, do nothing. The Ortho's say fusion at two levels. Neuro's say nothing, generally, because I don't have a clear nerve impingement issue...nothing to fix as they say. The Ortho's see the structure...tilting/Disc degeneration/multiple levels etc and say you have essentially a degenerative issue that can only be fixed by a fusion. That was 2 years ago... I'm see the Ortho again on Aug 21 knowing basically what he'll say. But I don't know what to do. Is it worth the risk? Is not doing the surgery a risk? Is this the right surgery? Is this doctor worth a damn? Is there another less invasive way to address this issue? Is disc replacement an option? I have tons of questions.

What I have read and know. I hear of so many failed fusion stories. I hear two level fusion are to be avoided if possible and three levels are only advised in rare cases as the person will have as much or more pain just from the surgery. I want to get on my feet...have a life...be active again...but my back stops me every time I try much of anything. I know my case is complicated, but not as complicated as many I've read. Prior to this recent issue from July 14, I got good days where I could walk and stand for decent periods and some days I even felt pretty good...relatively anyway. Yes, I am very limited still on these good days, but I'm not dying of constant pain. I fear having any surgery will not improve things...or rather the odds of improvement are low enough that I conclude surgery is just too scary. Also, I'm not on any pain meds now and the pain during an episode like now is kicking my butt. I don't think I can keep going this way, but don't see a "Fix" that I trust. What to do... Questions:

Are there any procedures that can be done to me to identify the exact source of my pain/problem...or at least narrow it down? To me it seems every problem has a source and you can't know you are fixing it until you know what it is.

Given my super long history does fusion address my likely issue.

If I can heal from this most recent episode...that's over a month and going...I suspect I'll be back here soon. So when is life so limited that you decide to roll the dice?

How do I find a good doctor?

Which surgery should I have

This forum is full of people that have rolled the dice. How did you make the decision?

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