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First fusion

Greetings, I am 53 years old with a history of back pain (spasms, referred pain, herniated discs, a laminectomy and increasing problems with walking) dating back to my mid-teen years. I had an emergency laminectomy in 1988 which restored leg function which had been lost when L4-L5 burst but have continued ever since with the same stuff most of you already know all too well. I also have very intense but usually momentary shock-like pains in my back, hips and legs which may or may not precipitate a spasm episode. My frequency, severity and duration of "back episodes" has increased significantly. I take 3200mg of gabapentin daily as well as a "PRN" usage of hydrocodone and flexeril. I nearly always take ibuprofen,usually 2000mg/day. I had an epidural at L3-L4 this summer with no benefit. Then I had a facet block at L4-L5 and it was almost too good to be true for several weeks but then gradually the pain returned and now I'm back where I started. Based on that result with the L4-L5 facet block my neurosurgeon is recommending an L4-L5 fusion to immobilize that area (bulging disc, retrolisthesis). He explained, and I completely understand, that this surgery can only address pain that is the result of movement in that joint. As much as I would like it, I understand that my other symptoms will probably not benefit at all from this surgery. Still, the daily pain has worn me down and I have refused to utilize much of the narcotic relief due to concerns about dependency. I guess I'd just like a bit of reassurance from people "who've been there" when it comes to fusion surgery.


  • EMS GuyEEMS Guy Posts: 1,036
    edited 09/25/2014 - 11:30 PM
    I would recommend going cautiously into surgery. I have Facet Joint issues as well and have had an L4-S1 fusion. My facet pain is usually handled pretty well by steroid injections about every six months. I've now got significant issues with L3-L4 and L2 - L3. My PM is going to continue doing injections as long as he can to avoid another fusion surgery. I'm ok with that. Fusion surgery for me was much harder on my body than my original surgeon led on it would be.

    I just had more shots yesterday - didn't sleep much last night because of the pain, but that's to be expected. Since I'm WC, they want me to have RFA again even though it didn't work much the first and second time I had it done. I guess they want to exhaust all options before having to consider the alternative - more surgery.

    Regarding medication; I was opposed to narcotics as well in the beginning. But, I have found a good mix of meds that work relatively well and do a good job with pain at least when I'm not having a bad flare up. The thing to consider about narcotics is knowing for yourself that you are taking them for a legitimate medical issue and not for recreation. I'm not apologetic about the meds I take to anyone. I get relief with them and if people want to judge me for that...well so be it!

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • The decision to undergo surgery or not, is one that you need to make in conjunction with your doctor. Retrolisthesis, depending on the degree of it, causes instability in the spine, and can cause further problems to develop over time such as bone spurs, which is your spine's attempt to stablize the joint, and can wind up causing nerve compression.
    Fusion surgery is a big spine surgery, no doubt, but if the pain you are experiencing is coming from the instability, it would make sense to stabilize that area of the spine, and then possibly treat the facet joint issues with radio frequency ablations if they continue to be a source of your pain after the fusion has healed.
    It is also a good idea to consult with a second spine surgeon, sometimes, they have other ideas or suggestions that might be an option worth exploring, and in others, it can reaffirm the decision to under go surgery.
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