Hello (Possible Fusion at L4-L5)

[Keano16]

There are a lot of myths about discogram. True is, if its performed by experienced doctor and controlled by pressure control device, it should cause your usual pains...maybe little worse.

As your condition is post-discectomy, have you explored all non-surgical and/or minimally-invasive surgery methods?

[Liz]

hi claudia,
sorry you are facing surgery but congrats on the upcoming wedding!

i just happened to read your post and i have to weigh in as your case is slightly similar to mine before i had any surgery.

i'm not sure how severe your thoracic curve is but if it's more than maybe 10-15 degrees i would strongly recommend AGAINST putting an ADR in your lumbar spine. Like you, my L4 and L5 vertebrae were level and my L3-4 is rotated and my thoracic is my main curve, lumbar just compensatory so i stand up straight. I put 2 ADRs in at L4-S1 and either the asymmetric load from my thoracic curve caused my L4-5 Prodisc to tilt over or it was that the Prodiscs were too tall and pushed up into my curve causing it to tilt over, not work properly, and resulted in severe pain. Either way I'd be very very careful about putting an ADR in with thoracic scoliosis. If you want an ADR i'd just inquire if your surgeon has put in other Prodiscs w/a similar curve as yours.

i have permanent nerve damage causing intense pain from a revision of that tilted over Prodisc to an XLIF but i had rare complications removing it so i really can't judge the approach. i think in experienced hands you could be fine and there are definite advantages to the lateral approach, but if your doc doesn't do lateral fusions i'd stick w/what he's comfortable with if you like him and he's a respected surgeon.

discograms cause very short-term, severe pain (if it's positive) but they are a good way to determine if your pain is discogenic. If it's not positive, i'm not sure an anterior fusion would help your pain as anterior just replaces the disc... you'd rather be sure you are removing the right pain generator before surgery. However, i just realized you don't have back pain, just leg pain, so i'm not sure about the discogram in that case. If you are concerned about it causing more pain you could schedule it for after your wedding and see how you feel then, esp as you're not having surgery until after the wedding.

jack is right that nerve pain can go on too long and result in chronic pain even when the nerve is no longer compressed, so if you have active compression i wouldn't let it go too long.

best wishes,
Liz

[ajj1001]

took me about 3 weeks to recover from my recent discogram. it wasn't pleasant but the results were key in deciding my options.

[claudia]

Hi Liz,

I am so sorry that your surgery wasn't able to give you the relief that you hoped for, but thank you so much for sharing your story. I actually have a 36 degree curve in my thoracic spine so there is a chance that I could have the same complications that you had from ADR surgery. However, I think that means I have an increased chance of more degeneration down the road, especially after a fusion, since i have read that scoliosis can accelerate DDD.

From what I understand (and someone correct me if I'm wrong), discogenic pain can reflect in your back or legs (or both). In my case I have been told that the disc itself is irritating the surrounding nerves, thus causing sciatic leg pain. From the MRi it appears that there is no nerve compression, just a severely dissecated and degenerated disc with an annular tear. So, as I understand it, removing the disc and fusing (or replacing it with an AD in the case of ADR) is removing the underlying cause of pain, if the pain is in fact discogenic, and can provide relief of symptoms.

I just spoke with my pain management doctor, and he actually thinks it is a good idea to have the discogram as soon as possible, since it can actually tell him what pain management treatmnet would be most effective for my particular case. So he scheduled me for August 9. Pain management is my best hope to be in as little pain as possible during the next months.

[Katie]

Hi Claudia, and welcome to the forum . And congrats on your upcoming wedding! My back pain just started getting severe and more complicated just before I got married, so my 'new' husband (seven years this August) has ridden a very long and bumpy roller coaster. And he's still here

I just had three different levels of surgery in March, and the L4/5 was done with the XLIF. I was quite shocked to read that your surgeon thinks that it can cause a higher percentage of nerve damage, as it is designed to do just the opposite.

I don't know if you are familiar with the procedure, but my surgeon used a probe to go through the muscle, which indicated exactly where all the nerves were as he came close to them. He was then able to navigate around them, avoiding cutting them when he next inserted the cage through the muscle to between the vertebrae for the fusion. The ligament was not damaged at all either.

Post-op, I had just a few weeks of moderate distraction pain in my legs from the nerves being stretched, as I grew over an inch and a half Before surgery, the only time I had leg pain was when my sciatic nerve flared on my left side, about two to six times a year. It was unbearable...I could barely move or even stand up, but chiropractic treatments eliminated it every time, even thought I had significant compression on my spine and nerves from both discs and bone spurs, etc.

Just before surgery, I could feel it tighten again, with strong twinges going down my leg. My chiropractor could and would not touch my back at that point, but said the sciatic was flaring because it was being pinched as it went through the butt muscle He used a tool (an activator??) to get the muscle to release, and it always fixed it in two or three visits. So he eliminated my leg pain without 'snapping' my back.

Over the past month, I've had some pain in the tail bone area, and tightness on the opposite side from before, on the right, with some sciatic symptoms. I was concerned that the surgery caused it, but in my first chiro visit last week, he said it was basically the same thing in reverse, and almost fixed it in one visit.

He was also amazed at the difference in my spine between a 'regular' fusion and the one I had with the PEEK cage. (I brought my post-op x-rays films with me). I have no other reinforcements, just the plastic disc like spacer between both the L4/5 and L5/S1. My range of motion at just three months is better than before surgery, and in his opinion, I will not likely have the damage to my spine from fusion later in life, as is typical of many, but not all fusion patients. He said the amount of space between the vertebrae is greater, and I still have a natural curve to my spine.

I'm sorry this is so long, but I wanted to tell you how different my prognosis is, and how well the XLIF surgery went for me. I was out of commission for almost five years pre-op, so my core muscles are shot, but other than that, I feel like a new person. I was about to start a new thread explaining that I feel like I have finally got my 'moxie' back just this week...that my self confidence and desire to live fully and with zest is finally back, and I walk like I mean it.., like I care about how I feel and look again.

I understand that yours is much more complicated because of the curvature, that it will take more to make things right. Half an hour into surgery, the doctor discovered that I had a moderate spondyosis at my L5/S1, not just DDD. Every one of the ten or so surgeons I had consulted with, including him, had missed it on the MRIs and X-rays, some of the top surgeons anywhere, including Germany and New York. So they don't always know what they are getting into until they are in there. It still worked out well.

Like others, I recommend that you get numerous opinions, all over the world as I did. Don't limit the consults to what you can afford, as the best can give you great advice, whether you go to them or not. Most are free, but some do charge for it, but eventually you will get a consensus of what your true problems and treatment plan should be.

All the best, and hang in there. The best years of your life are ahead of you

[KBear]

Claudia, Katie has offered some wonderful advice. I would be very careful in getting an ADR with scoliosis. Other than ADR it is also important how many your doctor has done. In my opinion, more important than what disc you get or surgery you have, is the surgeon who is doing it. You could definitely send your films overseas and get opinions and many places do this for free or a small fee. I would highly recommend doing that (Texas Back Institute in Texas, Stenum in Germany, Dr. B in Germany, Dr. Pimenta in Brazil, Dr. Bitan in NY- I know all these places will review a patients case without actually seeing them. I'm sure there are more, but I can't think of all the names right now.) Also, know that if you get an ADR and it doesn't work and you need a revision, not only is that a risky and life threatening operation, your chances of becoming pain free with the fusion are lower than if you would have just had the fusion in the first place. Keep researching and chose the option that you can live with, regardless of outcome. Spine surgery is a major operation and should not be treated lightly.

On the discogram, I have had 2 and had two completely different experiences. The first one was very painful, I cried the whole time and it hurt like crazy during and after it. The second time, I was sedated, woke up and asked a few questions to make sure I was coherent, they put the dye in, got my response and then knocked me back out (it was so easy and not painful- other than the dye part; but that was short lived pain). I think it will replicate your leg pain, if that is the problem, as my discogram made me have pain in my hips and was off the chart pain (I usually didn't have hip pain, unless I was just hurting really bad). Afterward, it took me 2-4 weeks to get back to 'normal' or at least my normal. The first week after was the worst, but it wasn't unbearable or anything. You can also ask for increased pain meds for after the procedure.
Kathy