Hello (Possible Fusion at L4-L5)

[claudia]

Congratulations Justin on creating this site as I'm sure it has helped hundreds. In my case, it has helped me to see so many other young people like me with back problems and who have improved after having surgery. Gives me hope!

This is the first time I have posted in any kind of forum. To introduce myself, I'm 30 years old and I hurt my L4/5 disc when I was 13. Two years ago I had a microdiskectomy and, like many people, instead of getting better, my pain got significantly worse after my surgery- I have burning and tingling in both my legs, but little or no lower back pain. It also seems that I have some scar tissue from my previous Sx. I have tried steroid nerve blocks but they have helped very little, if at all. My surgeon tells me that the cause of my pain is because my disk is so severly degenerted that it is irritating my nerves, and that a fusion could help me. He tells me that I'm not a candidate for ADR since I have some scoliosis He thinks that since my problem is only on one level (my other disks look ok on the MRI) that I should recover and significantly reduce my symptoms. However I am terrified of fusion since I have read so many horror stories of people who come out of surgery in worse shape, and I already have one failed surgery. I am also worried about the adjacent degeneration issue.

Since my surgery, 2 years ago I have had ups and downs in terms of pain (anywhere from a 3 to a 7/8 out of 10). I have some days occasionally when I have very little pain. I usually wake up in the morning with the least pain but it gets worse throughout the day. Sitting makes it worse but walking helps. I dont take any narcotics but manage it with Tramadol and Neurontin. I sometimes think that as long as I can get around and function, that I should not have this risky surgery, but on the other hand I don't want to live in pain anymore and want to have a better quality of life. I'm getting married in 5 months and I want to be able to enjoy my wedding and marriage. Also I plan to start a family after getting married and I'm worried if my back will be able to handle a pregnancy.

I am now seeing a new surgeon who is very conservative and would like me to hold on fusion as long as possible, but thinks its ultimately my desicion. I have an appointment next week to discuss which type of fusion would be right for me, and whether, if I have surgery now, if I will recover in time for my wedding. At this point I'm confused as to what to do.

I would appreciate any advice. Gracias!

[linda]

Welcome the the site Claudia! I felt like I was kind of reading my story as I was reading yours. I had never posted anywhere before either and took me awhile to get up the courage to do so. My pain is also a lot like yours but my bad disc is at L5 and is looks bone on bone on the MRI. I wish you so much luck on your decision. My doc also says that fusion is a last resort and I am terrified of having this surgery. Congratulations on your upcoming wedding. These five months are probably going to fly by with trying to get everything ready for it. I think you may be cutting it a little close by having it before the wedding but you are young and would probaby recover faster than some. Are you going to have a big wedding? Once again, welcome to the site and I look forward to hearing more from you.
Linda

[Cindylou]

Hi Claudia and welcome to SPS..... I would recommend getting several, if not 3 or 4 more opinions on your MRI. They likely won't all agree, but eventually, you should begin to see a pattern of what the majority are recommending. Let me also just say that fusion gets a bad rap when sometimes it could be the very surgery that is right for someone. Remember, it was the gold standard for years and years. And in many situations it still is. Just my 2 cents. (I've had ADR and fusion, by the way...) I wish you only the best. CL

[KBear]

Claudia,
I agree with Cindylou on getting multiple opinions on what to do. Fusion has a bad reputation, but it's not an accurate one. There are many who pushed for ADR when they were not a candidate for it and ended up with disastrous results. If ADR is not for you, don't do it, it will make you worse. My surgeon told me that if he got into surgery and did not feel ADR was right for me, he would fuse. I was fine with that, as I just wanted what was best and relief. I don't think I would push it and have surgery before the wedding, for fear of not being recovered enough for the big day (plus there is usually a weight gain associated with surgery- I gained 20-25 lbs after surgery). I would use this time to research your options and learn all you can about it, then have the surgery (if you decide to go that route) after you get married. I don't think I would have children before surgery, pregnancy is so hard on your spine as it is. Plus, the medications most of take to manage, are not safe during pregnancy (neurontin being one of them, not sure on Tramadol). I am 16 months post op and just now trying to have my 3rd child. I had just turned 29 when I had surgery and it took me a good year before I really felt a lot better. Last, I also think that it seems to me that the sooner people have surgery into an injury, the quicker they heal. I was in pain for 3+ years when I had surgery and I think this is a big part of why it took me a while to heal.
Ask any questions you may have, we are here to help,
Kathy

[Jack-of-all-trades]

Very good advice you are getting with this post. One point I haven't heard mentioned is that on occasion (not very often though) the pain pathways can become so ingrained after years of dealing with it that even with surgery the pain doesn't all go away.

I had the minimally invasive posterior lumbar interbody fusion with titanium and am pleased with the outcome so far. My surgery was in Dec-2009.

You seem young enough that waiting a year or so after getting married before having a family would help solidify your marriage. A year to grow your marriage together, then another year to have surgery and recover, then kids. So much of the time after the first baby comes the second one is not far behind. Seems like the first one really gets you body in the groove.

[claudia]

Everyone, thank you so much for taking the time to respond. This site has been so helpful as I have so many questions. I've been reading about the XLIF procedure and the doctor who performed my surgery is listed in their website. Thank you for the advice about getting as many opinions as possible. I have so far seen two spine surgeons who are considered among the best here in puerto rico, and they both recomended a fusion as my only, and best, option. I also agree that it would be best to wait until after my wedding, since 5 months is probably not enough time to fully recover, lets see what my doctor says next week. I'm also having a study of my nerves on monday to check if I have any permanent damage.

[Cindylou]

"Congratulations Justin on creating this site as I'm sure it has helped hundreds."

Probably more like thousands and thousands Claudia, but I know Justin appreciates the compliment all the same!

[KBear]

Very good advice you are getting with this post. One point I haven't heard mentioned is that on occasion (not very often though) the pain pathways can become so ingrained after years of dealing with it that even with surgery the pain doesn't all go away.

I had the minimally invasive posterior lumbar interbody fusion with titanium and am pleased with the outcome so far. My surgery was in Dec-2009.

You seem young enough that waiting a year or so after getting married before having a family would help solidify your marriage. A year to grow your marriage together, then another year to have surgery and recover, then kids. So much of the time after the first baby comes the second one is not far behind. Seems like the first one really gets you body in the groove.

I agree, even without back problems I think this is a good idea. I was 22 when I married my hubby and he was 31, so we decided to start trying right away. We had lived together for almost 2 years at that point, so didn't seem like marriage would change anything (even though people told us it would, we were too smart for them ). Boy was I wrong! We conceived on our honeymoon and found out a couple of weeks later (when I got the dreaded morning/all day sickness) that we were expecting. I have to tell you, I wish I would have waited and been married for a year before having a child. That first year is a big adjustment (even if you have lived together, things change) we all have expectations of marriage, whether we realize it or not and that first year is when we learn these things and work them out. I call our first year the 'power struggle' as we both wanted to be the boss

[Justin]

Congratulations Justin on creating this site as I'm sure it has helped hundreds. In my case, it has helped me to see so many other young people like me with back problems and who have improved after having surgery. Gives me hope!

Thanks for your nice words, Claudia!

I'm getting married in 5 months and I want to be able to enjoy my wedding and marriage. Also I plan to start a family after getting married and I'm worried if my back will be able to handle a pregnancy.

I'm sorry that you have suffered with spine issues for so long. Your situation (in terms of onset of spine issues) sounds very similar to mine. In regard to surgery before your wedding: I think it would be cutting it close. Recovery from spine surgery is a very "individual" process. However, over the years I have noticed that most people really start to turn the corner around the 6 month mark post-op.

At this point I'm confused as to what to do.

I think quality of life is the most important thing to remember when contemplating spine surgery. There's a "fine balance" of jumping into surgery right away and waiting too long. The best weapons you have as a Spine Patient are to research your options (understand what's going on with your body and what the proposed interventions entail) and to see a few surgeons regarding your situation (as you have done). The goal is to leave no rock unturned before you go under the knife.

[claudia]

Thank you so much Justin for your reply. I'm so glad I found this site, I have been spending a lot of time on it for the past couple of days (have hardly been on facebook ). I am just starting to educate myself about my condition, and there is really no better way to learn, that to hear about other people who are going through what I'm going through. All the stories about people's surgery experiences are just priceless.

So..my surgeon had a cancellation and he was able to see me today. He told me to definitely wait until after my wedding to have surgery as there is a good chance that I will not recover. I asked him about the XLIF fusion that I had read about here, but he told me that the chance of nerve damage with that procedure is 30% (too high imo), so he says that he prefers doing the fusion through the abdomen (I guess every surgeon favors one technique over the others...I will get other opinions as well). Another thing he told me was that I could actually be a candidate for ADR (!!!), since my scoliosis is higher up on my spine, in the thoracic area, and that the L4-5 vertebrae are straight enough (he thinks that the L3/4 would be a problem if I ever need Sx in that level). He says that he uses the Prodisc, but that having ADR over fusion is completely the patient's choice. I asked him what he would have if it were him having surgery, and he told me that he would have a fusion over an ADR. I says that he has only performed it on patients who have specifically asked for it. I think that this is actually the only doctor in all of puerto rico who is performing ADR, so if I want another opinion I would have to get on a plane and go to the states, where my insurance doesn't cover me. Anyways, now I am in the same dilemma as many other members of this site (Fusion v. ADR). More ?'s...

The also ordered a discogram. I have heard horror stories about discograms so I am so scared. How long is the recovery?? I'm scared that it will cause a permanent worsening of my pain. This past week has actually been a good week for me and I think my last steroid injection worked to some extent. Right now I am only taking 1600 mg of gabapenting and tylenol arthritis.