Possible spinal fusion from L3-S1

[Laga]

Hello everybody. I am a 54 year old carpenter. I have done concrete work my whole life. I am still working, but it is getting harder everyday. I have had back pain on and off for the last 25 years but it was always muscular, or so I thought. 6 months ago the pain started to go down my left leg so I knew something was different. After 2 months of Chiropractor and Acupuncture visits with no results I went to a Ortho surgeon. He said I need a fusion from L3-S1 since the discs were worn out and they were bone on bone. He did not what to do the multi-level fusion because the success rate is not that good. He wants to do a L4/5 fusion at first and then see what happens with the pain. This does not sound like good advice to me. I have read that a fusion puts extra pressure oh the discs around it. If that is true, and the discs above and below are already worn out, It sounds like I would be in store for more sugary in the further. If a fusion is necessary, I would much rather do it once. I have a appointment with a neurosurgeon in 2 weeks so I can get a second opinion. Any thoughts.

[rhatzy]

Laga,

You have come to the right place. Have you had an MRI? There are other doctors that have been doing ADR and ADR/fusion combos when needed. Most of the good ones are out of country and you can send them your MRI's and get a reply back. Depending on your situation, you might have to get a fusion at some level with ADR on others. you have three affected levels. I know people that have had ADR's at all three levels and also people with a combination because some level are too bad for ADR.

Check around this site, there is a lot of great information. I have had 2 levels in my back done with ADRs and I'm doing great.

Mark

[Laga]

I had an MRI a month ago. The doctor said ADR was not for me because of the arthritis in he facets.

[Greg]

Laga,

to the site...you've definitely found the right place to come to. You said the doctor only wanted to fuse 1 level and see how the pain goes This is just my opinion but I dont like the idea of that at all? Fusion is a major surgery and recovery isnt a couple day process. To go through it several times in case the 1st one didnt work would seem like hell. I'm not trying to frighten or persuade you in any way....just stating my opinion. And yeah there are people out there who didnt do that well with multi-level fusions but what operation doesnt have some negative results. I know several people who have had many level fusions and are living the dream us spine patients pray for every day.

Have you had a discogram done? If you have several levels that dont look good but the doctor is hesitant about fusing all three then a discogram would be a good test to confirm/deny which or how many are your pain generators. I have 1 really bad disc and one not so bad. They wanted to only work on one but we did the discogram just to be sure.....well both of them were my problems. I do need to mention that the discogram wasnt a walk in the park and hurt like hell I'm so glad we did this to me though because we avoided the mistake of needing to do a second surgery and we'll be fusion L4-S1 anteriorly on May 28th.

A discogram is kind of like an epidural steroid injection except they inject the disc with a contrast dye to increase the pressure inside the disc to simulate your pain. If it causes you pain than they know its a problem. Then they take a CT scan of the area and since theres contrast dye in your disc they can get a good picture and also see if your discs are strong enough (or not) to hold the liquid inside.

Spine Patient Videos | Spine Patient Society is a link to the video section on education of the spine. If you click on orthopedics, non-surgical procedures, then discography it'll explain what the discogram is better than I can.

My best piece of advice to you is become an expert on your conditions and research, research, research. Get many opinions from doctors to the point that with their opinions and your knowledge of your condition that the decision that is made in the end is one you feel comfortable and confident with. Ultimately whatever happens to you is your decision to make and if you dont feel its the right one then dont do it and find the one that is.

I look forward to hearing more from you and how you progress. I think I can speak for most everyone here when I say if you ever need anything were here for you. There are many experienced, well educated caring people that make this site the best place for a spine patient to go. Hope you feel better....keep us posted!

[Justin]

Hi Laga,

Welcome to the Spine Patient Society.

Hello everybody. I am a 54 year old carpenter. I have done concrete work my whole life. I am still working, but it is getting harder everyday. I have had back pain on and off for the last 25 years but it was always muscular, or so I thought. 6 months ago the pain started to go down my left leg so I knew something was different. After 2 months of Chiropractor and Acupuncture visits with no results I went to a Ortho surgeon. He said I need a fusion from L3-S1 since the discs were worn out and they were bone on bone. He did not what to do the multi-level fusion because the success rate is not that good. He wants to do a L4/5 fusion at first and then see what happens with the pain. This does not sound like good advice to me. I have read that a fusion puts extra pressure oh the discs around it. If that is true, and the discs above and below are already worn out, It sounds like I would be in store for more sugary in the further. If a fusion is necessary, I would much rather do it once. I have a appointment with a neurosurgeon in 2 weeks so I can get a second opinion. Any thoughts.

Mark and Greg have given you great advice. If it is possible, I would try and get a couple surgical opinions (as you are doing). These opinions might ultimately lead to the same surgery, but it will help put your mind at ease in terms of "doing the right thing" with your spine. As a carpenter, you know the whole "measure twice, cut once." This goes for spine surgery as well--like you mentioned above. I think it is a great game plan to see how many levels need to be "fixed" surgically from the get-go. It's better to have one operation that can appropriately address all of the levels that are causing your spine issues (of course, this goes with saying that these levels are implicated in your pain and are determined that surgical intervention is necessary). Going in multiple times causes a lot of "collateral damage" to the surrounding tissues.

Make sure to "work up" all of your pain generators (discs, facet joints, ligamentous strain/sprain, etc.) before committing to surgery.

Keep us posted.

[Laga]

I am in the process of doing my research. I have dealt with doctors before who are out just to make a buck and put their patients second. I believe this is what the first doctor was doing. I am going to PH right now but it is not doing much. I do have one question. Orthopedic surgeons and Neurosurgeons, both do back surgeries. When is one preferred over the other?

[Gilbert P]

Hi Laga

to SPS sorry you have to be here, We are here to help and support you.
We have all been through the ringer and you will find a solution for your issues.
I am also 50 and a Carpenter, work and played too hard with four major issues in my spine.
Neurosurgeons Specialty involved in the treatment of the Brain,Spinalcord,and Peripheral nerves.
Orthopedic surgeons use both surgical and non-surgical means to treat muscularskeletal trauma,sport injuries, degenerative diseases,infections,tumors,etc.
I hope this helps
Keep us posted
Gil

[Greg]

I am in the process of doing my research. I have dealt with doctors before who are out just to make a buck and put their patients second. I believe this is what the first doctor was doing. I am going to PH right now but it is not doing much. I do have one question. Orthopedic surgeons and Neurosurgeons, both do back surgeries. When is one preferred over the other?

Gil pretty much summed that up as simple as it can get. Unless my spine condition was a simple problem with a simple uncomplicated procedure (not likely for me)I would go to a Neurosurgeon....this is just my opinion though. When I had my shoulder surgery from a boating accident and I tore the ligaments and my bicep, I went to an orthopedic. But with my back (where my discs are pressing on the nerves), and especially since we're doing a multi-level fusion I am going to a Neurosurgeon. That doesnt mean that an orthopedic couldnt do it but I feel an orthopedic surgeon is more like the sports injury guy; torn acl, broken arm, fractured wrist, etc....

I feel that most orthopedics have a bigger specialty in areas other than the back where a Neurosurgeon is more likely to specialize in the back, have more experience in the back, specialize in the spinal cord and nerves and if someone is working on my spine moving around and touching nerves and my spinal cord....THAT BETTER BE THEIR SPECIALTY!

Hi Laga

to SPS sorry you have to be here, We are here to help and support you.
We have all been through the ringer and you will find a solution for your issues.
I am also 50 and a Carpenter, work and played too hard with four major issues in my spine.
Neurosurgeons Specialty involved in the treatment of the Brain,Spinalcord,and Peripheral nerves.
Orthopedic surgeons use both surgical and non-surgical means to treat muscularskeletal trauma,sport injuries, degenerative diseases,infections,tumors,etc.
I hope this helps
Keep us posted
Gil

Hope you didnt mind me changing the color of your post to add an emphasis and reference for mine....I wanted to add some emoticons to it but I was afraid I might get in trouble for copyright infringement

[Laga]

Thanks for the info guys. The first doctor I saw was a ortho who is a spine specialist. The one I will see in two weeks is a neuro. I have a friend who had a single level fusion by the neuro, and she is doing great.

[muddy]

Sorry L that you are here. I too have severe DDD and would require multiple-level fusion. I read an article in Medscape (signed in as a semi-professional/they don't care) and one article said that ~ 50% of all low back pain is from the facets. Now I have a blown L5-S1 disc and was given a facet epidural to see if I receive any relief from this. I did so I had a facet rhizotomy. I had considerable relief and one day of no pain whatsoever. Dig that.

So I hope that you are hooked up with a top notch pain mgt. doctor/interventionist. If you tell us where you live e.g. what city/town, maybe someone knows of an A+ doc, etc.

My best ~ Allan