Back Surgery

[GrantDawg]

Who has had it? Who can talk me off the cliff?

I wish like heck I had the mri report in front of me, but it seems everyone around me does but me. Lets just say no one is being very upbeat about it. Damage from C5 to C7, with a pretty severe bulge I believe in the C7 disc. Lots of nice little bone chips. I have nerve(s) being pressed by bone(s) and bone chip(s) (I don't know the numbers), pain and stiffness in the neck (sort of like that feeling you have when you are just getting over a crick in your neck, but it just never goes away) and arm. Most disturbingly, pain and tingling in the arm, more severe with certain movements. If I stretch my right arm back too far, it goes "cold" for about 36 hours.

It was 4 weeks into physichal therapy before they did the MRI. Nothing was really changing. Now we know why. I saw the doctor on Tuesday, and he gave me the option of trying ESI (epidural shot) or just going straight to a surgeon. I thought that was weird because I knew the guy was very anti-surgery, but my rn caseworker (workers comp sit) was the same way (who again was very anti-surgery). It was today at PT that my therapist sort of hit me with laymen terms on this. He hates back surgery as well, but the bulge is very bad, and there is a lot of bone chips. It makes it sound like the ESI might just be putting off what is going to eventually happen. He still encouraged me to try it, and started traction (which is now killing me).

Anyway, anyone have spinal fusion surgery before?

[Lathum]

So I never had surgery but I had lower back issues. Herniated three disk and I don't wish back problems like that on anyone.

I had the injections done and they worked wonders. I still have pain and have been to physical therapy, so for me it is managable. It sounds like you have a more severe issue though.

[JediKooter]

Damn, sorry to hear that GD. No advice or experience, but, hope you get it fixed and start to feel better soon.

[Rizon]

I have back pains from a couple of car accidents, but not like you guys have.
I'd rather have surgery than deal with the daily aches and pains, that's all the input I have.

[Lathum]

I'd rather have surgery than deal with the daily aches and pains, that's all the input I have.

The problem is people often have worse pain or show no signs of improvement. If you can find a treatment that is far less invasive that may be a better option. Sadly surgery isn't the magic cure when it comes to your back and can get very dicey.

[terpkristin]

I've run the gambit of lower back pain management issues and have had two surgeries. I think I may need a third, though at this point, we all think my genetic disorder is in play.

Without seeing the scans and not being a doctor (though I play one on FOFC...), my off the cuff remark is that if there are bone chips, they'll probably need to come out, regardless, though whether a cervical fusion is done..if it's all bone chips and bone deformation, I'm not sure why they'd need to fuse instead of just shaving things down. But, that's why I'm not a doctor...

That said, were I in your shoes, I'd give the ESIs a go, and ensure that you're working with a PT who specializes in spine management. I guess with WC it might be more difficult to be choosey. If possible, I'd get a second surgical opinion and possibly see a neurologist. The pain is being caused, after all, by pressure on the nerve, and sometimes aren't as cut-happy. Have you tried strong anti-inflammatory medicine (Naproxen or Celebrex, if you can take it) and/or oral steroids? Those, combined with therapy, are usually first line of defense (in my experience and talking with others with C-spine and L-spine issues), followed by ESIs, followed by surgery. I wish you lived near me, there's a FANTASTIC pain management doc I've seen and would recommend in a heartbeat.

One major downside of surgery is that it can create scar tissue that can ALSO irritate the nerves. My understanding from talking with other patients at PT, though, is that C-spine surgery usually alleviates the problem, where as lumbar patients can have mixed results. Some of this is because people have lumbar surgery for back pain (not radiating leg pain), and some people have mitigating circumstances (like me). A lot of people, at least those who get it done for the radiating leg pain, notice improvement. But from what I've read, a lot also notice improvement after a year of PT. So sometimes, as painful as it is, people recommend trying extended PT.

That's where I'm at now. I had my 2nd back surgery (both were for disc herniations with fragmentation--neither were a fusion) in early January and am now re-developing radiating leg pain. My doc and I suspect that my genetic disorder is playing a role here, and we may ultimately need to fuse the L5-S1 level. But given my work schedule this year, I'm probably going to try to suck up the pain and keep doing PT, hoping that long-term, I improve.

All of the above said, I've had a couple friends and coworkers get C-spine fusions for disc degeneration/injury and all have been happy with the results. They're back to their normal active lives and are pain free. One now has disc degeneration at another level, causing pain and numbness in her arm. She's trying PT before she has another surgery. So far, she's said it's really helped.

/tk

[thesloppy]

Lots of clinical trials have revealed that most of the major treatments for chronic back pain (surgery, chiropractic, massage, physical therapy) have roughly the same probability of success, without much indication for why or which method will work best for each individual.

That said, I personally really wanna avoid surgery if possible, and my approach has been when things flare up, to start with the least expensive, least invasive, and least permanent, and work through the options in that order.....which in my mind is 1> massage, 2> chiropractic, 3> physical therapy, and 4> surgery. YMMV. I figure you might as well exhaust all of your possible soft options before going under the knife for an irreversible procedure with questionably similar success rates.

[GrantDawg]

I've run the gambit of lower back pain management issues and have had two surgeries. I think I may need a third, though at this point, we all think my genetic disorder is in play.

Without seeing the scans and not being a doctor (though I play one on FOFC...), my off the cuff remark is that if there are bone chips, they'll probably need to come out, regardless, though whether a cervical fusion is done..if it's all bone chips and bone deformation, I'm not sure why they'd need to fuse instead of just shaving things down. But, that's why I'm not a doctor...

That said, were I in your shoes, I'd give the ESIs a go, and ensure that you're working with a PT who specializes in spine management. I guess with WC it might be more difficult to be choosey. If possible, I'd get a second surgical opinion and possibly see a neurologist. The pain is being caused, after all, by pressure on the nerve, and sometimes aren't as cut-happy. Have you tried strong anti-inflammatory medicine (Naproxen or Celebrex, if you can take it) and/or oral steroids? Those, combined with therapy, are usually first line of defense (in my experience and talking with others with C-spine and L-spine issues), followed by ESIs, followed by surgery. I wish you lived near me, there's a FANTASTIC pain management doc I've seen and would recommend in a heartbeat.
/tk

Thanks for the info. Yeah, trying/tried the anti-inflamantories with the steriods to start. I think the pessimism comes from the type or level of the bulge. The therapist said when we first started he figured I had a bulging disc and we were doing excercises trying to get it to move, but after reading the report (mind this was the mri after trying) he saw why were weren't successfull. I really don't know why, but the impression I had was there was too much out of place.

The difference between c-spine and l-spine seems to be why everyone has changed their tone on surgery. C-spine surgery just seems to have a higher success rate, and can have bad repurcussions from what I've read if you wait too long (permanate nerve damage, etc.). I just really don't like the idea of someone cutting a bone out of my spine through my neck.

[terpkristin]

Is it a bulging disc (not bone) or a bone spur or some other bone formation thing?

[GrantDawg]

Is it a bulging disc (not bone) or a bone spur or some other bone formation thing?


It is a bulging disc with bone spurs or chips.

[terpkristin]

It is a bulging disc with bone spurs or chips.

Well if it hasn't fragmented (pieces of the disc actually broken off) you MIGHT have luck with PT and ESIs. Bulging discs that haven't broken off can reduce. Certainly worth a go. As I said, one of my coworkers has had one fusion and now has more pain/numbness and has had good luck with PT.

Good luck. And if you want me to ask my coworker any questions or have anything I can answer, let me know.

/tk

[Thomkal]

My mother has had two fusions now (and an assortment of other surgeries over the years-like both knees replaced) so her situation is different, but I would tell you to commit yourself to the therapy afterwards to get best range of movement and function back-they likely will have you up on your feet within a couple days of the surgery. Get an X-ray a few days after surgery to make sure things were done correctly and more importantly nothing has happened since the surgery as we sadly learned from the second fusion.

I think the bone chips will likely require surgery-I think my mother had some removed during her fusions, so if you are having surgery anyway...

Good luck with whatever method you take. I can imagine the pain you're in from what my mother went through before her surgeries so my heart goes out to you.

[GrantDawg]

Update (and isn't it sad that it was this long):

I will be having a triple fusion with plate done on October 25th. I had both a neurosurgeon and a orthopedic surgeon (who will end up doing the surgery) recommending the exact same surgery. I now know why there was intial pessimism from my therapist. There are three herniated disc, with a fourth very close. That is why the plate (to hold the bottom weak one while the other three are fusing into place). It is been a long, painful battle, but here it is. Without surgery, I could lose use of my right arm or cause it to atrophy (several nerves are being pinched down the discs),

Both doctors were great. The ortho took me step by step through the MRI and showed me exactly where the nerves were that are in danger. He said that I have the same type of weakness in the neck that Peyton Manning has. On top of that I am also arthritic.
So, joy and fun. I get to have my neck cut open.

[duckman]

Neck surgery is no fun. I had it myself six years ago (cervical laminectomy of C1 and C2). I'll be praying for you.

[Suburban Rhythm]

My Dad had a back fusion in 1970...that is how my parents met, my mom was a nurse on the floor he was on.

I don't think I have much to add because, hopefully, technology is alot better 41 years later. His scar runs from his waist to the middle of his back. And he was in a full body cast, knees to chest, for 6 months.

But he told me a story that I'll never forget.

My uncle (his brother in law) had a station wagon. They used the station wagon to take my Dad everywhere--sliding him in the back of the of the station wagon was the easiest way to get him around.

One night they going out drinking. My dad grew up in part of Pittsburgh called Mt. Oliver, where there might be 2 houses, then a bar, another house, a body shop, couple more houses. etc. The car is parked on the street, heading downhill. My uncle is struggling to slide him out of the back of the car. Finally he gets him out, but isn't sure what to do with my dad while closing the door, so he props him against the telephone pole.

Across the street is an older woman sitting on the porch watching this...and in disgust, she's yelling in the window, in her just off the boat accent "Lou....Lou....come out here. Look at zeeze two! Dis-a one is so drunk he don't know how to stand already...and deys a-goin in da bar! Lou..he's a riddin' in the back ova car cause he can't sit...and nows he can't stand!"

So this really has nothing to do with anything, but if you happen to end up in a full body cast, but a station wagon.

Seriously, good luck. Like I said, technology now is infinitely better than what he went through.

[terpkristin]

Good luck. I've got a coworker who's had the same surgery. She's pain-free now.

/tk

[GrantDawg]

Thanks for the thoughts/prayers everyone. As an update: I had the surgery Tuesday. I was out of the hospital on Wednesday. I am able to walk around much better than I thought. I'm going through a lot of pain, but I was going through a lot of pain before the surgery, so it really hasn't been worse (except the neck brace is itchy). My right arm was better the first couple of days, but has gotten back to the same level of pain as pre-surgery. Not a major concern yet, because there is probably a good bit of swelling that still needs to go down. The surgeon said the herniations were a good bit worse than even the MRI showed. All in all, it has been better than I was prepared for. Should start PT in December.

[Lathum]

Good luck to you, enjoy the drugs!

[JediKooter]

Wow that was a quick in and out. Good to hear you're already doing better GD. :)

[CrimsonFox]

Great!

[duckman]

Good to hear!

[terpkristin]

Glad to hear it went well, GrantDawg!

Will you have to do PT?

/tk

[GrantDawg]

Glad to hear it went well, GrantDawg!

Will you have to do PT?

/tk


Sorry not to respond in a week. I haven't been on the computer much at all since the surgery. Hard to use a mouse. :)

Yes. I'll start PT sometime next month.

[terpkristin]

So...

I guess it's my time to post in this thread. After having 2 diskectomy/laminectomies in my lower back, I've still got a lot of pain caused by (according to my doc):
scar tissue encasing the nerve roots
enlarged spinal nerve/spinal nerve root due to the trauma and the irritation from the scar tissue
a new bulge at L4-L5, a level above where my previous 2 surgeries were

Whee fun. My doc is recommending another surgery, this time an L4-L5 decompression and then a fusion. The fusion is recommended because of the scar tissue and the other stuff...since my pain CAN be made to go away if I find the "magic position," and can be made much worse by moving...

If I get this done, it's going to be by far my biggest surgery. The doc says I'll be in the hospital 3-5 days (previously I'd only ever spent a night in the hospital, and usually due to other things, not the surgery itself...like the anesthesiologist giving me something I'm allergic to). He says I'll probably have to be out of work for 2-3 months (well, he said I could probably work from home but getting in and out of a car and sitting for extended durations will be bad).

So...anybody ever had a lower back fusion? I'm not sure I'm going to do it yet. Because my chief complaints are pain and numbness, it's not a "required" surgery...it would only become "required" if I lost control of my legs or bowels or bladder. I'm also going to start seeing a medical pain management specialist (my previous ones were not medical, they were interventional only). Anybody ever had to take short term disability from work?

/tk

[GrantDawg]

So...

I guess it's my time to post in this thread. After having 2 diskectomy/laminectomies in my lower back, I've still got a lot of pain caused by (according to my doc):
scar tissue encasing the nerve roots
enlarged spinal nerve/spinal nerve root due to the trauma and the irritation from the scar tissue
a new bulge at L4-L5, a level above where my previous 2 surgeries were

Whee fun. My doc is recommending another surgery, this time an L4-L5 decompression and then a fusion. The fusion is recommended because of the scar tissue and the other stuff...since my pain CAN be made to go away if I find the "magic position," and can be made much worse by moving...

If I get this done, it's going to be by far my biggest surgery. The doc says I'll be in the hospital 3-5 days (previously I'd only ever spent a night in the hospital, and usually due to other things, not the surgery itself...like the anesthesiologist giving me something I'm allergic to). He says I'll probably have to be out of work for 2-3 months (well, he said I could probably work from home but getting in and out of a car and sitting for extended durations will be bad).

So...anybody ever had a lower back fusion? I'm not sure I'm going to do it yet. Because my chief complaints are pain and numbness, it's not a "required" surgery...it would only become "required" if I lost control of my legs or bowels or bladder. I'm also going to start seeing a medical pain management specialist (my previous ones were not medical, they were interventional only). Anybody ever had to take short term disability from work?

/tk


Feel for you. I haven't had lower back surgery, so I really can't answer you. I know it is much more tricky than what I had. You might want to try the pain management and see how much it helps before going for surgery. Good luck!

[CU Tiger]

So...

I guess it's my time to post in this thread. After having 2 diskectomy/laminectomies in my lower back, I've still got a lot of pain caused by (according to my doc):
scar tissue encasing the nerve roots
enlarged spinal nerve/spinal nerve root due to the trauma and the irritation from the scar tissue
a new bulge at L4-L5, a level above where my previous 2 surgeries were

Whee fun. My doc is recommending another surgery, this time an L4-L5 decompression and then a fusion. The fusion is recommended because of the scar tissue and the other stuff...since my pain CAN be made to go away if I find the "magic position," and can be made much worse by moving...

If I get this done, it's going to be by far my biggest surgery. The doc says I'll be in the hospital 3-5 days (previously I'd only ever spent a night in the hospital, and usually due to other things, not the surgery itself...like the anesthesiologist giving me something I'm allergic to). He says I'll probably have to be out of work for 2-3 months (well, he said I could probably work from home but getting in and out of a car and sitting for extended durations will be bad).

So...anybody ever had a lower back fusion? I'm not sure I'm going to do it yet. Because my chief complaints are pain and numbness, it's not a "required" surgery...it would only become "required" if I lost control of my legs or bowels or bladder. I'm also going to start seeing a medical pain management specialist (my previous ones were not medical, they were interventional only). Anybody ever had to take short term disability from work?

/tk

Never had back surgery or any back issues, so Im poorly equipped to respond other than this. On another web community this topic just came up and a good friend who is a doctor posted the following reply..

"General and vascular surgeon here.

You want to quickly read Bonati Spine Institute's website today. In surburban Tampa on north gulf shore. I have referred a number of patients here with great success. They decompressed 2 cervical levels and 2 lumbar levels on my wife with perfect symptom relief and virtually no recovery.

Their philosophy- Avoid spinal fusion procedures if at all possible. Especially for straightforward causes of nerve root compression. They perform surgery under local anesthesia and twilight sedation through a 3/4 inch incision through an arthroscopic device. No fusion is needed when this minimally invasive technique is done. You are back at work in 2-3 days and exercising vigorously in 6 weeks. My wife spent 6 hours in a shopping mall the day after one of her procedures.

Interview people having back surgery. A common theme- they are never the same again. They may have relief of severe symptoms and pain, but the back is never normal, especially after fusion procedures. Most can have normal lives, but are not athletic or as athletic again.

If you seek an opiniion there, Dr Bonati is elderly and doing OK. But see one of the younger buck neurosurgeons. Strongly advocate neurosurgeons over orthopedists for these procedures. Many current and former NFL guys have had this procedure as well as celebrities. They are a worldwide referral center. No one in the Carolinas or GA does this procedure as it has a steep and lengthy learning curve and most surgeons do not have the time or ability to learn it. Only a few centers worldwide.

Your local surgeon and docs will not advise for the procedure as they do not know how to do it and have no experience with it."

dont know anything other than I trust the man who gave the opinion.

[Suburban Rhythm]

So...

I guess it's my time to post in this thread. After having 2 diskectomy/laminectomies in my lower back, I've still got a lot of pain caused by (according to my doc):
scar tissue encasing the nerve roots
enlarged spinal nerve/spinal nerve root due to the trauma and the irritation from the scar tissue
a new bulge at L4-L5, a level above where my previous 2 surgeries were

Whee fun. My doc is recommending another surgery, this time an L4-L5 decompression and then a fusion. The fusion is recommended because of the scar tissue and the other stuff...since my pain CAN be made to go away if I find the "magic position," and can be made much worse by moving...

If I get this done, it's going to be by far my biggest surgery. The doc says I'll be in the hospital 3-5 days (previously I'd only ever spent a night in the hospital, and usually due to other things, not the surgery itself...like the anesthesiologist giving me something I'm allergic to). He says I'll probably have to be out of work for 2-3 months (well, he said I could probably work from home but getting in and out of a car and sitting for extended durations will be bad).

So...anybody ever had a lower back fusion? I'm not sure I'm going to do it yet. Because my chief complaints are pain and numbness, it's not a "required" surgery...it would only become "required" if I lost control of my legs or bowels or bladder. I'm also going to start seeing a medical pain management specialist (my previous ones were not medical, they were interventional only). Anybody ever had to take short term disability from work?

/tk

TK...see my post from earlier. My dad had one done, but back in the 70's, where he ended up in a full body cast, knees to chest, for 6 months. So, at least be thankful that, with today's technology, you'll probably be feeling good in a few weeks.

[terpkristin]

Well, I scheduled my surgery today. It will be on September 25th, the day after my birthday (poor planning on my part but it was the soonest I could do, allowing for time to get everything done).

I was really hesitant on it as you can see above, but I ended up seeing a neurosurgeon who gave me a lot of confidence that he could do it, and that it would help. He doesn't do the surgery alone--he does it hand in hand (as it were) with an orthopedic spine specialist, so each does the parts of the surgery that they excel at. He also said that they do a fair few revision procedures, and that they have a very high success rate. After I saw him, I was pretty much sold but I had to make an appointment to see the ortho dude. I saw him today and he was also very optimistic about it (contrary to the other two surgeons I saw, my original one and another one...both orthopedic dudes). They both said I was young to have this done, but with the amount of pain medicine I'm being forced to take, with the structural issues that are there, combined with signs of instability already there (thanks in part to my genetic disorder)...basically, it needs to be done, why wait (and continue taking so many drugs) until I'm "older."

I'm really nervous about this one. I'll be in the hospital for 2-3 days and off work for a month, maybe a bit more. I still need to get a CT scan done (my insurance is being a bit of a pain) and go back and see both docs again...but it's scheduled. I'm looking forward to not taking pain meds again, though.

/tk

[DaddyTorgo]

Well, I scheduled my surgery today. It will be on September 25th, the day after my birthday (poor planning on my part but it was the soonest I could do, allowing for time to get everything done).

I was really hesitant on it above, but I ended up seeing a neurosurgeon who gave me a lot of confidence that he could do it, and that it would help. He doesn't do the surgery alone--he does it hand in hand (as it were) with an orthopedic spine specialist, so each does the parts of the surgery that they excel at. He also said that they do a fair few revision procedures, and that they have a very high success rate. After I saw him, I was pretty much sold but I had to make an appointment to see the ortho dude. I saw him today and he was also very optimistic about it (contrary to the other two surgeons I saw, my original one and another one...both orthopedic dudes). They both said I was young to have this done, but with the amount of pain medicine I'm being forced to take, with the structural issues that are there, combined with signs of instability already there (thanks in part to my genetic disorder)...basically, it needs to be done, why wait (and continue taking so many drugs) until I'm "older."

I'm really nervous about this one. I'll be in the hospital for 2-3 days and off work for a month, maybe a bit more. I still need to get a CT scan done (my insurance is being a bit of a pain) and go back and see both docs again...but it's scheduled. I'm looking forward to not taking pain meds again, though.

/tk

Yay!!

[GrantDawg]

Good luck.

[Sun Tzu]

Good luck Terp.

I thought I might chime in here.

I have a mild herniated L4/L5 off to the left, combined with a bit of spinal arthritis. I had an MRI done about 9 months ago, and I saw a PT for about a month. I'm pretty athletic, and I played sports for 20 years or so, including semi-pro baseball, that likely led to this injury.

I've been doing stretches prescribed by the PT twice a day for the last 4-5 months, and I had an ESI back in April. The shot wore off about a month ago, but I can honestly say I'm 80% symptom free thanks to the stretches. I have minimal pain down my left leg, occasional tingling, and occasional odd "discomfort." All of these things I can live with. I'm starting to do some low-back strengthening exercises, but the stretching alone has dramatically improved my quality of life.

Something else I'd like to add...

Your attitude during the rehab/stretching/strengthening process is paramount to making strides in improving your pain management. I decided a while back that I just wasn't going to live with pain. I decided that this is MY body, and since pain is in the mind, and the body has the capability to heal itself, I'm going to do everything within my organic power to put my body in position to heal. I keep this attitude up every day, and I really, sincerely think it has made a huge difference.