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When does one know when it is time for fusion L5-S1,L4-L5

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Posted 1/13/2008 5:02 AM (GMT 0)
The ortho. doctor and the pain doctor I am seeing suggests fusion. I don't want to be cut on right now but the pain in back and leg is getting terrible. Other than pain is there any other symptoms one should look for in determining when it is time to have the fusion. I guess this sounds a little crazy, but I am really apprehensive about this for some reason. Had bi-latteral total hip replacements and could not wait to get them done. But this fusion stuff really bothers me.  
Posted 1/13/2008 5:30 AM (GMT 0)
I knew the time was right when I just couldn't function any longer the way I was and the nerve damage was getting worse. If you wait too long, and have nerve compression, the longer you wait, the slimmer the chances of recovery of the nerves are.

I flat out refused the idea of surgery or even going to see one when my back problems started again in August of 2005. By October, I'd had enough of moaning in my sleep because of the pain, the numbness, and the not being able to do anything.

I went to the chiropractor because he had always gotten me on my feet before when my back flared. I saw him for a few months and was not getting better, in fact was getting worse, and finally after a series of events, saw the surgeon.

The rest is not so great history.

Sandi

Posted 1/13/2008 4:52 PM (GMT 0)

mrsm123, thanks for the reply. Sad to hear about the extra problems with the adhesion,went thru that myself. From looking at your back problems they are almost the same as mine except I have severe DDD. I did the laminectomy in 98' and did well as far as the surgery went but I waited too long to have it done and had bad nerve compression,adhesion which never got better. Have allready lost most feeling in foot and absoluety no reflex in the ankle/foot and lost about 50% reflex at knee according to the Dr. Also starting to get fairly weak in the lag. Do you think it is time?  I am trying to wait till L3-L4 gets bad enough so he can fuse it along with the other two lower ones and only have to be cut on once. Maybe it is a bad gamble. Sure don't want to get paralisis in the leg though. Just don't know what to do!!!  The screws you are talking about are they the ones from the straps to hold spine while bone is growing/fusing or did you have only hardware without a fusion.

Would like to hear from all that have been thru this situation so maybe get the best game plan and not be foolish and regret waiting. 

Posted 1/13/2008 5:01 PM (GMT 0)
Oh yea, I asked about SCS and the Ortho said was a good candidate for that and would suggest it to the pain Dr.  When went to the pain Dr. he said no to the SCS because it would have to be taken right back out for the fusions,also said insurance would not pay for it since it would just have to be removed. He said have to wait for the SCS till after fusion.   The insurance gods,aren't they just wonderful.
Posted 1/13/2008 10:03 PM (GMT 0)
I had an L4-5-S1 fusion in September. Waited for 3 years after having taken a bad fall, plus had severe DDD. Nerve pain down leg and numbness in feet have still not improved, and I know I may have waited too long. I only wish one of the many MD's I'd seen over the 3 years had told me about nerve damage, waiting, etc. Despite the length of time the nerve had been compressed, my surgeon still gave me an 80=90% chance of healing the nerve pain. He still tells me it's too soon, we need to wait another 6 months, blah blah blah. Frankly, I rarely see stories of people whose nerves did heal after a year or so, although maybe they've gone on with their lives and don't post on this board - lucky for them! Since you've been through surgery before, I'd suggest asking a lot of questions about nerve damage and the REALISTIC chances of recovery. I would suggest, as others have, not waiting until the nerve has been damaged for too long. Good luck!
Posted 1/13/2008 10:35 PM (GMT 0)

I also have severe DDD throughout the lumbar spine. I tend to forget about that with all of the other problems I've had to deal with. For me, my decision was made because of the condition that my lumbar spine was in, and I didn't realize how bad off I really was but if I were you, I would give serious consideration to getting it done. The longer you wait, the less likely that the nerves can recover. My surgeon flat out told me that I needed to get it done and soon for the first surgery. In fact, from the day we discussed my options , it was 10 days later that I was in the OR and that was only because it took that long to get the myelogram and CT/MRI scans done again, along with having to donate two pints of my own blood to myself.

As it is, nerves only recover at 1mm a month, and it's going to take a lot of time if the nerves do recover.

I think for each of us, we have to decide if we can continue as we are, and given that you are still experiencing a decrease in your reflexes and ongoing symptoms of damage, I wouldn't wait too long.

As scared as I was of the whole idea of back surgery, I was more scared of paralysis and even I could tell that the pinching off of the spinal cord at three levels was not a good thing.

Sandi

Posted 1/13/2008 11:23 PM (GMT 0)
I think the rate of recovery of nerves is 1mm/day - which is slow enough if you think about it. And I've read that depends on how damaged the nerve was (was it just the sheath or the actual body of the nerve). Also, the recovery stop somewhere between 1-2 years in that the nerves that are farthest from the initial injury site that haven't regenerated during that period have likely died and will not recover. So a couple of years after surgery whatever nerve pain you have left is likely what you'll have to live with. Anyone know anybody who's recovered - or whose nerve pain has at least improved after a year or so?
Posted 1/14/2008 2:54 AM (GMT 0)
My nerve pain stopped improving about 6 months after surgery...it has been 2 years now and I have noticed no change for the better since that time.

As far as when to proceed with surgery, I would have to agree that it is a personal decision on how much you will/can tolerate. I was scared to death to have the surgery and had put it off about 5 years, until my doctor told me I was working myself into a life in a wheelchair. My right leg was weak and I actually kind of dragged it when I walked, I still have a foot drop on that side, but now only walk with a slight limp. I was falling a lot, too, from basically tripping over my own foot/leg. I do wonder sometimes if I had done the surgery sooner if the results would have been better.
Posted 1/14/2008 6:07 PM (GMT 0)
Dear MRSM123-Sandi,

I see by your electronic signature you have many of the same physical issues that I have. One thing in paerticular caught my attention...you indicated you had a revision of a failed back surgery. I remember reading about failed back symptoms as if it were a name of a disease many years ago. I am curious, what was your procedure and did it yeild possitive results. I've had a couple surgeries to relieve the most severe narrowing but the most recent surgery left me in much worse condition. Sometimes it feels as if my screws and bolts are being torn out of the bone. Is there a specific procedure to address the back surgeries that fail or am I confusing the nomenclature? Hope you are having a good back day.

Sincerely,

Jim
Posted 1/14/2008 7:07 PM (GMT 0)
eyes  Hello,Hello,Hello, How are you. Wife had back surgery 3 wks ago and is killin me with the put my socks on,put my shoes on, hand me this,hand me that,give me my dog,take my dog out. And this one is the best-SHAVE MY LEGS GEEEEEEEZZZZZ gIVE A MAN A BREAK.

anywho,THANKS Sandi,PAlady and Sue for your reply. Went to my PCP today to go over my last two specialist appointments with him. He said boy you sure seem to be in a good mood today. I said yea,not on that dang pain medicine you were giving me(Lortab & Percocet) Told him finally got something to give me some better relief and could actually get around and had some feeling in my foot and lower leg for the first time in 10yrs. Discussed with him about the waiting for the fusion and he said pretty much the same as you all did. Said what is done is done with the nerve damage and it won't get better only worse as time goes on and told me to seriously think about this fusion stuff and weigh my options out good. I recon if a person waits too long they may give themself a world of MORE HURT for no good reason. Sooo I guess I will get it done when the misses heals up and goes back to work. Also talked to him about getting it done with a minimally invasive procedure and I guess have to agree with him. He said that with something straight forward like a break or such that would be a good decision BUT with DDD ,arthritis and this AVN it would be better if the surgeon had enough room to look around in and check the whole area out to see how extensive the damage is as to just being able to look at just one specific area. He is a friend as well as my PCP and said he would help all he could to get me thru this but I should not wait too long like you all said. Gotta go,I heard the misses down stairs yell-I NEED MY SHOES ON!!!  Wish she would wear slippers. mad
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