advice for painful back

 I,m usually on fibro site but also deal with low back chronic pain. Wanting to know how do you decide having back surgery or not.. I,ve been diagnosed with degernative disc disease, joint facet syndrome and along with fibro. I also was told according to the mri i have a small tear in my L5. I just had spinal epidural injections in my back 5 days o.k. and am still experiencing pain. I know it takes awhile for them to take affect I,ve had them before. My surgeon told me 2-4 wks. He was giving me the shots following by way of x-ray and told me that I need to do something about my spine.  He said there is surgery called spinal fusion. I know what it is and recovery time and not a very easy surgery. I,m just so worried in having to make this kind of decision. I,m 53 ,,,just had surgery for a torn meniscus,which he took out and 1 caprpal tunnel surgery in hte last 8 wks. I am cleared to go back to work, but I,m so worried about my knee and back. My job is very physical and demanding and heavy lifting. I,m going to hang on there for a few months and the look for something else. Please would love to hear from anyone if they have had this procedure and how and what you think about it. I don,t want to make the wrong decision. thanks.   Chris

hey mickey, how are ya? you do have a bad lumbar spine. if the epidural is not helping by now it's probably not going to cure you but he may have done the epidural injection as a diagnostic approach. immediately after the injection when the lidocaine or marcaine was working; did you get dramatic pain reduction in the areas where you were numbed-up? i had a PLIF in Oct. 2008, posterior-lumbar-interbody-fusion with metal instrumentation. i had exactly what you have with the disc-dessication and facet joint-arthropathy. i strongly suggest that you get a good neurosurgeon to determine if you need surgery now or if you do you want to try to find one of the better doctors around. the fusion operation involves doing a laminectomy and removing the back of the vertebrea getting around the spinal cord some how and grabbing the disc and getting it out. then a facetectomy may be done to remove the arthrtic or degenerated joints. then they put some bone-graft in and screw it down tight. my fusion came out amazingly great. i got big pain relief and the ability to have greater mobility. after 2 years and 3 months i have muscle pain and inflammation pain in my lower back and the left foot has severe neuropathy/nerve pain as a result of the fusion surgery. according to my neurosurgeon that is a common side effect so oh well! if you absolutely have to because you can't stand it anymore then get with a surgeon thats done a fellowship program in spine surgery, there are not many in any given town other than a big city or metropolitan area. Orthopedic practices have spine fellows but no general orthopedist should perform this surgery on you. you would be down 4-5 months before you were 100% and the surgery is up there on the pain scale even if it was good. i came out ahead. good luck, HAPPY HOLIDAYS

Mickey,

Welcome to the CP forum! What most surgeons don't tell you is that fusion or for that matter, any back surgery done primarily to relieve pain is not going to work in most cases.

Back surgery, in my opinion and the opinions of many back surgeons is that it should only be done for structural problems or what are called mechanical problems. This usually means a spondylolysthesis ( slippage of one vertebra or more out of alignment with the rest) or other mechanical problem that can be fixed with surgery, such as stenosis  ( where the nerves exiting the spinal cord  or the spinal cord itself, are compressed at a specific level(s).

The tear in the outer portion of the disc can also be treated with another form of injection, in which they introduce a metal coil into the disc, and then heat it, so that the inner core of the disc is heated causing the entire disc to shrink and repair any tears.

If you have ddd, it is not a disease, per se, but rather the state of the discs drying out as we age. Anyone over the age of 18 has some degree of ddd.

The facet joint problems can be addressed with a rhizotomy, which is a burning of the nerves at the facet joint. In fact, before doing that, they can do specialized injections to see if numbing the nerves surrounding the facet joints improves pain levels. If that is positive, then a rhizotomy is usually the recommended treatment.

Anyway, before having any type of spinal surgery, you should get at least two opinions, and make sure that there aren't any other options available before going ahead with it. One thing that I learned the hard way was that the surgeon's opinion of a successful surgery was much different than what mine was.

The recovery from a spinal fusion is at least a year. And that is with no complications or other concerns. It is a long road, and difficult physically and mentally, so you really want to get at least one orthopedic spinal surgeon consult and one spinal neurosurgeon consult under your belt before deciding to undergo surgery.

Sandi