Pending back surgery

I have a report from the neurosurgeon concerning his proposal for my back surgery. Of course, I don't know what much of it means so I will just quote from the e-mail he sent to me.

"recommendation is to proceed with a decompressive laminectomy to involve L3-L4 and an instrumental fusion at L3-L4 and L4-L5 using pedicle screw instrumentation and local bone as well as allograph. This rec is to treat my lumbar stenosis, spondylolistnesis at L3-L4, neurogenic pseudoclaudication, and radiculopathy The recommendation for the fusion is due to the presence of the spondylolisthesis at L3-L4."

I am to be a couch potato 2 weeks . Week 3 I may drive. I am not to lift anything for 3 weeks up to 5-10 pounds.

Any thoughts on this?

Thanks for listening :)

D'anne McGown

It will be a longer recovery process than what your doctor is saying
so clear your calander for a few months and just take it easy. Also, read up
On older posts about fusions and google lumbar fusions and read
all you can on this and do keep in mind this is major surgery and possibly
seek out a second opinion...from what people tell me once surgery
always surgery and I will send you many prayers...
Hope it goes good for you in what you choose to do..keep
us posted as we do truly care... many well wishes, thinking of yoy.

One other thing. Your doctor mentions using local bone. I would question him about this. They normally use bone from the Iliac Crest which is the largest part of the pelvis. My surgeon did not take a chunk out of the iliac crest for the spacer, this was a donor bone but he did take scrapings from the iliac crest. This area bothered me for a long time after the surgery. Check into this because when a large section of bone from the iliac crest is taken, pain for long periods of time can be the result.

Thanks everyone for your opinions. Yes, I know the doctor is saying 2 weeks and I don't expect that at all. I am a 62 year old female, pretty healthy and am a domestic engineer:) I intend to follow doctor orders to a tea and add some weeks to what he says. I am having this surgery June 20 in Houston. The surgeon is tops in his field of spinal neurosurgery and I have had another doctor look at the results. I wish to do the surgery while my health is what it is now, and I should not have complications unless something not expected. The way my back is now is that it hurts all the time--sometimes worse than others. I have to bend a bit forward when walking to offer some relief. I cannot stand for long and my energy level is cut in half due to the stenosis.

I have had a cervical neck surgery and it took 9 good months--this was a 5 fusion - so basically I got a new neck. That was 2 years ago. I was very careful and I'd say that surgery was 80% success. I am thankful and hope to have the same luck with this lumbar fusion.

Is it true that if some bone is taken from your body that it helps promote quicker healing? Seems like it's a double edged sword-- as getting it from your body is good for the recovery, yet you probably hurt twice as bad in the area from where bone was taken. darned if you do and darned if you don't.

I do appreciate your thoughts and have certainly taken them to heart. I plan to be prepared to mind the doctor and to be realistic about the recovery.
Your notes have scared me enough to really take extra care of my body during this recovery. Thank you.

Scorpiogirl, when I first saw a surgeon 2 years ago he said they would not do surgery until I was in wheelchair. They changed their minds as I was needing a cane mainly for balance and was in so very much pain.

I am still glad I had the surgery even though I am hurting, my mother in law told me when she had her fusion to get out of bed as quickly as possible after the surgery. The nurse told me the same day I had fusion a lady in the room beside mine had the same surgery as I and she was on day 3 and not out of bed because it hurt too much. Be strong, listen to instructions and if you want to talk we are all here.

Oh yes to answer your question I have much better balance now.

Scorpio, you're going to get lots of varying opinions and stories. Serious back issues like yours aren't straightforward; everyone's different.

I had very similar issues to yours, but two disc levels lower (L4-5, L5-S1). I had a decompressive laminectomy initially by one doc to relieve foot numbness and pain running down the back of my left leg.

That failed, and I ultimately had a bilateral (entry from both front and back, in two separate stages) fusion at the above-noted disc levels. It did the trick; I have been completely free of pain for four years. I know that's not common but it's important to know that some of these really do succeed. My neurosurgeon had told me I'd be better - at my worst I couldn't walk 50 feet without stopping due to the pain - but he couldn't say I'd be pain free.

You asked about the actual process, hospitalization, etc. I'm sure this varies a bit, but in my case I was hospitalized for four nights. First couple days, frankly, aren't pretty. I was flat on my back for 24 hours (precautionary, to ensure that the newly-installed hardware doesn't displace), with a catheter and on an IV pain pump. The first attempts to walk aren't fun. Physical therapists were great, very supportive. It gets better day by day.

At home, as others have noted, it's walking and lying down, walking and lying down. No sitting, which stresses the spine. All I can say is that it does improve day by day and you can't expect it to go faster than your body will allow. Have help around; you will need it. And take the meds -- they really help.

My neurosurgeon did not use an allograft (bone from hip); he uses cadaver bone and material (cement, basically) with added bone-growth hormones. I understand that most surgeons aren't using allografts any more. You might ask your surgeon why he does.

Also, my surgeon was part of a clinical trial that used a bone stimulator post-surgery to enhance bone growth at the fusion site (the idea is that the bone forms a solid mass at the site of the discs that are tilting on top of each other to eliminate slipping, which causes pain). My guy really believed in it, and all I know is that I had a great outcome.

The only odd thing in my case is that I didn't see the surgeon for six weeks. Yes, six weeks. He used sutures that dissolved under the skin, so there were no sutures to remove. And he told me there was no reason to see me sooner; the important thing was to take it easy and allow healing. I expected to see him more frequently and more often. But it worked.

This is not easy; it's major surgery and you'll hear lots of horror stories. Some people do not get better, and others only get modest relief. But others do great. I am a success story, and it took three surgeries and seven doctors for me to finally get there. Be optimistic! And take care.

Scorpio you have been given some good tips, the one about taking your meds is a must, don't try to go without your pain medication when you get home, its easier to stay on top of the pain rather than letting it get out of control, once it gets out of control its so hard getting it t settle down quickly. Stool softners are a must, you don't want to strain and pain meds can plug up the plumbing, eating 4-5 prunes a day works well if you like prunes. The reacher/grabber Jag suggested is awesome for getting stuff off the floor, we have 3 here at the house, at night be sure to have some bottled water & meds at bedside in case you wake up & need to take meds. Try to have easy foods available to pop in the microwave. I noticed many are on walkers when they go mainly to help with balance. Are you going to have help at home when you are released from the hospital?

No one here wants to scare you by any means, we just want you to have the very best outcome. Also, in case Rose does not see your questions, click on her name and you will be able to bring up some of her posts and find the one where she tells about her activities that she should not have done so soon.

Take care...Susie

Just FYI for the technical terms...

Allograft means from a donor bone/tissue.
Autograft means from your own bone/tissue.

I think someone accidentally reversed the terms. So Scorpio...your Dr. is wanting to use donor bone for this particular surgery.

Did they use your own bone for the cervical one? And wow....I have never heard of someone getting a 5 level cervical fusion....Were you in an accident that caused this and they did emergency surgery? So what levels are you fused?

That is absolutely amazing that you have recovered so well from that one...This new surgery should be a piece of cake! LOL....

There are studies on both allograft vs. autograft and yes, the percentage is a bit higher for using one's own bone for the fusion as any time there is a foreign body that is used in a surgery....everything from a fusion to transplants of heart, liver, etc....There is always a chance of the body rejecting it...

I've had 3 cervical fusion surgeries and the first one was autograft (using my hip bone) but without any instrumentation (no cage/plates/screws) and the last two were allograft with instrumentation. I was very lucky to not have any trouble with my hip and having any lingering pain. The only time it bothers me is if my dog steps on me while jumping on the bed...lol.....

And I had a fairly rare occurrence after my first surgery that after a few years....my body reabsorbed the bone into my body...It just disappeared/disinegrated. So the levels collapsed again.

The second surgery was a terrible mess and was in excruciating pain from the moment I woke up...

The third one was done by both anterior and posterior approach and now all shored up with plenty of titanium. Still have residual chronic pain but the surgery itself is a success in that it releived the pressure off the nerves.

As mentioned and as you know....each person heals differently and you will just have to take it one day at a time. And as I wrote to Rose on another thread....the key is that when you have the good days...to not do too much to make the bad days even worse.

It's all about baby steps....literally! LOL...But I think you are going to do just fine since you have already been through a HUGE surgery on your neck...And as you mention...you are going to follow the Dr.'s orders to a T.

We will be praying for you~