spinal lumbar fusion and rheumatoid arthritis

I am 71 female with RA. I was active and exercised daily until left calf leg pain 2 years ago. I had several PT sessions and multiple epidural shots. My body responds well to steroids, but epidural shots worked for shorter and shorter time periods. I had 4 epidural appointments & 8 separate injections over 6 months.
5/29/18 I had decompression surgery. (Laminectomy L4-L5 for removal of synovial cyst, left decompression, foraminotomy, right. Decomprssive laminectomy at L5-S1 with bilateral foraminotomies & microelectronics.)
I received a lot of steroids during surgery and felt good except for incision pain for about 10 days. Since then my pain is worse. Surgery relieved radicular pain in my calf, but now have radicular (hot searing pain) in my left thigh and severe aching pain in my low back.
Post surgery MRI shows Advanced degenerative disc disease throughout lumbar spine and disc bulges at L1 through S1 with spinal stenosis and osteo arthritis. This is most significant in L & R L2 and L5.
The L5-S1 disc protrusion causes compression of the passing right and left S1 nerve roots withinth lateral recesses, greatest on the left.
I am wondering if I should see a surgeon to do fusion surgery because the bones in my back have been compromised by 20+ years of RA. I fear more laminectomy surgery will further compromise my spine. I would appreciate hearing from anyone who has had lumbar spinal fusion surgery.

Seashell:
Thanks you for your quick & thoughtful response. I know my RA is a factor in slow healing, but glad you mentioned it may lower my success rate if I want fusion surgery. I Googled Corticostroid pain flare, but don't think that is a cause of my pain. Last shots were 7 months ago. I believe previous surgeon prescribed them too often and not good for my body. They gave relief, but each time shot lasted less time... about 2 weeks.
I wonder if there is anyone with RA on this forum that has had successful lumbar spine fusion.

Hello AZdiane & welcome to Healing Well. I have read your post a couple of times & have a question. Is the lumbar fusion something your surgeon has offered as an option?

We do have a member, Birder Nancy that just underwent a fusion recently. We have not had an update from her since surgery. I hope we do hear something soon as I am getting a little concerned that we haven't heard from her. Over the years we have had numerous members have this surgery. We have a Google Custom Search towards the top on the left. You can type in "chronic pain forum lumbar fusion" & will be able to pull up a lot of older threads on this subject. Keep in mind if you read those threads, no one had RA.


I would have some very real concerns on a successful fusion with a 20 year history of RA. Given your age this is going to affect the healing process which is lengthy with this surgery. You have one surgery under your belt, odds go down a little when a 2nd surgery is done. I will be honest, people in their 40's & 50's struggle with the recovery. It is a tough surgery. I did a search & could not find anyone in the archives with RA & a fusion. We do have an RA forum but it is really slow in that forum.


Here is something you may want to consider doing. Obtain a copy of all your scans, MRI's & a copy of your operative records. Search out the very best spine specialists in your area. I not talking a jack of trades orthopedic either. There are orthopedics that specialize in this area or a fellowship trained neurosurgeon. These 2 specialty drs are the very best you get. I would get a consult with each for an opinion. I would only say this is my op report, these are my symptoms & I would like for you to give me my options. I would not ask if a fusion is an option, I would just ask what are my options. Never ask a dr what would you do if you were in my shoes or if I were your mother what would you tell her to do.


You are less than 6 months post op which is truly too early to consider any more surgery any time soon. Have you tried any of the medications used to treat nerve pain such as Gabapentin or Lyrica? If not I would ask the dr to let you try one of them. It can take a little time to become fully effective, but well worth trying.


You need to really take your time & explore all avenues here. Keep us posted.