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  • Additional fusion/disc degeneration

    Hi all -
    I had spinal fusion T-4 to L-4 in 2000 at the age of 57. This site was very helpful at the time with advice and suggestions. I have not been pain-free since then, mostly muscle spasms and low back pain. But until now it has been tolerable with exercise and stretching. A few months ago I started having unmistakable nerve pain in the buttocks and legs. After many tests, cortisone injections, oral steroids, and many pain meds, none of which helped very much, this morning I saw the surgeon who did my original fusion. The X-rays show that I have virtually no disc left between L-4 and L-5. I'm scheduled for myelogram and CT scan next week, but my doctor has already said I will need an additional fusion.

    Research I've done about artificial discs calls it still experimental and not appropriate for someone with leg pain. Does anyone know of any other alternatives to surgery?

    If anyone has had similar surgery I would appreciate some feedback, specifically in terms of the relative severity of the surgery, recuperation time off work, additional limitations in movement, etc.

    Thanks very much.
    Trulyaries
    FeliciaFeliciaFelicia
    10/24/00 posterior fusion T4-L4 at age 57
    8/5/05 posterior surgery for spinal stenosis at L4-L5; laminectomy and fusion
    5/14/07 posterior revision with fusion to sacrum
    2/11/08 anterior discectomy L5-S1, and reinforcement of fusion with plate attached to L5-S1
    3/9/2011 and 3/11/2011 revision surgery with Dr. Lenke, St. Louis - complete revision and fusion with instrumentation from T1 to sacrum, one lumbar osteotomy.

  • #2
    Hi Truly...

    I'm in the same situation. (Actually, my initial problem was just L3-L4, but now L4-L5 and L5-S1 are both showing problems as well.) I had a CT-myleogram about two months ago. I can tell you that I was able to minimize my pain somewhat by doing daily physical therapy exercises to strengthen my abdominal muscles. Unfortunately, I hurt myself in November, and can no longer lay on the floor to do the exercises.

    If you can find a really good physical therapist who can teach you exercises that offload the impact on your spine, I think it may help.

    Unfortunately, I've begun to think that not dealing with my L3-L4 problem, I may have sped up degeneration in the levels below. :-(

    Regards,
    Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

    Comment


    • #3
      Linda, thanks for the reply. I had been trying to keep up with my stretching and exercise until my physical medicine doctor told me to stop until we knew exactly what was going on. You point out a concern I have - if I get L4-L5 fused, how long before the next segment starts to deteriorate and I need another fusion?? I was debating about taking early retirement next year and I think I may be forced into that decision even earlier - my job is physically and mentally too stressful for this back.
      TrulyAries
      FeliciaFeliciaFelicia
      10/24/00 posterior fusion T4-L4 at age 57
      8/5/05 posterior surgery for spinal stenosis at L4-L5; laminectomy and fusion
      5/14/07 posterior revision with fusion to sacrum
      2/11/08 anterior discectomy L5-S1, and reinforcement of fusion with plate attached to L5-S1
      3/9/2011 and 3/11/2011 revision surgery with Dr. Lenke, St. Louis - complete revision and fusion with instrumentation from T1 to sacrum, one lumbar osteotomy.

      Comment


      • #4
        Hi! I'm really sorry to hear about your pain. I'm particularly interested in this because (although I'm much younger than you and haven't had surgery yet) I have big problems at L5-S1 with degeneration.

        I just wanted to write because recently I read something online by Dr. Boachie, some kind of transcript of a class he had given about spine surgery, which involved scoliosis patients who also had disk trouble. (I'm pretty sure it was on the Hospital for Special Surgery website when I searched "boachie.") Anyway, from what I remember it recommended not stopping a fusion at L5 (Linda? anyone?). Presumably your doc will talk about his reasons for choosing a level, but it might be worth remembering to ask if he doesn't.

        By the way, I'm not sure if scoli people are encouraged to partake as disk replacement guinea pigs. One surgeon I saw in Philly was willing to have me go through the initial tests (since my spine "wasn't even that curved so far down") but I'd rather they had some longevity (and pregnancy) results before I go down that road...

        All the very best. I'm so sorry this is happening for you. By the way, after PT, spinal injections, acupuncture, etc. etc. failed, I halved my pain with a very low dose of amitriptylene (Elavil). If you haven't tried it, it might be worth a shot.

        Take care - Laura
        30y/o
        Upper curve around 55
        Lower curve around 35

        Comment


        • #5
          Hi Laura...

          Selecting the levels at which to start and stop a fusion are why these docs get the big money. People with long fusions that stop at L5 have a significant chance of needing additional surgery:

          http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15371700

          Hi Truly... There's no way to know if you'll ever have problems above or below your fusion. If you're going to have difficulties, I think they usually surface in about 8-10 years in older adults. You'd have to talk to a surgeon about this, but I suspect that leaving a painful disc unfused for any length of time is probably as bad for the discs below it as the longer fusion would be. In other words, we're probably screwed no matter what we do. :-)

          Regards,
          Linda
          Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
          ---------------------------------------------------------------------------------------------------------------------------------------------------
          Surgery 2/10/93 A/P fusion T4-L3
          Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

          Comment


          • #6
            Thanks to all for the advice. I love Linda's "we're screwed no matter what we do." Would that be a pedicle screw?? (LOL)
            TrulyAries
            FeliciaFeliciaFelicia
            10/24/00 posterior fusion T4-L4 at age 57
            8/5/05 posterior surgery for spinal stenosis at L4-L5; laminectomy and fusion
            5/14/07 posterior revision with fusion to sacrum
            2/11/08 anterior discectomy L5-S1, and reinforcement of fusion with plate attached to L5-S1
            3/9/2011 and 3/11/2011 revision surgery with Dr. Lenke, St. Louis - complete revision and fusion with instrumentation from T1 to sacrum, one lumbar osteotomy.

            Comment


            • #7
              DDD at L4-L5

              Hi Truly,

              I am new to this site, first time posting, and I ran across your question. I am in the same boat. I am 52, I had my fusions in 69 and 71 when the rod was put in. I was 14-15 for my fist fusion. My doc is dead and I am seeking a new one now. What I have been told by several docs over the past 2 years is this: The rod and fusions put trememdous stress on the last Disc because it is one only one working. It falls apart, DDD. Also the top of my spine, C3, C4, C5, C6 & C7 are also in trouble. If they fuse the last disc at L4-L5. this may or may not stop the pain. The stress goes down to the hip joints. Once you fuse past the Lumbar all the stress goes below. Right now I have 2 disc that have heriated. One at C6-7 and of course at L4-5. I have days that I can't walk because I can't use my legs. The pain is unbearable. My left arm and had have lost 50% of it's use. My left side feels like it is sinking for lack of a better word. My left leg has lost feeling, my left hip has pain and I lock up. I did the epidurals and they helped. I have a great Pain Mgt. Doc. He didn't think it was even going to touch my pain, but for the love of God, it helped. I am disabled now. I take one day at a time. I do what I can on my good days. No one wants to do more surgery for now. When I can't walk any more or I can't get relief from the pain, they will do more. For now, I just take it one day at a time.

              Good luck

              Comment


              • #8
                Post-op problems years later

                All,

                Once again, I find myself rethinking surgery when I read stuff like this. I just keep praying and will keep you all in my prayers.

                Chris

                Comment


                • #9
                  Ddd

                  Bern:

                  After I wrote my initial post, my surgeon diagnosed my problem more accurately as spinal stenosis at L4-L5. I had tried every other treatment possible, so finally agreed to another surgery. The nerve pain I had was absolutely the worst pain I had ever had in my life and I would have done anything to stop it. I had surgery last August (decompressive lumbar laminectomy L4-L5, re-instrumentation and fusion to L5 level). We agreed not to fuse to S-1. The nerve pain is now gone. However, I do have lower back pain and some pain in the upper back from osteoarthritis. I made the mistake of going on the road for 6 weeks for my job about 8 weeks after my surgery. I'm sure that didn't help my recovery. So in January I quit my job (for now) to focus on exercise and I just finished 8 weeks of PT. My therapy has focused on tightening the abdominals and keeping the lower lumbar/pelvic area immobile, as well as strengthening and stretching the legs, upper back, neck. My upper cervical area is much better; the lower back is getting better but not perfect yet. My therapist reviewed all of the strength exercises I have available to me at the fitness club and eliminated any that put stress on the low back. I have come to the conclusion that the exercise will be a lifelong thing and hopefully I can avoid any further surgeries.
                  I don't know why they don't want to do more surgery on you - you're still young enough and obviously in great distress. I wish you the best.
                  FeliciaFeliciaFelicia
                  10/24/00 posterior fusion T4-L4 at age 57
                  8/5/05 posterior surgery for spinal stenosis at L4-L5; laminectomy and fusion
                  5/14/07 posterior revision with fusion to sacrum
                  2/11/08 anterior discectomy L5-S1, and reinforcement of fusion with plate attached to L5-S1
                  3/9/2011 and 3/11/2011 revision surgery with Dr. Lenke, St. Louis - complete revision and fusion with instrumentation from T1 to sacrum, one lumbar osteotomy.

                  Comment


                  • #10
                    hi...i am fused down to l4...and am almost 1.5years post op. i have low back pain-sometimes more of a strain sometimes achy always stiff, my left leg falls asleep sometimes when i sit and gets numb-as well as my but and left arm...is this all normal?

                    Comment


                    • #11
                      Dear Truley,

                      Thanks for the response. I think I haven't found the right Doc for the job. I live in FL and I can't find a surgen that has done Surgical Revision. I wear a brace, or a coresett now and it is helping to give me some support. I blew out a disc at C7 and I still can't get my left hand and arm to work correctly. I have lost a lot of strength and my hand still shakes. MY left side where the rib cage is pushed in feels strange. It feels like it is collapsing or my side is pulling down, like the muscle is weak. I did 5 months of PT for the lower back and for my arm and hand. It helped but I am not the same. I did do a series of Epidurals and it killed a lot of the nerve pain. I need to go back again but it lasted almost 4 months. I wasn't pain free but I wasn't stuck in a chair unable to walk or use my legs as before. Now I can't walk far, I can't sit long, and I am very stiff in my neck and lower back. The pain is as you described when I blew out the 2 discs ( C7 and L4 )UNBEARABLE. But it is healing and I just get nerve pain down my leg, I have numbness in parts of my left leg and I feel like I am being tasserd (spelling?) in my lower back when I over do. Any way, I need to keep looking for some help, but for now I just take it easy and stay at home.

                      Bern

                      Comment


                      • #12
                        Hi Bern...

                        Check out Anthony Moreno in Clearwater and Harry Shufflebarger in Miami. Both have done quite a few revisions.

                        Regards,
                        Linda
                        Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
                        ---------------------------------------------------------------------------------------------------------------------------------------------------
                        Surgery 2/10/93 A/P fusion T4-L3
                        Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

                        Comment


                        • #13
                          Thank you Linda,

                          I live 1 hr north of Tampa so my insurance should cover Clearwater. I will let you know how it turns out.

                          Bern

                          Comment


                          • #14
                            Dear Trulyaries,
                            Can you describe with some detail the exercises that you do at the fitness club as well as the ones that a person shouldn't do because too much stress is put on the lower back? I also have a long fusion (T-3 to L-3) and am trying to separate the "good" exercises from the "bad" exercises.
                            Shelley

                            Comment


                            • #15
                              Originally posted by BeachinIt66
                              hi...i am fused down to l4...and am almost 1.5years post op. i have low back pain-sometimes more of a strain sometimes achy always stiff, my left leg falls asleep sometimes when i sit and gets numb-as well as my but and left arm...is this all normal?
                              No, it's not normal. You could still be having low back pain, but the numbness you describe is not normal. You should definitely see a doctor. If everything else checks out you should get some physical therapy. I recently had numbness down my right arm, mostly when I sat down. A few weeks of physical therapy took care of it.
                              Truly Aries
                              FeliciaFeliciaFelicia
                              10/24/00 posterior fusion T4-L4 at age 57
                              8/5/05 posterior surgery for spinal stenosis at L4-L5; laminectomy and fusion
                              5/14/07 posterior revision with fusion to sacrum
                              2/11/08 anterior discectomy L5-S1, and reinforcement of fusion with plate attached to L5-S1
                              3/9/2011 and 3/11/2011 revision surgery with Dr. Lenke, St. Louis - complete revision and fusion with instrumentation from T1 to sacrum, one lumbar osteotomy.

                              Comment

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