Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum. ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Neurology (Expert Forum)
Spinal Fusion
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
Spinal Fusion
by traditionall, Dec 26, 2006 12:00AM
I have been experiencing lower back pain for about 10 months. An MRI and x-rays indicate that I have an unstable back at L3-L4 and that I will need decompression, instrumentation and a spinal fusion, PLIF for spondylolisthesis and Spinal Stenosis. From what I've been reading, few people have had a positive out come..with many having pain and numbness and leg pain where they didn't have it before. I do not have nor have I ever had leg pain. I take Vicadon occasionally for my lower back pain. Naturally I am scared to death of having a PLIF procedure. I consider my pain an annoyance but something that I can live with for the time being as long as I can rest and don't over do it. I live alone and simply can not take a risk that I will be worse off after the surgery than I am now. I also can not afford to take off the time it will take to recouperate. Job is physically demanding. Would a back brace help stablize my back and should I wait until my pain is much worse than it is now before I have the surgery. Since hurting my back 10 months ago I have tried physical therapy..it hasn't helped much. However, know one has told me what I should be lifting and what I shouldn't be lifting. And I have not had an opportunity to rest my back. How will I know if I am causing nerve damage? It is my plan to have another MRI done as well as another xray to see if there is any change in the stability of my back. If it continues to deteriate I guess I won't have any choice. If it hasn't changed I was hoping I'd be able to avoid surgery. What do you think?
Doctor's Answer
by CCF-Neuro-M.D.-SH, Jan 23, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The success of back surgies depends on the way that you define it. In the surgical literature a successful PLIF (Posterior Lumbar Interbody Fusion) is defined by a fusion (successful growth of bone graft) confirmed by xray. PLIF has a 90-95% fusion rate in most studies (the spine is fused by a bone graft to stabilize the spine). However patients are more likely to define success by an absence of pain (or other symptoms) after the procedure. Since back pain is multi-factorial, there is often not just one thing wrong when a patients presents with back pain. An MRI can identify a problem in the spine stability and a PLIF can fix that one problem, but if that was not the cause of your pain then a successful PLIF will be viewed as a "failure". The key is to determine if there are any other factors that are contributing to your pain, so back surgery if needed will have the best chance of improving your condition. Rarely the bone graft or 'cage' can press on the nerves in the lumbar canal if fusion is not achieved and cause back/leg pain, and may require additonal surgery. Things patients can do to reduce the risk of incomplete fusion is stop smoking (if you smoke)and allow time for recooperation/rehab. I would suggest that you take your repeat MRI to a neurologist and have him examine you. Your neurologist will be able to determine if the symptoms/exam are consistent with the pain comaing from a spinal stability problem (it seems likely in your case) and/or if there is progression in your spinal instability. You can then return to your surgeon armed with this information.
I hope this has been helpful.
The success of back surgies depends on the way that you define it. In the surgical literature a successful PLIF (Posterior Lumbar Interbody Fusion) is defined by a fusion (successful growth of bone graft) confirmed by xray. PLIF has a 90-95% fusion rate in most studies (the spine is fused by a bone graft to stabilize the spine). However patients are more likely to define success by an absence of pain (or other symptoms) after the procedure. Since back pain is multi-factorial, there is often not just one thing wrong when a patients presents with back pain. An MRI can identify a problem in the spine stability and a PLIF can fix that one problem, but if that was not the cause of your pain then a successful PLIF will be viewed as a "failure". The key is to determine if there are any other factors that are contributing to your pain, so back surgery if needed will have the best chance of improving your condition. Rarely the bone graft or 'cage' can press on the nerves in the lumbar canal if fusion is not achieved and cause back/leg pain, and may require additonal surgery. Things patients can do to reduce the risk of incomplete fusion is stop smoking (if you smoke)and allow time for recooperation/rehab. I would suggest that you take your repeat MRI to a neurologist and have him examine you. Your neurologist will be able to determine if the symptoms/exam are consistent with the pain comaing from a spinal stability problem (it seems likely in your case) and/or if there is progression in your spinal instability. You can then return to your surgeon armed with this information.
I hope this has been helpful.
I know how reluctant you are to venture into a spinal fusion, for several reasons. I know I was in your shoes a while ago. Unlike you, I did have pain going down my hip and leg. Still, I put off the spinal fusion, until it got to the point where the Vicodin wasn't working anymore for the pain. At that point, I was ready to try just about anything, so I went back into my neurosurgeon's office and signed the necessary papers to have the fusion done. It turned out to be a very successful surgery and the pain going down my hip and leg were gone, as soon as the surgery was over. Of course I had a lot of post surgical pain, for awhile, but that is to be expected. If you are like me, you will know when the time has come to agree to surgery, when you can not stand the pain anymore. I wish you all the luck in the world, with the decision you make. By the way, I had the same diagnosis as you have.
I have a similar diagnosis but not as close to needing surgery. My Orthoepedic Surgeon wants to avoid surgery until or unless I arrive at the agony stage.
I had pain into my buttocks and could not stand in a line, or walk a beach.
then I had two epidural shots in my lower back. the second one has totally eliminated my pain and I can both walk normally and stand in a line although not forever, without some discomfort.
You may want to ask about those shots, they are not painfull and may work for you.
oberlyus
Quick run down. Feb 2004 fell on ice. Tore rotator cuff left shoulder. Surgery june 2004 to repair. Still had severe pain that should have been gone after the repair. 2 1/2 yrs after the fall, after many diagnosis found that there was a herniated disc pressing on my spinal cord. I had been put through PT and told to wrok past the pain. Surgeon stated that the herniated disc was so severe that he said I could have been paralyzed with one wrong move. Physical therapy had me lifting weights and all sorts of things. Surgeon said that surgery was needed to fuse the neck at C6-7. Donor bone not of my own was used. Surgeon was amazed at how quickly I recovered. I was back to work 3 wks after surgery. Surgery was done through a 4 in insision in the front of my neck. Spine surgery Feb 2006 Instant relief since day of surgery until about 2 months ago. Now there are things that have me concerned. The left side was the effected side before surgery concerning pain and motor skills. Now I am experiencing neck pain, headaches, left hip pain, and left arm and hand pain. Left thumb seems to contract to the point that I am unable to straighten it all the w