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L4-L5 S1 fusion vs. disc replacement vs. living with pain
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L4-L5 S1 fusion vs. disc replacement vs. living with pain

My name is Jim, and I was injured on the job seven months ago, I ruptured the S1 disc between L4 and L5. I am bieng covered by workmans comp. at this time, and they have sent me to several differrent doctors, and a couple of back specialists, and seven months of PT. I'm told that I have a severe back injury, and its my decision to have more pt., surgery, or to try to live with the pain. I'm only 39 years old and have a young child and a wife that I'm resopnsible for, I'm afraid of making the wrong decision on my back and on my and my familys future. I am happy with all the different doctors and workmans comp. and I trust them, but I can't seem to get the information that I need to make this important decision. The Information I'm looking for is what are the realistic risks of not having surgury, or having a fusion performed, or replacing the disc. When I ask the specialists and doctors about which way is the safest and best for me they tell me its my decision to make. I'm not a doctor and don't know much about this type of injury, I have looked into it on the internet, and I start to get lost because I don;t understand the complicated language used by the people in this proffesion. Can someone please help me understand what the ramifications for each scenario and in language that I can understand on this decision? Thank you,
                                                                                                  Jimken    
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Attempting to make informed decisions regarding several different treatment options can be very frustrating, especially when the various doctors offering these options are not able to provide data that might assist you in this process.
As a post cervical fusion patient (C4-C7), I was given no other option besides the fusion.
I am fortunate that the surgery was a complete success and most of my preop pain and radicular symptoms was gone within three hours of the surgery.  Unfortunately, others having similar surgeries have not had such good outcomes.
If your symptoms have been present for over seven months of PT, it is doubtful that additional physical therapy will prove beneficial.
Surgery would be indicated if there is significant degenerative changes of the vertebrae and intervertebral  discs that is resulting in nerve compression or affecting changes on the spinal nerve roots or spinal cord.  The results of your most recent MRI could provide this information.  Terminology such as "moderate to severe stenosis" or "nerve encroachment" are examples indicating that surgical intervention might be appropriate.
The type of surgery being offered is important.  Are they recommending fusion?  An artificial disc replacement is done only if there is no indication of degenerative disc changes such as facet bone spurring or factors that are causing instability of the spine..  ADR is most successful when the degenerative changes are confined to the disc itself.
ADR is aimed at trying to maintain the movement and function of the spine as related to other discs.  It is usually done only on one level and insurance considerations do exist.
If you are considering ADR, the work comp company would be the one providing authorization for this procedure and they may have some parameters related to age, activity level, etc.
If you have some specific questions regarding any potential surgery, please post an update and we will try and assist you further.

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Hi Jim, my name is Suzy and I am a 47 year old nurse from New Zealand, i had a discectomy( removal of a disc at l4/5) and more recently in april this year i had a spinal fusion at that level. It hasnt been a success and I do regret having it done, i have more pain than before the surgery and have been told I can no longer go back to my career of 26 years as  a nurse. I too hurt my back at work initially in 1989 and again in 2008 when I had no choice but to lift a dying patient at the hospice i was working in, due to the other nurse ( the RN) being asleep. now i can not work and am living on oxynorm pills for pain( morphine). I would get a lot of information before you make a decision re the surgery. i was told they cant gaurantee it will be a sucess and for me it hasnt been but others i know, it has worked so it is a real tricky question. all i can advise is gets lot of information before you decide. good luck with it and hope it improves for you.
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