Surgical procedure for Spondylolisthesis

[heyjude]

44yr old female w/20 years low back pain.  Spondylolisthesis at L5S1 diagnosed at age 17. Degenerative disk disease since 1990 in cervical/lumbar area.  1998 anterior spinal fusion w/ray threaded cage device at L5-S1.  2001, cervical diskectomy at C4-5 & C5-6.  Continual low back pain indicates surgery is needed to correct Grade II spondylo w/posterior incision.  Pediscule screws are needed to stablize spine.  My neurosurgeon wishes to wait on the surgery until spondlyo shifts to a grade III.  I am taking 750 mg Loracet 4 x daily as well as flexeril for muscle spasms and pain.  I am unable to work at this time.  My question is this; how long is too long to wait for the surgery?  Without it, am I risking increased nerve damage or paralysis?  Walking, sitting and standing increase the pain.  Reclining position is all that offers relief.  Even w/pain meds, the pain is excruciating at times.  I also have Fibromyalgia and Osteoarthritis.  What are the surgical risks of the surgery needed to correct the spondylo?  Surgeon says it's risky, painful, considerable blood loss and risk of damage to spinal nerves.  He will do surgery when pain meds cease to provide any comfort.  My future is in limbo.  any advice?
Thank you,
Judy

[CCF-Neuro-M.D.-JT]

Your case does sound complicated, however you did not mention exactly where you need the surgery in the lower back. A surgical redo in the same area of L5-S1 does make the surgery more complicated than a region with no prior surgery, but not necessarily impossible. The risks involved with ANY spine surgery (including less complex cases) are blood loss, infection, and cord/nerve damage as stated by your surgeon. But keep in mind that the surgery doesn't always "fix" the pain, also. THe amount of pain and disability you report is concerning. And if there is some nerve compromise already from the spondylolisthesis, it can certainly progress to the point where all surgery can do is prevent worsening rather than reversing the problem. You could consider an EMG of your leg (if one is affected depending on the location of the spine problem) which can help evaluate just how bad the nerves and muscles are being compromised. Finally, consider a second opinion by a neurosurgeon at a major academic or clinical center that specializes in spine. If you are \in the Cleveland area, Drs. Benzel and Kalfas are outstanding spine surgeons who do very complicated cases. GOod luck.

[smokeater]

Judy,
I would get a second opinon.  I would not wait for someone to tell you  that.  that sounds crazy.  I am not a doctor by any means but that sounds like that is too risky to wait.  I mean any surgery has risks but geese, I mean first of all you are taking a risk of becoming physically dependant (not on purpose of course) on narcotics, your body is becoming weaker because it has to bear the load in other places becuase your back cant bear the brunt of the weight that it normally should, and I would think that it would be causing further nerve damage.  Again I am not a doctor so this is just my opinion so take it as you will but sweetheart I would definately get a second  opinion for sure.  You can never be too careful.  This is your body and your future and if you dont feel right or confortable with what your doctor is telling you and your instincts are telling you that something is off than you should go with your instincts because they are ususally right on target most of the time, atleast that has been my experience anyway.  I hope you get better.  Good luck and God Bless you and may God Bless you in every possible way.

[LP]

Hi, Judy -

I'm a 39 yo F dealing with a grade II spondylolisthesis (L4-L5).  I'm considering spinal fusion after 4 months of physical therapy, 2 epidurals, and anti-inflammatories.  My orthopedic dr. says the surgery is effective 80% of the time.  He recommends posterior lumbar fusion with instrumentation.  He gave me a pamphlet explaining spinal fusion surgery, and I found it very helpful.  The risks and complications it outlines are infection, nerve damage, bone graft shifting out of place, bones not fusing, or blood clots in legs.  Even so, my only fear is being incapacitated for a long period of time.  Since you are already unable to work, and in severe pain, I would seriously consider it.  Get a second opinion first, and let me know what happens!

[kscs]

Have you asked your Doc about BMP, Bone Morphogenic Proteins, to help in the fusion.  New technique that is coming out in probably a year.  AMA will probably okay it in about six months.  After that, another six before it can be used.  As I understand it, it takes the place of the using your bone from your hip, or that of bone from the bone bank.  Another procedure I heard about from a PA, called AGF-Interpore Cross.  To be honest with you, I haven't checked on that one so far.  Good luck to you.

[heyjude]

Thank you all for the advice.  I found a spine clinic on the west coast that is willing to look over my records so will get a second opinion.  I forgot to mention that the spondylolisthesis is also at L5 S1.  The neurosurgeon said the previous surgery had taken well and the bone was doing what it was supposed to be doing.  I did have an EMG, and there was nerve/muscle damage in my left leg.  I have numbness on that side as well.  I'm concerned about the nerve damage.  I am not even able to wash dishes.  After a couple of minutes standing at the sink, my lower back begins to shake and I can't stand up straight.  I'll send an update after I received a 2nd opinion.  Thanks again for all the advice.
Regards,
Judy

[corvette]

Yes, Post. spinal fusion is a major surg., but it sure was worth the risk for me.  I am 2 weeks post fusion with a cage and screws and rods, and I am doing ok.  I only stayed 1 1/2 days in the hosp.(I hate hosp), and I hope this surg. will reduce the pain .

[ezreader]

Judy, I had the very surgery that you are speaking of...spinal fusion of L4/L5. I was in extreme pain before the surgery and had to stop working. Because my back feels better now than before I feel the surgery was a success. But there was a complication with the surgery that I must point out. I had quite a bit of blood loss with the surgery and my blood pressure dropped to 54/24 later in the day of the surgery. This drop in blood pressure and the length of my surgery caused a stroke in my left eye (Anterior Ischemic Optic Neuropathy or AION). I now have limited vision in that eye and have had to adjust my life greatly. While I think the spinal surgery was important for me and has improved my life it did change it for the worse. If I had known ahead of time that this surgery had a possiblility of causing a stroke in the eye (or eyes) which could lead to blindness I probably would'nt have had it. My all time favorite thing to do is read, something which I have trouble doing now. Everyone comtemplating surgery needs to make an informed decision on what's best for them AFTER they have all the facts.

[CarlPet]

I too am getting spine fusion of L4&5. did you get yours done yet lp and how is your eye now ez. wondering about recovery. did you give your own blood for surgery.  you can write back to ***@****     appreciate any correspondence. very apprehesive. one other quick question.  how long sex out after fusion.

[jim tom]

i was first diagnosed with spondyloisthesis january 1999. i also had slipped and buldging discs.  in march 1999 the disc was removed.  following the pain got worse. i was refrred to a pain clinic. there i was told that since the initial surgery did not help and because of my age i was not a candidate for surgery.  i am now 64 years old. dr said, "you can expect to be on narcatics the rest of your life."  i survive on pain killing drugs.  barely survive.
is there a chance for me?  should i find a surgeon i possibly undergo surgery?  since i am 64, should i just bite the bullet and live like this for my remaining years?

[JoChar]

A related discussion, Grade 4 spondyolothesis was started.