Is fusion going to be the only way to permanently fix a recurrent ruptured disc?

[lucyskeeper]

My husband had a ruptured disc (L5-S1). In 2002 he had a diskectomy. It was successful until October 2003 when he fell down. They then did an MRI showing both a ruptured disc(L5-S1 again) as well as a synovial cyst. In January 2004 they were going to do both another diskectomy and remove the cyst at the same time. The surgeon said while removing the cyst they also looked at the disc and it looked very good so he left it alone.There was a spinal fluid leak that required 3 stitches. Since that surgery my husband has had constant leg & foot pain and severe numbness. He just had another MRI showing the disc is bulging out again(L5-S1 once again). Because they have already performed 2 surgeries in the same area, the surgeon is recomending the complete removal of the disc and fusing it. He says the success rate of the diskectomy goes down with each surgery. My husband is 35 years old and works as a laborer in the auto industry. Is fusion the best route to take or are there better options? What about disc replcement? Is it beyond the experimental stages yet? What is the success rate of fusions? What kind of limitations would my husband have after a fusion? The surgeon says L5-S1 is the best place for a fusion and it won't hinder his ability to bend is this correct?

[biker40]

Hello. I recently had a Posterior lumabr interbody fusion at L4-L5. I has degenerative spodylolistheis and my vertebra sliopped 7 mm over the other. Some pain but more numbness, 12 weeks now and still some pain and numbness but spiane is more stable. I waited 6 montths and 2 opions befoe underging it...I was told reovery is 6-12 months....Patience is definately a virtue here and compliance to therapy.

[esb]

Greetings,
My deal:  I have had two microdiscectomies- One in June 03 and then again in Sept 03.  Both were at the L5S1 level and the first was a huge, sequestered disc (yes, the doc was thrilled-- put it in for a study-- no bone shatter at all) piece which was removed without incident.  Then, I screwed up and lifted something very heavy (without thinking... it happened to be my very ill 12 year old dog... ouch.)  Reherniation and the MRI showed a complete loss of disc at L5S1.    I am almost 40 years old, have had a lot of success since the second operation, and have actually been able to get back to teaching low impact aerobics and I walked a 6.2 mile race in March!  
The all impt question, which I have avoided asking:  the vertebrae are OK to self fuse?  I was given every indication that they would fuse healthily on their own.  I have not done much research... not sure I wanted to know... while becoming as strong as possible in the meantime.  I feel good.  May I get your input on the long term?

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

Without seeing your husband and reviewing the films, I can not recommend a specific procedure. However, the rate of recurrent disc after discectomy is 5-10%. A fusion would remove the disc and place either bone, or a metal cage with a substance for bone to grow into to fuse the vertebrae. Disc replacement remains experimental at this time. A single fusion should not result in any noticable limitations in this region and would remove the disc as a potential problem in the future. The success of a procdeure is dependant on the surgeon and patient, therefore, you should ask your surgeon his success rate. Good luck.

[lucyskeeper]

Thank You everyone for your input. Although I am very sorry to hear of all your problems, it's nice to know we are not alone in this. I forgot to mention that my husband will be having the epidural steroid shots this week. He had them prior to his 1st diskectomy. His surgeon felt they will help make him more comfortable while we weigh our options. The anestesiologist giving him these shots feels he will not need any surgery after he receives the shots. It just seems that each specialist thinks his specialty is the answer. I think if we asked a used car salesman he would say buying a car from him would fix his back problems. I understand that there is no 1 right answer, so any input is very helpful

[Zav]

DISCLAIMER: I am NOT a doctor.  Just a 38 year old patient with osteoarthritis, bone spurs, thinning/bulging/herniated cervical discs, bone loss in the front of the cervical vertebrae, back in constant spasm and narrowing of the cervical foramen. I have had this condition for 6-8 years.

Personal history:
About 8 years ago, at the age of 28-30, I found out that my upper spine was fusing.  An MRI and x-rays revealed herniated discs, bone spurs, worn neck vertebrae, narrowing of the cervical foramen, muscle spasms throughout my back and neck (right levator scapulae mostly)  Prior to that my health was perfect.  155 - 160 lbs, 5 foot 11, active.  Family history of diabetes, alzheimer's, & depression.

The neurologists wanted to fuse my entire neck.  I opted for no surgery and figured I'd figure it out.  Actually the root of my problem which everyone missed was T3 "moving" anterior which influenced the neck vertebrae to move in counter to T3's change of position.  After C2 had been "out" for about 4 years, the discs thinned, bulged, vertebrae became irritated and started to fuse.  My MRI showed that my neck was that of a 60 year old with osteoarthritis, spurs, degenerated and herniated discs.

8 years later, without surgery I'm almost back to normal.  I'm still in maintenance and monitoring mode as I call it but I have no more crippling pains running down my arm if someone touches my shoulder.  My neck turns both ways now.  My back still "goes out" (I hate to use that term) but it realigns generally with stretching, or self adjustment and often stays there.  I can resume an active life within limits.  The emotional hell that I went through is much less now.  Jesting aside, a mere purgatory.  No surgery for me but my condition is but one data point.  

One of friends who has had C2-C3 fused is in more pain after the fusion than he was before it and would strongly recommend against it.

Another who had a lumbar discectomy is living just fine, without problems and would strongly recommend it.

What you've got sounds different than my experience.  Each person's back is likely to be unique.

Do your research.  No matter now bad you feel, you need to gather information.  Become educated on the matter.  Differentiate useful information from useless or dangerous information.  Collect your own case studies on people who have been through what you have been through.  It's your life and your duty to yourself.  There is no Undo button on surgery.

I wish you the best.  

Do your research.

Alex Zavatone

[LT CAGE]

I had an LT Fusion Cage device with the infuse transplant in September 2003. I had previous surgeries at the L4/L5 and the L5/S1 levels. It was the biggest mistake I made. It was so much as the surgery, but the surgeon that did my surgery. In order to place this device, you have to be licensed by the FDA. There was a surgeon in the clinic that was licensed and that gave all of the surgeons access to the fusion device. It is only approved to go in from the stomach and the sides to place the fusion and mine went in through the back.

I am now in cinstant pain and looking at having to have a morphine pump. The device in trials has a 99.8% success rate. That is only if it is in the right hands. I have talked to other people who had there's done correctly and they wouldn't trade it for anything in the world. I have been told by others that by the end of 6 weeks they were working again and at 12 weeks they felt back to normal. I wish I would have had a different surgeon.

I hope you do some research like you have asked the neuro on this board. He gives straight up to the point advice and direction to go on. I wish your husband the best and keep posting as you can to let us know how he is doing.

[pattiobb]

I'll leave your question for the doctors to answer, but I wanted to do a bit of cheerleading for you & your husband!

Fusion is wonderful as long as it is treating the root cause of the problem. My difficulty was that I had worn away most of the interlocking sections of the spine because of gymnastics & other sports.  My spine was able to slip out of position which caused problems with discs, muscles, etc. I had 2 surgeries for disc/bone problems L4-S1.  The first surgery got me through about 18 months.  The second didn't go well, so it was followed within a year by the third- a fusion.  And for what it is worth, even though there were many areas with disc problems, the surgeon only fused the base of the spine.  From the minute I woke up after the surgery I knew things were better. It took a fair amount of exercise & PT to stabilize the rest of the spine, but I was back to full activity plus some sports within 8 months. It has been 14 years and though I still have back problems, the fusion has made it possible for me to live a very active life.  

As a word of caution, fusing one area does transfer some stress to other areas in the spine. Your husband will have to protect his back with exercise & good form. I still have had problems with muscle spasms & the like.  Daily exercising & stretching takes care of it.  If I skip more than 1-2 days, I end up having trouble walking!  Seems like a fair trade though- 45 minutes in the gym each day for the rest of the day of mobility!

One thing that I had to accept (with great difficulty) is that I was not going to have a 100% recovery.  Obviously, your husband's situation is different, so he may!  But I had to learn to be realistic in my expectations from treatment.  I no longer expect to be able to waterski, horseback ride or kick box!  But, I do many other lower impact sports.  Make sure that your husband has time to talk with his doctor & physical therapist about the goal of treatment.  Maybe I'm uptight this way, but I needed to have a written out plan for recovery *before* I had any medical intervention.  

You may want to consider a visit to a pain clinic.  I found that biofeedback, TENS & relaxation work better for me than the pain pills.  On the pills, I am more likely to do something that would reinjure my other touchy areas. I also hated the feeling of being medicated.

And for what it is worth, I recently reinjured my back by being stupid!  Fusions only protect a small area & are not a substitute for proper lifting, posture, exercise & all of that.  Don't forget to make time for physical & occupational therapy!

Good luck to you & your husband!  With good medical care, some exercises to strengthen his back & a little TLC from you, he *will* get better.