L4/L5/S1 herniation, DDD, surgery yes? surgery no? WHAT surgery?

[MamaAng]

I have been fighting with my L/5-S1 disc bulge for 2 years, a mth ago I ended up in the ER in enormous pain.  The MRI showed that my small disc bulge is now large AND L4/5 is now bulging as well.  My pain doc put me on Oxycodone and sent me to an Ortho. surgeon.  He told me he would do a microdiskectmy on L5/S1.  He would not touch L4/5 and if L5/S1 was unstable he would not fuse it.  I want options.  I want ONE surgery, not a cascade.  If L5/S1 is unstable after surgery won't L4/5 will get worse, correct?  My pain doc thinks that a fusion at L5/S1 and an artificial disc at L/4/5 would be the way to go.  Unfortunately NO surgeons in my state perform this surgery.  So, thoughts?  Have you had surgery?  If so what surgery was it?  

[Kalvin]

Mine got to the point that I could hardly walk. I had a very severe herniation as the result of a fall, nerve and spinal cord compression, and I just kept on working through the pain like a dummy, until it got to the point that they had to wheel me into the hospital.

I had a Posterior Lumbar Interbody fusion at L4-5 with screws and rods, its an open back procedure. It took forever to recover and feel better, I had to do 6 months of P.T. to learn how to reuse my leg. Good news is, I haven't had a problem with my low back since, it's been almost 9 years. I know I'm lucky.

I understand your concerns about problems down the road, but I think the idea of doing the ADR and the fusion is just too much, why put yourself through that, when you don't need to. Successful fusion's don't always correlate with pain reduction. You could have a perfectly stable spine and develop chronic pain from one of  these procedures, and then when you go back to the Surgeon and tell him you still have pain, he'll scratch his head and tell you "well everything looks okay, there's nothing else I can do".  I've been through this with my neck.

It's unlikely that you would develop instability as a result of the micro, unless the herniation is massive, and the surgeon should be able to roughly determine the size of it prior to surgery. The thing I would worried about with a micro is the chance of re herniation, and supposedly its about 7-10%. I still think its worth the gamble, compared with having a fusion and a ADR, but that's just me. Are you talking about canal stenosis or foraminal stenosis?

I think you're doing the right thing by getting more opinions, don't rush this decision its a very important one.


Take Care

[MamaAng]

Thanks for answering :)
L4/5 is a new bulge and it is minor, it isn't causing any symptoms, yet.
L5/S1 used to be a minor bulge, it is now a HUGE bulge causing a lot more problems, it is now flat up against the thecal sac.  I do have DDD and DJD.  I have adult-onset scoliosis in my thoracic.  I have moderate stenosis in L4, L5, and S1.  The back pain, weakness, and foot issues (I have to really concentrate to get my right toe to lift) are all from L5/S1.  I also lost feeling along the right side of my right thigh.  I don't know if I have any instability.  Yes, I am worried that the Micro-d would cause instability.  Given the weakness at L4/5 with it now herniated.  In the past 2 years I have had 6 LESI's, they no longer work.  Surgery is on the horizon, I just don't know which one.  The first Ortho Surgeon I talked to would only do the Micro-D, wouldn't touch L4/5 and even if there was instability refused to fuse L5/S1....so it will be interesting to see what a diff. doc says.

[Kalvin]

How bad is the bulge at L4-5, is it a bulge or a herniation, are you having any symptoms as a result of it? Do you have instability issues at L5-S1 like slippage, severe DDD and severe disc space narrowing and the resulting low back pain? Or are you worried that the Microdiscectomy will make the level unstable?