11436443 tn?1418296107

Spinal decompression w/ Coflex or anterior-posterior fuson

What can I expect if I have decompression surgery at L4-S1 w/ Coflex device implanted at L4-L5 vs. anterior-posterior fusion L4-S1?
My background: I have been diagnosed w/ many spinal conditions w/ the end result being spinal instability, chronic moderate to severe pain, nerve pain & weakness, an inability to walk unassisted, and long term-disability (over 16 yrs. now due to a lack or absence of access to necessary medical care, beginning at age 34) which is worsening in conjunction w/ the loss of life as I once knew it as an educator, fitness/sports/dance/yoga instructor, traveler/backpacker, and elite athlete.
I am keen to begin a better life w/ less pain and increased mobility, function, and normalcy now at age 50.
Thank you in advance for your replies.
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7721494 tn?1431627964
What a wonderful post.

Helping people with chronic pain is very important to me, but I rarely receive feedback about the efficacy of my advice. When I do, it is most satisfying.

Let me add that surgery should always be investigated to the fullest by anyone who consents. I believe in second opinions, and the informed patient. Surgery should usually be reserved as a last line of treatment, except in cases of emergency.

Thank you for your feedback and best wishes.
Helpful - 0
11436443 tn?1418296107
Thank you for all & your most recent reply. I emailed 4 of my most recent questions to my lumbar spine surgeon after gaining a much greater understanding (thanks primarily to you) of what would be done during a L4-S1 decompression w/ Coflex at L4-L5.

I then copied & pasted your youtube link and ended up using the search words you used in the link to view 4 different surgery videos, w/ the longest being over 10min. That long video actually helped me to better understand the shorter, maybe less visual at times, videos.

All the videos seemed to have some of the same info while, at the same time, offered up something new & important the other ones didn't have. It was definitely a worthwhile experience. Thank you very much for the suggestion.

I am scheduled to meet w/ my lumbar surgeon on Wed, so I'll be re-editing and preparing my revised questions in hopes of getting the most helpful information out of this time together.

That would be a good idea to let you & the community here know how things are going, as you mentioned many read but may not ask.

One thing I'd recommend from my experience is to not go into surgery until the surgeon has made him or herself available to answer the questions each of us needs answered.

My decompression & Coflex surgery was postponed due to bacterial infection, but I also didn't feel comfortable going into this - or any - surgery w/ a blindfold on, w/ my phone calls & messages unreturned at that point.

As you admonished, "Information is power." Thank you, philnoir.

Kindest regards,
Helpful - 0
7721494 tn?1431627964
Connie Ray, these are good questions.

Problems with the L4-L5 and L5-S1 discs are common because they hold the weight of the entire upper body.

Ask your doc to show you, on the MRI film, exactly where the problems are. I'm assuming that 7mm mass is what's compressing the cord, but I have no idea what it looks like in there, or what the issues are at L5-S1 (this is where the spine takes a little jag backwards to fit the pelvis -- easy to see as a landmark on the MRI sagittal view.)

Don't forget to look at the Youtube videos -- they will help you visualize the process and thus provide answers to many of your questions, as well as give you more questions.

Information is power.

Also, if you can, let us know how it is going. I'd be interested in the outcome of this surgery, and I also imagine that for every question posted here, 100 others are reading and dealing with similar issues.

Best wishes and good luck with this procedure.
Helpful - 0
11436443 tn?1418296107
Hello again and thanks for the incredibly detailed, step-by-step description about how the L4-S1 spinal decompression and Coflex placement at L4-L5 would begin and progress.
I didn't know the 7mm of herniated material could be removed during this procedure or that the Coflex device can provide stability in addition to what I understood its primary purpose to be, and that was holding open the area where the nerves would be decompressed so they wouldn't be compressed again. My previous understanding may be incorrect in this regard.
It seems as though the decompression w/ Coflex could be a viable alternative to an L4-S1 anterior-posterior fusion. I will ask the surgeon my questions, including this one I will ask you as well: Do you think the Coflex device could provide adequate stability in my medical circumstances as you understand them? (I would also ask my surgeon, "If you were in my position, which surgery would you select at this time & what would your reasons be for your decision?")
I am so amazed by your knowledge and thankful to you for sharing it so generously w/ me and - I quickly noticed - many others. I also like the comic strip that represents your profile picture...
Kindest regards,
Connie Ray
Helpful - 0
7721494 tn?1431627964
Again, you need to ask the surgeon these specific questions, but I'll get you started.

During the decompression phase of this surgery, your doc goes in through the back, making a small midline incision above the spinous processes at L4-L5, and dissecting tissue down to the bone. He'll retract the skin and upper tissue to access the space between L4-L5, and then create an open channel by removing a little bone and ligament to access the cord channel. Then using instruments called a Kerrison punch and curette he'll remove all of the material that's putting pressure on the cord, including that 7mm of extruded disc gunk. (See the videos)

When he's confident the cord is decompressed, he'll reshape both L4 and L5 for insertion of the Coflex device and screw it down.

Coflex is a simple way to maintain disc space and to stabilize the spine. It's a specially formed piece of titanium designed to fit between the two vertebrae, with tabs and screws to keep it in place. From what I've seen, Coflex is a good product.

Seeing is believing. Here's a list of videos showing this surgery.


I don't know how he plans to do the anterior L5-S1 fusion, I don't know. He may choose to do this in a separate procedure, as it is completely different kind of surgery. You'll have to ask him about this, and all your other questions. Write them down so that you'll remember them.

Incidentally, skill in surgery comes with practice. Surgeons who have done the same surgery more than 700 times statistically have a greater chance for successful outcome. Young surgeons may seem bright and shiny, but if it were me, I'd want an older, well tarnished and experienced cutter.

Best wishes for a positive outcome.
Helpful - 0
11436443 tn?1418296107
Re your spot on comments plus & including recommended questions of "So, what's life going to be like after surgery? How long will you be disabled? What percent chance of improvement does your surgeon give for success? What are possible negative consequences of surgery? Will you be able to walk? Will you have pain? What are the negative consequences of NOT doing surgery? These are the questions you need to ask, and ask them ASAP before you have another attack of paralysis

I have had the L5-S1 7mm herniation/rupture since 6/98. It was a work injury & and I received conservative treatment through my PPO from 7/98-5/00 & 1/06-8/06 following severe reinjury, and care increasing from conservative treatment from 4/10 until present. I had little or no access to medical care during the large time gaps in treatment during which my medical condition, mobility, and function has deteriorated since 8/07 and especially - ordering to my surgeon - in the past 6 months.

I did not realize what I experienced was "temporary paralysis," and even the terminology and its (now understood to be) eminent reoccurrence further highlights my (acknowledged but scared reluctance w/o adequate information) to surgically address my lumbar spinal conditions & how they manifest themselves symptomatically.

Given what you know, in your opinion, would you do the L4-S1 decompression w/ Coflex at L4-L5 (which doesn't seem to address the 7mm herniations/ruptures at L4-L5 and L5-S1) first or move directly to the L4-S1 anterior-posterior fusion which would include spinal decompression as well? What might I experience following either or, perhaps inevitably, both surgeries if I start w/ just the L4-L5 decompression w/ Coflex at L4-L5?

Thank you so much for sharing your knowledge and recommendations w/ me. I am extremely grateful!

Kindest regards,
Helpful - 0
7721494 tn?1431627964
Now you've added important information -- A  7mm rupture is huge, but the real problem is in the muscle weakness you report. Muscle weakness in this case is a sign of neurological deficit -- a serious problem. Your bout of temporary paralysis demonstrates the severe consequences of leaving this problem untreated.

This is one reason I hate reading MRIs here, out of context, and without any information of symptoms (which others ask me to do all the time.)

Whenever cord patency is threatened, decompression surgery needs serious consideration. If you're feeling these symptoms (other than pain), you need to make a quick decision about surgery.

So, what's life going to be like after surgery? How long will you be disabled? What percent chance of improvement does your surgeon give for success? What are possible negative consequences of surgery? Will you be able to walk? Will you have pain? What are the negative consequences of NOT doing surgery?

These are the questions you need to ask, and ask them ASAP before you have another attack of paralysis.

Call your doctor tomorrow. Get this done.

Best wishes.

Helpful - 0
11436443 tn?1418296107
Thank you so much for your feedback & positive reply. I forgot to mention I also have "two large ruptured discs" at L4-L5 and L5-S1 along w/ L leg weakness which has, as of 9/2/14, left me for 4-5 wks. unable to move in or out of bed & to get to/from the bathroom, etc. w/o my BF providing physical support & stability in conjunction w/ my use of my walker w/ seat or a cane in smaller spaces.
I have had constant L leg nerve pain that is moderate to severe since 9/2/14, following the "freezing up" of my lower spine where I couldn't move at all on my own. I formerly had occasional bilateral leg weaknesses that would just last a second or two, but leave me at risk of falling. I have very limited mobility, even gentle aqua classes have been disallowed since 10/12, and I have had balance problems w/ numerous falls for approximately 4+ yrs. The idea of being able to attend a concert, ballet, or movie let alone travel is exhilarating, as is having a more "normal" life w/ less pain.
Given this additional information, in your opinion, would you recommend trying the L4-S1 decompression w/ Coflex at L4-L5 before a L4-L5 anterior-posterior fusion or going directly to the L4-S1 anterior-posterior fusion?
My proposed surgeon has expressed concern w/ leaving the 7mm herniations/ruptures at L4-L5 and L5-S1 untreated. After only meeting w/ me for 5mins. and not having sufficient information plus having a bacterial infection, I postponed the decompression w/ Coflex. My surgeon has now scheduled me to return (out of area, very expensive on such a small disability income) on 12/17/14 to meet w/ me for up to 45 mins. to answer my questions about both surgeries.
Thank you again for your feedback, helpful information, and positive reply. I am keen to hear back from you regarding further insights & recommendations you many have w/ the add'l info I've provided.
Kind regards,
Helpful - 0
7721494 tn?1431627964
I like to warn people about the dangers of surgery, and to put it off for as long as possible. However, in your case, the diagnosis of "spinal instability" has made surgery a necessity.

Surgery may reduce some of the stabbing pain, and opening the spinal canal should improve related parasthesia, for example any numbness.

The Coflex device, in addition to stabilizing the spine, will increases intervertebral space and may address that sciatica if there is no prior nerve damage. There's a Utube video that shows the installation of one of these devices if you're interested.

The benefits can far outweigh the risks. Can you imagine, sitting for a concert or on an airplane? This may become possible after treating L4 - S1.

Ask your doctor about recovery times, activity limitations, etc.

Best of luck!
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