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Fusion of L-5/S-1

      Re: Fusion of L-5/S-1

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Posted by CCF Neuro MD on July 06, 1997 at 20:44:13:

In Reply to: Fusion of L-5/S-1 posted by Hop McIntosh on June 28, 1997 at 13:09:12:
  I've been in severe pain for aprox.18 months in my lower back and right leg
  I had 3 on the job injuries, the last of which put me out of work completely.
  My MRI revealed I had a herniated disk at L-5 /S-1 and the small wing like
  bone on the side of the vertabre(L-5) has broken off and is floating. I have
  had 3 steroid blocks that only provided temp. releive of my pain. L-5 has also shifted out of place aprox.
  1 cm. I have yet to have a 2nd opinion or the "needle test" or the "spinal-dye" test.
  My doctor also stated I had a PARS defect, any info on this defect?
  The surgeon said no other doctor would disagree with his conclusion because it is such a clear cut case.
  He wants to go in and remove the floating bone, remove the disk and fuse L-5/S-1
  with the help of a plate and pins. Does this sound right? Or are there alternate
  treatments I can research?
  If I do go through the surgery I am told I could be in a cast/brace for 6-12 months.
  What will be my limitations? Will I be able to attend classes this summer and fall
  or will I be confined to laying down all the time? Will I be able to drive?
  How serious does my injury sound? Enough to do surgery? I require serious medication now
  and can't perform daily activities without a great deal of pain and lack of sleep.
  I want to get on with my  life or I should say reclaim the life I once had!
  I also underwent emergency surgery for a fractured neck in 89' from a cliff diving accident.
  They fused C-3/C-4 together and placed me in a halo for 8 months. I still have some stiffness and
  some neck pain from time to time, a lot of bone spurs-they tell me.
  Is this back surgery going to be similiar to my neck surgery? Is the recovery time about the same?
  I am a 33 yr. old white male-smoker(2 packs per day) I was a drinker for aprox.15 yrs,but have been
  sober for 8 months.
  I am desperately tring to find some answers to my questions, I am very nervous and anxious about
  my condition and it's just getting worse. I realize I've asked a lot of questions in a rather
  unstructured way,and I apologize. Any advice or answers will be greatly appreciated.
  E.H. McIntosh
Hello, Hop,
  It seems very clear that your back problem needs to be fixed.  Without examing you and seeing your MRI scans it is quite difficult to make specific recommandations.  However, the general scientific data is pretty clear.  
  The diagnosis of lumbar disc herniation is based on the clinical syndrome.  The fully developed syndrome consists 1) pain radiating into the buttock, thigh, calf, and foot; 2) a stiff spinal posture; and 3) some combination of numbness and weakness.  When all components of the syndrome are present, diagnosis is easy; but most neurologists prefer to corroborate their clinical impression by some kind of imaging studies, such as MRI.  The spinal dye study you were refering to sounds like CT-myelogram, which offers refined definition of root sleeves, in my opinion. A tougher question to anwser is whether you are a good candidate for a surgery.  In general, surgery referral is considered if neurological deficits are severe or progressing or conservative therapies have failed.  
  Given your specific situation, I think you will benefit the most from a visit to our The Center For The Spine at the Cleveland Clinic Foundation, which offers a unique, coordinated approach to a complicated back problem.  The services available here include: top quality diagnostic capabilities, pain management, physical therapy and surgical options.  This way, we can offer you a full neurological evaluation and discuss in detail treatment options with you.  To make your appointment, simply call 216/444-BACK (444-2225) or 800/223-2273, ext. 42225.  Hope to see you soon.
  This information is provided for general medical educational purposes only.  Please consult your primary physician for your specific medical condition.

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