Anterior Posterior Lumbar Fusion Surgery at L5/S1

[IMC55]

Hello everyone.  My mom has been suffering from severe leg pain for at least 5 years.  It has gotten worse and now she is at the point where she can only walk a few feet before needing to take a break.  She can't sit long either due to pressure on the back of her thigh.  She has pain and numbness from her left buttock down her thigh, calf, and to her toes.  Her ankle feels extremely tight.  We have seen so many specialists to determine what's going on.  She went for cortisone injections in her back twice, with no success.  We saw a neurologist who did a nerve conduction study.  He also looked at her MRI and thought it was a pinched nerve.  Surgeon didn't agree.  We saw another neurologist who prescribed gabapentin, which helped for a couple months, but is not helping anymore.  We finally got the doctor to approve another MRI, focusing on the lumbar area.  He thinks there is slight narrowing of the area where the L5 nerve exits.  So he recommended doing a selective nerve root block injection specifically at the L5/S1 area to help diagnose.  We did this twice and my mom had relief for about a week.  Then the pain returned.  On average, my mom sleeps 2 hours a night, if at all.  She can only lie on her right side.  She is otherwise healthy, but this pain is taking away her quality of life.  She can't go out because the pain is too much.  Nothing helps.  We have tried pain meds, but she doesn't tolerate them well.  Finally, we saw the surgeon this week and since the selective nerve root block helped (even if it was only a week), and the MRI does show some narrowing of the area where the L5 nerve root exits, he is willing to do surgery to try and help my mom.  He said that all her symptoms are pointing to the L5 nerve (since her pain pathway corresponds exactly to the L5 nerve) and that if the narrowing of that opening is truly the issue, he is certain that surgery will help.  But the diagnosis is not 100%.  I want my mom to get the surgery, but I am afraid based on what I am seeing on the message boards online.  The surgery that they are recommending is an anterior posterior lumbar fusion surgery at L5/S1.  The surgeon said that they will make an incision in the front of the body, move the muscles aside (no cutting), move the large intestine... then they will remove the disc between L5 and S1.  Then put in a piece of bone from her left pelvis, plus cadaver bone.  They will add a metal plate, screws and rods.  Then turn her over and make two small incisions from the back.  Using x-ray guidance, they will add additional screws.  He told me he did a surgery this morning and the patient is already up and walking by afternoon.  And that his friend's wife had it and she is doing better after two weeks.  I am very scared for my mom and I am not letting her know my fear because I need her to stay positive and confident.  My mom is almost 70 years old.  Living with the current pain really isn't an option for her because it is so bad, so I feel like we need to take this chance.  But, I would like to hear what others are saying.  There are so many horror stories out there, but I try to remember that there are successful surgeries out there and maybe those are the ones that aren't shared here on message boards.  Please let me know if any of you have experiences to share... Thanks again and I'm glad to have found this community.

[Kalvin]

I saw your response, sent you a message.

[IMC55]

Hi Kalvin,

Thanks for taking the time to respond to my post.  I've heard people say similar things about how these message boards are usually for people who have failed surgeries and that the successful ones are not usually discussed here.  As the surgery approaches, my mom is becoming a little hesitant. I think it's because she is afraid of the recovery time and whether or not she will be able to do basic things such as taking a shower or using the bathroom.  

Was your surgery similar to my mom's?  Sounds like it helped?  How long did it take for you to recover and were you able to get up within a few days after the surgery?  How bad is the recovery period?  The pamphlets say 6 months to a year... is this really the case?  I am sure they are being on the conservative side, but it really depends on the person, I suppose.  

The nurse tells me that my mom will be able to move around right away, but I suppose it will just depend on how well my mom does with the surgery.  My main fear is that the surgery will not help and may worsen her condition.  But, not taking the chance with surgery is not a good option either because of the amount of pain she is in.  I completely agree that diagnosis is key... the MRIs do show some impingement on the nerve, but it's not a textbook case where it's completely clear cut.  The fact that the selective nerve root block injections helped, is some confirmation of the source of the problem... is this enough to go off of?  I hope so.  And quite honestly, I don't know what other tests we could do at this point to confirm.  And perhaps the MRIs may not show how severe the problem is and only when you go in there, do you see how bad the pinching might be.  

Thanks again for all the information...

[Kalvin]

Sorry to here your Mom’s been going through all this, and my sympathy to you as well. It’s very difficult to see someone you love suffer, not to mention the stress involved. These boards are not a good place to gauge surgery success rates. On our forum the Neck & Back, several of us are here as a result of failed or unsuccessful surgeries or treatments. Many come looking for answers or compare notes so to speak. Being that several of us have been through these surgeries, medications, incompetent doctors, etc, etc we are able to share experiences and offer support to people who come here scared, in pain or confused. That being said, most people that have successful spine surgeries don’t post on boards like this. They get on with their lives and move on, however there are exceptions.

Its sounds like she’s tried pretty much every conservation treatment out there, the only other option at this point would be Pain Management. Diagnosis is key, in spine surgery. If they can correlate the MRI findings to her symptoms and are reasonable certain the problem’s at L5/S1, the chance of success is very good.  The likelihood of the surgery helping, given the type of pain she’s experiencing is much greater, than lets say, something like nonspecific back pain, which is much more difficult to diagnose.

Several years ago, I had a bad fall, got to the point where your Mom is now, practically not being able to walk, MRI showed a large herniation at L4/5. They went in, did what they had to do and it worked out fine. The problem you get into with spine surgery is with people that have so much stuff wrong with their spine, that the odds of surgery in a specific location relieving their pain are not good. Of course, a lot of patients aren’t made aware of this. That’s why it’s not uncommon for some people to have 4 – 5 back or neck surgeries.

Sounds like you’ve done your research. Word of caution, it’s a going to take awhile for her to recover from this, and like you wrote in you’re post, trying to keep her positive help will help tremendously, and it'll help you too.

Hope everything goes well and if you have any questions just let me know.