what's my future look like after lumbar fusion?

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New to the forum here. A quick recap of my history: I broke my tailbone in 2000 playing soccer and have experienced lower back pain off/on ever since. Finally this January everything came to a head when my disc ruptured. After some land based PT and an epidural it was decided that I needed a discectomy. My MRI showed severe DDD in L5-S1, moderate DDD in L4-L5 and mild DDD in L3-L4.

I had the procedure in March and got nothing from it. My pain level increased and was an "8" on the pain scale around the clock.

After several months of trying to get a disc replacement approved by my insurance we were forced to go to plan B, fusion. My disc replacement was denied 4 times because I had multiple levels of DDD and their policy stated that I needed healthy discs on each side of the disc in question. In July I had an anterior lumbar fusion on L5-S1 at 42 years old.

It's been a rough 2 months post-op. I now suffer from bad sciatic pain in each leg and the expected back pain. I manage my sciatic with gabapentin and that seems to help. My back pain is managed through regular Tylenol. Recently I just started aquatic PT. The decompression really seems to help but it will be a long road ahead. This brings me to why I'm here, what is a timeline for me to expect another surgery for my next level?

At my age I can expect to see more of these but if I do my exercises and follow the ergonomic advice I've been given what kind of time does that buy me?

Thank you for listening and offering any advice.

Thanks, Brent

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18 Replies

  • Posted

    brent66392...I wish I knew what to suggest to you, but it might all depend on the Dr. They all seem to have different opinions when it comes to matters of the spine. I have a problem at L5-S1 as well...the foraminal neural opening is severely narrowed; at least that's what it said on the MRI (23 months ago). I had a repeat MRI Aug. 13/2017, & in the exact same area, it said "moderate narrowing at L5-S1". So in my mind..which is it?...severe or moderate?

    Siatic pain is very common, but extremely painful. I do not have it. Was taking Gabapentin for the pins/needles I experience in my legs. I also experience burning now & again, but the Gabapentin did nothing for the burning. I've said to the doctor a few times, that if I keep taking the Gabapentin, I wouldn't be able to accurately say if the problem is progressing or not. To me...stop the progression...I'm sure it can be done...medicines just mask what's going on. Depending on how much Gabapentin you take or how long you've been on it..you just can't stop taking it. You must wean. I'm sure you know this. 

    About the only person who could give you a 'ballpark' estimate as to a timeline for another surgery would be your surgeon. Sorry I wasn't of more help., but please let me know how you get on.

    • Posted

      Thanks for the reply Mike92384. You are exactly right, you get a different diagnosis, prognosis, etc depending on which doc you talk to. I truly hope you get the exact path forward that your condition requires, hopefully not surgery unless that is the best option for you.

      I've only been on gabapentin for about 6 weeks and I take it on an as needed basis. Once my nerves get used to being stretched back out from the years of compression I believe the leg pain will go away.

      I do appreciate your comment, that is help in and of itself. You take care.

    • Posted

      Hello brent66392...thanks for your reply. Where the Gabapentin is concerned, the Neurologist I had a first prescribed it, & told me that I should take it EVERY day, & it works better as it builds in the system.

      I took it for just a short period of time because it did nothing for the burning. As it turned out, I felt she was a lazy Neurologist., & felt she didn't have to follow me anymore because she believed my problems were caused by the L5-S1 I told you about. The Neurologist who's taking care of me now, doesn't believe the L5-S1 is the cause. So, when I see him Oct. 5...we'll have quite a bit to discuss because as mentioned,I  compared the MRI of 20 months ago to the one Aug. 13 & there's a difference in the two. 

      I was not aware that it was ok to take Gabapentin as needed. I will NOT take Lyrica. I've heard too many horror stories about it...the side effects are horrid...etc. Actually, I don't want any medication because as I've stated, it only masks what's going on. I need the progression to STOP.

  • Posted

    2013 laminectomy of L4/L5 to get rid of a bone spur crushing my sciatic nerve root.  Totally successful.  2015 TLIF (posterior) fusion of L3 through S1...gotta pay the price for 45 years of hockey sometime.  Doc said my back was a "junkyard".  Hospital, brace, PT.  Very successful.  2017 LLIF (lateral) fusion of L2/L3 for bilateral foraminal stenosis.  FANTASTIC technique!!!  One overnight, no brace, no rehab!!!!  Search YouTube for "globus lateral" to see a cute animation.  90-minute op.

    A few things for you...

    Yes, if you have a TLIF fusion with the rails and screws, you are in danger of messing up the next disk above and below the fusion.  I wouldn't worry about sacral...just L4/L5 right now.  You have to care for your back.  Bending, heavy lifting, etc. can all get you in trouble.  Doc warned me that with L2/L3 now fused, I CANNOT screw up L1/L2.  It's a transitional area that cannot be fused.  If that joint goes, then he has to TLIF fuse me T9 through L2...not good...so I have to be very careful.

    I too have some lower back pain but then I had both a hip and a knee replaced so I can't tell what's causing the discomfort.  I stay away from the nerve meds completely.  Gabapentin (neurontin) and Lyrica are off my list.  Hate them...especially the weight gain.  I see a chiropractor to stay well aligned and use arthritis-strength Tylenol when needed. I also stay away from the NSAIDS for stomach reasons.

    Topically, you should try Voltaren Gel (RX in the US).  Excellent anti-inflammatory...second best on the planet.  Also exercise...stay in shape.  You need strong muscles to support your back.  

    PS: My daughter shattered her coccyx a decade ago.  5' 2", 115 pounds of sheer muscle squatting 310-pounds...slipped...spotter missed the bar...fell on her tailbone and the weight came down.  Compression fracture of L1 repaired but continuous pain for two years until her tailbone was actually diagnosed.  Needed to have all the tiny pieces and shards removed surgically by a neurosurgeon at Mt. Sinai Hospital (the spine capital of the world) in NYC.  Took her a while to recover but she's back to about 95%.  Graduate nutritionist and ACSM-certified personal trainer for 16 years.  Now she destroys P90X!!!  Gotta stay in shape.

    • Posted

      Chico Marx...I agree about the meds. If you read my comments to brent66392, I say that meds only mask what's going on. I have taken Gabapentin in the past...it did nothing for the burning which was my major complaint. The pins/needles?...well, they're tolerable but a 'pain in the butt' at times. I refuse to even consider taking Lyrica..all for the reasons you stated. I've heard too many horror stories. 

      Voltaren here in Canada is an OTC medication. You can get the regular strength that can be used a few times per day, or the Extra Strength that's supposed to be used just twice daily.It's a marvelous gel. As for the Tylenol Arthritis Strength...you won't get better. A few years back, I was having pain in some of the joints in my fingers. I used the Tylenol Arthritis strength...When I saw the Rheumatologist, he told me it was an excellent product. I do not have any Rheumatic disease, but saw a Rheumy 'just in case'. 

      You made mention about 45yrs of hockey. Where did you play?

      Also NSAIDS can destroy the stomach. Avoid Aleve as well. Besides, you can't take Aleve if you're on bp medications. 

      Hope you're feeling better. I think this forum is great & it allows us to share our stories, & give suggestions to others in the hope it helps. 

    • Posted

      If you've been diagnosed with one or two level stenosis, you MUST consider the LLIF procedure...

      http://qqmovies.info/discuss/the-expandable-spacer-570509

      Immediate relief, one night in the hospital, no rehab, no brace.  AMAZING solution.  Yes, the picture can be a bit frightening but the procedure is a breeze.  Really, really go search YouTube for "globus lateral" to see the animation.  They can slip in one or two devices in the same op.

      Started on metal wheel skates (with the full boots!!!) in the streets of Brooklyn at age 7.  Went through bigger and bigger sets of goalie equipment over the years.  Soaked rolls of old fabric electrical tape in water for a week then froze them for another week.  Constant supply of "pucks".  Goalie for Fordham University ice hockey '67-'69...no mask.  Then marriage, work, family...lots of club hockey, both ice and roller, virtually every week during the season until my early 50's.  Four knee scopes and then a metal hip pretty much ended it all.  If I didn't have almost 5 pounds of metal in me, I'd be eligible for an over-70 league in 5 months!!!  Considered reffing but even that is too dangerous with metal hip and knee plus two fusions.  Not worth the risk.

    • Posted

      Thanks for the replies Chico and Mike. That's quite a history of back procedures Chico Marx, I only hope that you are in rarified air and other people do not endure what you have. And I thought my year has been brutal!!

      When I take gabapentin I always get the relief I need with 30 minutes, the burning butt and legs always goes away. I was given lyrica as well and thought it was a joke, and then I wondered why I was given an anti inflammatory right after a fusion. That retards the whole fusion process! I wish you luck on the 5th, I really hope they get your diagnosis and treatment heading in the right direction.

      Chico, given that I'm 42, no prior back trauma other than the tailbone, a sedentary job and hobbies like golf and landscaping do you think I can make it 10 yrs before the next level gets addressed? Assuming I follow all the proper guidelines for my back going foreward that is. I know, not a fair question to ask.

    • Posted

      There's just no telling.  What's the condition of each vertebra at the current time?  How quickly does your spine degenerate?  How much stress do you put on it exacerbating the situation?  How fast does your DNA regenerate cells?  

      See?  No answer.  All you can do is identify the risk factors and mitigate what you can when you can.  When I had my first knee scope, I had no idea that I was on the road to TKRville...  Sometimes these things take a long time to develop, sometimes not.  From first scoping to the knee replacement took 15 years.  When I had my TLIF, L2/L3 looked fine...18-months later I had stenosis.  Your neuro is the only one that can see the whole picture and give you any sense of your future and what you can do to put off any further complications...if you can at all.  Just like life itself, it's a crapshoot.

      I'm having wrist surgery next week for a torn (worn out) ligament.  That will be operation #29 in the past 18 years.  Mostly minor crap like trigger fingers (7), carpal tunnel (1), shoulder impingement (2) but there were a few "interesting" other surgeries.  I've always bounced back very quickly...until the TKR.  The metal in my hip, knee and back were varied.  I totally rehabbed my hip in exactly six weeks spending 5 hours a day, six days a week in a therapy pool and at the gym.  Then there's the knee...18 months and still working on it.  The TLIF fusion was difficult; the LLIF was a 24-hour snap.  Sometimes you're the bug; sometimes you're the windshield.  You can follow all the guidelines and still have something develop.  Crapshoot...

    • Posted

      CHICO MARX...Thanks for the reply!!! Yes, I do have some spinal canal stenosis...MODERATE spinal canal stenosis at C4-C5 in the cervical spine (neck) with severe right & mild left neural foramen stenosis.

      L3-L4 has disc bulging., with moderate bilateral facet hypertrophy, which is worse on the right, along with MILD spinal canal stenosis. At L4-L5, there's mild to moderate facet hypertrophy. I think the majority of my problems is in the cervical spine., & I do get a lot of headaches, & lightheadeness at times. 

      I don't honestly know if I qualify for surgery or not. Surgery has not been discussed at this point. All I recall my Neurologist saying at the last consult was that he didn't think the L5-S1 was the cause of my skin burning sensation in the legs because of his test. Also, we hadn't run the MRI at that point (June 2), but as I've previously written MRI was done Aug. 13/2017 which is how I know the results...I obtained a copy of the written report! The Neuro also said that it would be inappropriate for him to refer me to a Neurosurgeon when I don't have back pain. Well, I don't have BACK pain, but I certainly do have pain in my shoulders (very likely caused by what's going on in the neck), my neck muscles at the back become sore, AND the headaches are at the back of my head, & sometimes the pain shoots to the side of my head, the top or over the eyes. I truly believe all of this is caused by what's going on in the neck!!!!!!  I'm no doctor, but to me, it makes sense!!  My quality of life is diminishing as well because when the headaches strike, I go lie down in my bedroom to watch tv. This can be as early as 7PM. How ridiculous.

      I'm fed up now...have been "suffering' with burning sensations in my feet & legs, along with tolerable pins/needles since late January 2014. Enough is enough. Blood tests always come back stellar. 

      Something's going on, & I need to find out just 'what'. 

      Sorry to vent like this, but surely you can tell I'm at wit's end with it all.

    • Posted

      brent66392...one question please. You say the Gabapentin gives you relieve within 30minutes, & the burning sensation in the butt & legs goes away. How MUCH Gabapentin do you take???

      If my memory serves me correctly, I think you wrote that you take the Gabapentin just when needed. My former Neuro said it should be taken every day in order for it to build up in the system. Well, as it turned out, I didn't like her...thought she was lazy, so I never did go back to the Gabapentin., & I will NOT even consider Lyrica. I don't like the the idea of any medication 'building' in the system., AND when that happens, one must wean. 

      Please advise...thanks in advance.

    • Posted

      Mike92384, the gabapentin I am prescribed is 300 mg capsules 1 to 3 times per day as needed. I always take one at a time and most days I can get by with one pill, rarely do I take 2 in a day and I never have taken the allotted 3 per day. My pain doc has never mentioned that it must be taken daily to build upon itself.

      In fact the further it becomes from surgery (2 months now) the less I take them and I might go a day in between taking one. The land based PT I'm doing at home combined with the pool therapy have really sped up my diminishing dependence on them I believe. In a sense I feel like I'm already weaning off of them.

    • Posted

      The "gold standard" test for the spine is a CT/Myelogram with contrast.  Gives the docs a complete "map" of your spine.  I'd suggest one to get a definitive diagnosis.  You have too many things going on just to let it all pass.  Gotta see a neurosurgeon.

    • Posted

      CHICO MARX...Thanks for your note. I didn't know the 'gold standard' test for the spine is CT/Myleogram with contrast. Doctors here seem to use MRI a lot. When the Neuro agreed to a new MRI test because I said the original was 20 months old & 16 months old respectively, he agreed, but asked that it not be done by contrast because he didn't want me unnecessarily explosed to the radiation in the contrast, & having it done by contrast would take about 8 months to get because the technician wouldn't be available.So, it was a regular MRI of the lumbar, cervical & brain. The Neuro also said there wasn't much difference between the MRI with contrast or the one without. Who am I to argue?...I'm not a healthcare professional. I would think a CT scan could be arranged much sooner. I had one done by the ENT back in February...by contrast as well, & I got the appt. rather quickly. That CT scan was of the head. 

      Not to worry, when I see the Neuro onThursday, I'll be armed with a bunch of questions, AND I won't take any B.S.either, although I will be a gentleman.

    • Posted

      MRIs can be inconclusive.  For me, that happened with four knee MRI's plus the one on L4/L5.  Docs all went in and found the problems.  Meniscus tears and ripped femoral condyle on each knee and then the bone spur at L4/L5 causing my sciatica.  

      For the CT/M, they lie you face down on an x-ray table and inject the contrast dye exactly where they want under fluoroscopy. Then they wait for the fluid to spread and do a bunch of x-rays to make sure everything is going where it's supposed to.  Finally, they get you into the CT room and do the scan once they are sure that the dye has fully migrated to the area of the spine they want to study.  Whole thing takes about an hour.

      For me, this confirmed the stenosis that was suggested but not confirmed by the original MRI.  In addition, my doc had a pain shot injected at the exact spot about a month later.  These don't usually work on me but the few days of temporary relief I got confirmed the exact site he wanted to attack.  The CT/M gave him the "map" he needed to do the LLIF procedure.

      Do the research...know your stuff.  If he says "one level fusion". you say "LLIF".  If he says "No", you ask "Why?"  (Remember that an LLIF is for lumbar vertebrae....don't know about the same procedure for cervical or thoracic.)  This is YOUR body and YOUR health.  Take charge of it.

    • Posted

      CHICO MARX...You're so right..it's MY body, & MY health. When I see the Neuro on Thursday, I'm going armed with a lot of questions. EMG & NCD does not test for small fibre neuropathy. I haven't had a skin biopsy nor a doppler. I won't settle for the burning in the feet & pins/needles in the legs to be 'idiopathic'.

      Yes, I've got things going on in the neck as I've described to you, & also some things in the lumbar spine, but from what I read on the MRI written report, there doesn't seem to be all that much going on in the lumbar that would affect my legs unless I'm not reading things properly. I wish I could attach a copy of this written report so you could see/understand what I'm trying to get across. My best friend will be accompanying me to the Doctor, & believe me..he's got questions. 

      Do you know of a way I can attach the written report so you can read it?Thanks in advance.

    • Posted

      Won't do any good.  I'm not a doc.  My cousin is one I send all of mine to him for translation.

      Just remember that this should not be adversarial but complementary.  You each have information to share so that you can make an informed decision.  

    • Posted

      CHICO MARX...Oh how lucky you are to have a cousin who is a doctor. I have nobody in my family as a member of the medical field.

      Believe me, I have no intention of the appointment with the Neuro come Thursday for it to be adversarial.

      We`re adults..but I do have several questions. Back in June when the Neuro & I had a conversation over the telephone, he gave me his word that if there was anything that concerned him regarding tests, etc...that he`d let me know. I haven`t heard a thing, so I`m assuming all is ok with the exception of what`s on the MRI results. 

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