2 level lumbar fusion and confused

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Bigphil

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Hello,

I had a MRI done recently via upright/sitting.. The findings were grade 4 DDD and posterior disc protrusion.. This is my 3rd MRI and the first 2 showed only age related issues.. I have consulted with 3 doctors, Ortho/Spine, Pain Clinic, and now a neurosurgeon.. The last MRI that showed the DDD and disc protrusion was looked at by the Ortho and Neurosurgeon and both agreeed I need l4-l5 and l5-s1 fusion.. The neuro sent me for a discogram and heres where Im confused.. The discogram came back saying it was basically negative in both level however the pain scale was higher in l5-s1.. I did a CT after the discogram and it showed a small annular tear that was also picked up on the discogram at both levels.. Can a discogram be negative and still need a 1 level or even a two level fusion? I have tried all the conservative treatments and the epidural/facet shots and had no releif.. My pain is terrible when sitting or riding.. Any type of lifting besides a milk jug.. Thats about my limit. even lying down at night is difficult.. I have left sised back, buttocks, and leg pain.. The back and butt feels sharp and burns and the leg pain feels like I have touched a electric fence.. I take that as some nerve impingment somewhere.. Can the DDD progress to severe if not fused? A PLIF endoscopic is the reccomendation.. Does this sound like the right thing to do? Has anyone had similar problems and been confused?

Thank You
 
Welcome to the board. I'm sorry to hear of the events that led you here, but hope you will find some answers to your questions and some support among us.

I hope to answer your question kind of through the back door, as it were. Discograms are a procedure that is not erabraced by everyone in the spinal community. Many patients have had lurabar fusions without having a discogram, myself included.

One reason for the controversy is that it is a subjective test. The results, in part, rely on the person giving the test to get the needle placed appropriately, and it depenRAB on the patient's response, and the test-giver's interpretation of that patient's response.

The fact that the CT scan picked up annular tears in both discs is perhaps more useful. Discograms are often ordered to reassure the surgeon that he is operating on the disc that is the pain generator. He doesn't want to operate on L4 only to find out after recovery that it was actually L5 that was causing the patient pain....It is only one small part of the decision to perform surgery....and is used to confirm what the surgeon suspects rather than to define it.

The Discogram is just one piece of the puzzle. More important is listening to the patient describe his symptoms, along with what the imaging shows and any physical tests that are performed on the patient by the physician.

If you can live with the pain, you can continue to live with DDD. It is not an emergency situation unless you were to develop bladder or bowel involvement or foot drop. If the nerve is badly compressed, you probably would not want to leave it that way forever, as eventually it can cause permanent nerve damage. Chances are, nerve compression will not get better on its own.

Fusion or artificial disc replacement are the two procedures that are used to treat DDD, fusion being the more common by far (at least in the US.)

When were your 3 MRIs taken -- in other worRAB, are the first two quite a bit older? Were they taken when you were lying down or were they all done positionally?
 
My surgeon or any other, never even mentioned a discogram and from most I have spoken to, the surgeons make their decision from the MRI and the patents description of pain and weakness etc. That said if you are ready to have surgery you will find someone to help you eventually. It took me 5 surgeons to find the one for me and he did a great job. I no longer have the nerve pain you speak about on my left side. I had a one level fusion. L5-S1 as when he was operating he could see that the damage was more pressing at that level so he postponed the disc replacement he had planed. I believe he is correct so far.
Allan
 
Thanks for your reply.. The 3 MRI's were done as of 03-08 was 1st.. The 2nd was 01-10 both done lying down in a tube.. The 3rd was done 12-6-10 and done sitting/upright.. The pain has progressed since 3-08 MRI.. I am just concerned that I wont have any issues with the discogram but the CT will confirm my problem.. Since my 1st MRI the DDD has gotten worse.. The it was called Disc Desication and Minor facet hypertrophy.. Now the disc is mod/severe DDD and about 1/2 to 3/4 indented and leg/hip pain is worse.. He did mention the PLIF and I am wonering the Hospital stay time and heal time b4 normal activities.. I will ask him 12-27 but just curious now... Thanks again
 
I can give you some general information on PLIF. I have had two, a one level at L4-5 and more recently, a 3 level at L3-S1. Here in the US, the patient will be in the hospital 2-3 nights barring any complications. Before the patient can be discharged, he must be able to show that he will be able to minimally function at home -- walk to the bathroom, clirab steps if his bedroom is on the second floor, or if his home has steps to access it, etc. The other prerequisite is that the patient's pain must be controlled by a medication taken orally. I think most people will agree that the first week to ten days is difficult. It hurts to move, to turn over, to change position. But gradually surgical pain resolves as it heals.

For most surgical patients the story would end here and he could return to his normal life. With spine surgery, healing and recovery is just beginning. The next several months will be very important as the fusion sets up, the bone grows and fills in. Even though signs of fusion may be seen as early as three weeks, it takes a full year for the bone to grow strong and harden.

At the beginning movement will be restricted. The patient will be instructed to avoid any activity requiring bending at the waist, twisting, pushing, pulling, and lifting anything heavier than a gallon of milk (including pets and small children! :dizzy:) Most doctors instruct their patients to limit the amount of time spent sitting to 15-20 minutes at the beginning. Walking is the most important activity and is necessary for proper healing and bone growth, to keep the nerves stretched out and to hopefully limit the formation of scar tissue.

Many patients are told to plan on being off work anywhere from 3 to 6 months, depending on the job. Some patients are able to go back a little bit sooner, and some will need more time.

Most surgeons will send their patients to physical therapy at some point after surgery. Some begin quite soon while others wait until 3 months to begin.

I think many patients begin to feel a bit better by the 2 month mark, and by 3 months most are starting to feel somewhat "normal". At six months many patients are able to resume more strenuous activities, but still need to be mindful of their newly repaired back. After a year, strenuous exercise is actually supposed to make the new bone grow stronger. People have been known to engage in activities like kayaking, mountain clirabing, scuba diving, etc. (not me!!)

People that have a successful recovery, in general, are those that first of all are very careful in their selection of a spine surgeon, and to the best of their ability, feel convinced that they are receiving the proper surgery for their specific problems. After surgery they are careful to follow their surgeon's instructions in all respects, and are not in a hurry to press and rush their recovery by doing restricted things ahead of schedule. They are diligent about walking short distances several times each and every day. And then further out, they always remeraber that their spine has been surgically altered, so they always try to use good body mechanics and maintain good posture at all times. They stay physically active and keep their back and core muscles exercised and balanced, maintain a healthy weight and don't volunteer to help their friend move or plant a tree, etc.

What I always try to remind people of is that some doctors tend to minimize the procedure, suggesting it casually. If the patient has not done his research, he is shocked to discover that back surgery is a life-changing event. We are used to something like an appendectomy where the surgeon goes in, removes the appendix, the patient recovers from the surgery and within a couple months, is back to his routine life.

Back surgery is a life-altering procedure. While most people would do it over again, they are never the same as they were prior to the onset of their back problems or injury. Fusion is a BIG surgery and takes a long time to recover from. It requires a great deal of patience and perseverance.

Sometimes, despite all the best efforts and intentions of the surgeon and patient, the results do not turn out as the patient and surgeon had hoped. This brings me to my final comment. There is no guarantee how a back or neck surgery will turn out.

I hope this gives you some information on the process of fusion surgery. I hope I have not been too blunt as I do not mean to discourage you. I just feel it is very important that people understand what they are getting into when they sign the forms for surgery. I think it is easier to have a positive attitude and to move forward when you know what you're entering into....And, yes, I would do it again without reservation.

I'm more than happy to try to answer any questions you might have...it was my first surgery ever when I had my first fusion, and I put it off as long as possible and was terrified. Many kind people on an online forum such as this helped me with all my questions, and I was so grateful. I was so well-prepared ahead of time, and so prepared for the worst, that the reality turned out to be easier than I was anticipating.;)
 
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