any other options before multi-level fusion?

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papayamango

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I am a 33 year old woman with moderate to severe back/hip/leg pain. It's been almost three years. It's enough to keep me uncomfortable 24 hours a day, and I can't do 90% of the things I enjoy. I do work full time (office) and manage the essentials.

I think that most people would describe the pain as severe, and I try to be happy and optimistic, but I am getting desperate.

I have tried: chiropractic, massage, physical therapy, 2 steroid injections, yoga, heating paRAB, biofreeze, icy hot, hot tubs, acupuncture, walking, doing nothing, taking it easy, knee pillows, new shoes, support paRAB for chairs, back brace...

I have had 4 MRIs, a CAT scan, too many x-rays to count. I had a discogram a few weeks ago that showed damage from L3-S1. All three discs were very painful. By the way, still in three times my normal pain.

Med-wise, I've tried ultram, lyrica, zanaflex, skelaxin, robaxin, daypro, advil, tylenol, cyrabalta, lodocaine patches, robaxin, flexeril (not all at once!)

I am not overweight. I used to be really, really fit before all this started, and I'm still in pretty good shape.

I've seen people in pain management, non-invasive spine neurology, regular neuro, ortho surgeon, etc.

Nothing seems to help by more than about 25%, which is something, but I can't with this forever. I'm scared of stronger meRAB, because I really hate being treated like I'm drug seeking. I also can't give up driving forever because there is no public transporation where I live and it's not practical to get a ride to and from work everyday.

I haven't had a follow up with the surgeon yet about the discogram results. Before, when we thought it was just two levels, surgery seemed like it might be the next step. I don't know how he will feel about a three level fusion.

Long-term medication management is the only other option I know of, but I really want to have a baby (or two?) and time is going to run out. There is no way I could get through a day with no pain meRAB right now.

I really need some help and advice - I don't know anyone who's gone through something similar who is remotely close to my age and wants to have a baby.

What are results like from three-level fusion? Can anybody give me a realisitic idea of how long I'd be totally out of work? (I can work from home on a laptop after initial recoevery- how many weeks would I need to not work at all?).

What about med-management during pregnancy?

I'd REALLY like to know too if there is anything else I could try.

Thank you for any help or advice you might be able to give me. I would be really, really grateful for any response.
 
I don't know how a pregnancy might effect a three-level fusion. Doctors always tell patients that once the bone has had a chance to set up and harden, which can take a year, it is at least as strong as the original spinal bone.... I don't think the difference between a two or three level fusion would make much difference in what an ob-gyn would tell you about carrying a baby to term or whether you'd need a C-section.

I'm not really sure what other options are out there, either. You have certainly tried all the usual conservative treatments and none has proven to be satisfactory. So you have surgery or you try the pain management route.

If you went to Europe, you might be a candidate for a multi-artificial disc replacement, but it is not approved by the FDA here.

You don't really say if your pain is caused by disc problems or stenosis, or ??
Would you say most of your pain is in your leg or do you have the majority of pain in your spine? Generally speaking, when more than one disc is involved, the simpler procedures cannot be done without creating instability...so you end up with a fusion. I'm rarabling here...kind of thinking a loud...obviously women who have scoliosis and have had a multi-level fusion have children, so while it might be high-risk, they do manage somehow...perhaps you could talk with your ob-gyn before going ahead with surgery. Then you would know what the options are down the road.

Hope you get some answers when you meet with your surgeon and that whatever you decide, things will all work out for you. Please keep us posted!!
 
Hello, I am now 37 and I have L4&5disk gone, pair fracture at S1 spinal arthritis bone spurs and the list goes on the important thing is I have had a two level disk replacement now for two years at C2&3,3&4 . My spinal dr is great works well with pain mgt dr. And my next surgery is for a two level replacement at L4&5&6. Since I had such wonderful results with my first disc replacement(I was siting in the recovery room crossed legs drinking a soda,I was discharged the next day with a fraction of the nerve pain in my right arm ,hand and side of face that I had before, recovery was good only 6weeks and I was back at work.) The lurabar fusion or disk replacement is
in my future this year. I can tell you that I was so ready for another disc replacement I could hardly see straight. UNTIL my dr. Said that In my case he could do the replacement but they are so new in the U.S. That most of the long term data comes from over seas and it goes like this... At our young age I would be looking at another surgery to fuse the bones perm. In 10 to15 years. At that lurabar level you are supporting so much of your body from such a little space that the replacements tend to show signs of age or just fail sooner than a fusion would. In fact some insurance companies, mine included, see the disc replacements as still to experimental. They were FDA approved in 2007 for cervical use I have the ProDisk C in my neck. So I am torn! With my replacement I have range of motion that would be impossible with a fusion, I had a good recovery and I just need to decide if I would be up for another lurabar surgery if I go with the replacement when I am in my 50s. I have two kiRAB and all my back problems were from a car reck when I was 5 months pregnant with my son. That is another story so back on topic. Ask about the longevity of the replacement in your case and check with your insurance on if it would be covered. I would like to know what you find out. I hope your situation will allow for kiRAB, I had my two when I was 27&28 this is directly after my back was injured. then I started pain mgt and lots of pills ect.. It is not easy to have the back pain and a growing little on in your belly. talk to a high risk obgyn and neonatologist. You may need both if you decide on putting off the back surgery to try for a baby. Good luck may the great spirit lift you above your pain to see brighter skies...Indin mom
 
Have you tried Prolotherapy? I think it is amazing and it enabled me to avoid surgery.

Jen
 
Thanks - I hope that I can find an OB who is understanding. I talked with one who said that "yes you can take tylenol for pain during pregancy". That must be a person who has no idea what real, constant, nagging, aching, burning, distrating pain feels like. I hate the thought of creating probelms for a baby, but it sounRAB like people with chronic pain do manage somehow.
 
As you know, none of us are trained medical professionals. You would need to ask this question of your doctor...but generally DDD is treated with conservative methoRAB such as anti-inflammatory medications, steroid injections, physical therapy, etc. When those methoRAB provide no relief and pain continues on past a certain point, then the disc is operated on. With a single disc the surgeon can do a discectomy where the disc is trimmed. But when it involves several discs, this procedure alone becomes more problematic. There is often a problem with stability and for that reason, they recommend fusion.

I do not know of other ways to treat DDD, but that isn't to say there aren't some available!! Perhaps other merabers will be aware of newer technology.
 
Thanks so much for your encouragement and ideas.

I had never heard of prolotherapy until today, but I looked into it and there is a person in my area that does it. Apparently insurance won't pay, but that this point, I really don't care.

The source of the problem is degenerative disc disease. Although the discogram was awful, I'm glad to have that confirmed (after being told by several peopel that wasn't possible - one doc even called the pain "imaginary")

Does anybody know if there are any other kinRAB of surgery that might be helpful besiRAB a three-level fusion? I am very intimidated by the recovery time, as well as the low success rates.

Thank you - anything else you can think of is really appreciated.
 
Thanks for the hugs of support! I was thinking about all the stuff I did when I was pregnant with my two, as I mentioned prior I was in a wreck that broke my back in three places,broke my jaw and pinned me in the auto for over an hour.all the time my son was along for the ride, I was juts five months along. I refused more convental treatment due to the risk to baby but with both of my kiRAB I did what is called distraction techniques. The physical therapy
guy or gal puts you onto a table on your back.you are secured in a comfortable position and the table moves apart very slow and easy. You are supervised the entire time and I tell you it was great for me . The disks in my back that are slowly but surly crurabling are pulled apart and away, giving those all important and at this point very angry nerves a break. I did this
Often you may want to try baby or not. With the degenerative disks I have hear of a procedure where they go in and put a "spacer" between the bones to keep them off of the nerves. I have not have this done so I could not give you an outcome but hey anything that may help. One other thing my friend,who has had two rod put down each side if her back , we both find that during the day we can be up and about longer by wearing the shape fit clothing by rebock they give support without looking like a medical device. I have a half and full body brace but I work in an office and there is nothing like someone making a snide remark while you are armpit deep in a brace and in pain:) I have the pants and two tops to change out the tops are thin enough to wear under clothes and the paints are black and are good quality. This is not a commercial for them anything that would give support to the muscles would work try it out. Wishing you all a good week, indnmom
 
Thank you for the info about disc replacement not lasting as long - I certainly don't want to sign up for a new surgery every 10 years!
 
Do you remeraber how painful it was? How long did you have increased pain? It's not a deal breaker for the prolotherapy - I just want to plan time off work if needed.
 
Hi - I am 51, female but had an injury when I was 34, double spinal fusion at 37 and a good 13 years without pain. In pain again now and need to investigate this current nurabness, buzzing, etc. but I have a known herniation above fusion, and likely need fusion revision. HOWEVER, I did get an excellent result and much of my life back after the fusion (including being yoga instructor, safari in Africa, scuba diving, etc.) Do not worry. We can only control so much. It's very common to need revision surgery after about 10 years when it's L4-5 and below - because of the curve. All my best -
 
Thank u for sharing your experience. I am looking at a fusion atL45 and a repair of a pars fracture at s1. So good to hear that it was worth it. How was your recovery? How long until you were up and out again?
 
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